Eating Reflex Seizures in a Patient with Congenital Bilateral Perisylvian Syndrome

We report a young man with congenital bilateral perisylvian syndrome (CBPS), who showed eating reflex seizures (ERS). His ERS were related to the taste of foods. The subtracted ictal SPECT co-registered to MRI (SISCOM) revealed the hyperperfusion in the insula as well as the subcortical nuclei and brainstem. The ERS in CBPS may be partially related with the taste function of the insula and SISCOM may be helpful for the localization of the epileptogenic foci in ERS.

One Case of Reflex Focal Seizures Associated with Nonketotic Hyperglycemia / 대한간질학회지

BACKGROUND & SIGNIFICANCE: Focal seizures are usually due to an underlying structural lesion of the brain but occasionally caused by metabolic disturbances such as nonketotic hyperglycemia (NKH). Reflex focal seizures associated with NKH have been reported. CASE: The 69 year-old man was admitted in our hospital due to clonic movements of the right leg. His seizures did not occur spontaneously but were provoked by active or passive movements and tactile stimulation of the affected leg. The convulsive movements of the right leg often spread to the left leg without involving any other parts of his body. The seizures regressed with the control of hyperglycemia only. COMMENT: We report a patient presented with reflex focal seizures as the initial manifest-ation of NKH.

Startle Epilepsy: Clinical Characteristics in 8 Patients

BACKGROUND: The focus of this paper was to determine the clinical characteristics of startle epilepsy characterized by reflex partial seizures of the sensorimotor cortex. METHODS: Eight patients with startle epilepsy were evaluated for their clinical seizure history, neurologic examination, MRI, routine EEG, video-EEG monitoring, and ictal SPECT. RESULTS: Etiologies were: perinatal injury (4 patients), kernicterus following hemorrhage during infancy (1), near-drowning at age 4 (1), and unknown (2). The age of seizure onset varied from several months to 16 years. All patients had spontaneous as well as reflex seizures. Effective triggers included several sensory modalities, typically proprioceptive and auditory. The stimuli should be sudden and unexpected. Seizures usually occurred daily and were medically intractable. Neurological examination was abnormal in 6 patients. Five had mental retardation, and 4 with motor deficit. MRI was abnormal in 6 patients, generally showing large encephalomalatic changes involving cortical and sub-cortical structures. Five had bilateral lesions. The semiology was characterized by unilateral or generalized tonic posture. Scalp interictal and ictal EEGs had limited value to lateralize the epileptogenic focus. Intracranial EEG in 1 patient who underwent surgery showed ictal onset on the lateral sensorimotor cortex. CONCLUSIONS: Startle epilepsy is a rare but distinctive epileptic syndrome characterized by reflex seizures triggered by unexpected sensory stimuli. Some clinical findings including etiologic events (kernicterus following hemorrhage, near-drowning), high incidence of bilat-eral lesions, ictal onset on lateral sensorimotor cortex without involvement of medial cortex, and ictal SPECT findings have not been reported or were different from previous studies.