Epilepsia refleja por agua caliente: a propósito de un caso en un lactante / Hot-water epilepsy: case report in an infant

La epilepsia refleja por agua caliente es un tipo de convulsión poco frecuente cuya fisiopatología se desconoce. Estas crisis reflejas suelen iniciarse pocos segundos tras el contacto con el agua y, comúnmente, a temperaturas de 37-48 ºC. Los automatismos y las crisis parciales complejas, con o sin generalización secundaria, son el modo de manifestación principal.La exploración neurológica y el electroencefalograma intercrítico no suelen presentar alteraciones, lo que puede condicionar un retraso en el diagnóstico, por lo que es fundamental la sospecha clínica.El tratamiento antiepiléptico se inicia cuando se asocia a otro tipo de epilepsia o cuando ciertas medidas sencillas, como el descenso de la temperatura del agua en el baño, no controlan las crisis. Es posible la desaparición espontánea. Cuando es necesaria la terapéutica farmacológica, existe, normalmente, buena respuesta.Se presenta el caso de un lactante con diagnóstico de epilepsia refleja por agua caliente.

Hot-water epilepsy is a rare type of seizure whose pathophysiology is unknown. These reflex seizures usually begin a few seconds after contact with water, commonly at temperatures between 37-48 ºC. Automations and complex partial crises, with or without secondary generalization, are the main manifestation mode of this type of reflex epilepsies.Neurological examination and intercritical electroencephalography are usually normal, which may condition a delay in diagnosis, and the clinical suspicion is fundamental.Antiepileptic treatment is initiated when associated with another type of epilepsy or when certain simple measures, such as lowering the water temperature in the bath, do not control crises. Spontaneous disappearance is possible; when pharmacological therapy is necessary, there is usually a good response.We present the case of an infant diagnosed with hot-water epilepsy.

Central Regulation of Micturition and Its Association With Epilepsy / 대한배뇨장애요실금학회지

Micturition is a complex process involving the bladder, spinal cord, and the brain. Highly sophisticated central neural program controls bladder function by utilizing multiple brain regions, including pons and suprapontine structures. Periaqueductal grey, insula, anterior cingulate cortex, and medial prefrontal cortex are components of suprapontine micturition centers. Under pathologic conditions such as epilepsy, urinary dysfunction is a frequent symptom and it seems to be associated with increased suprapontine cortical activity. Interestingly, micturition can also trigger seizures known as reflex epilepsy. During voiding behavior, frontotemporal cortical activation has been reported and it may induce reflex seizures. As current researches are only limited to present clinical cases, more rigorous investigations are needed to elucidate biological mechanisms of micturition to advance our knowledge on the process of micturition in physiology and pathology.

Epilepsia fotosensible / Photosensitive epilepsy

La epilepsia fotosensible es una forma de epilepsia refleja que ocurre en pacientes con crisis provocadas por la estimulación luminosa intermitente a variados estímulos (televisión, luz solar, videojuegos u otros). El objetivo fundamental de este trabajo es la presentación de 4 pacientes con las características de esta epilepsia. Se describieron las manifestaciones clinicas de cada uno y su tratamiento. Ningún paciente presentó crisis epilépticas espontáneas. En todos los niños la maniobra de la fotoestimulación fue positiva, pero no provocó crisis epilépticas. Se concluyó que lograr la eliminación de los estímulos que provocan las crisis es más importante que su tratamiento medicamentoso

Photosensitive epilepsy is a kind of reflex epilepsy occurring in patients with crises provoked by the intermittent luminous stimulation to different stimuli (television, sunlight, videogames, etc). The main objective of present paper is the presentation of four patients presenting the features of this type of epilepsy. The clinical manifestations of each and its treatment were described. Any patient had spontaneous epileptic crises. In all children the maneuver of photostimulation was positive, but without epileptic crises. We conclude that the achievement the elimination of stimuli provoking crisis is more important than its drug treatment

Reflex Epilepsy Induced by Playing Oriental Card or Board Games

BACKGROUND AND PURPOSE: There are currently few studies on clinical profiles of reflex epilepsy induced by thinking and spatial tasks. We studied the clinical characteristics of reflex epilepsy induced by playing oriental card and board games. METHODS: This study included 17 patients who presented with seizures that occur predominantly while playing games. We collected clinical data via protocol-based interviews. EEGs and brain MRI were performed. RESULTS: All of the subjects were men, and all of them were older than 30 years at the onset of seizure. Thirteen patients (76%) experienced their seizures while playing the oriental card game "Go-stop" and the remaining four patients (24%) experienced them while playing the oriental board game "Baduk". Generalized tonic-clonic seizures were frequently preceded by prodromal symptoms, but myoclonus was not evident. Most patients had no spontaneous seizures and generalized epileptiform discharges on EEGs, and infrequent seizures that were well controlled. CONCLUSIONS: Our patients exhibited some features that differ from those described previously in the literature, suggesting that the clinical spectrum of reflex epilepsy induced by thinking and spatial tasks is wide.

Reflex Epilepsy Induced by Tooth Brushing: A Case Report / 대한간질학회지

Reflex epilepsy describes seizures which are precipitated by clearly recognized stimuli. Reflex epileptic seizures triggered by tooth brushing are rare. We report a case with reflex epilepsy occurring exclusively during tooth brushing. He began having seizures at age 28. Neurological examinations and brain magnetic resonance images were found normal. On long term video-EEG monitoring, he presented two episodes of simple partial seizure induced by brushing molar and premolar teeth, which was right facial clonic movement persisting 3-5 seconds. He was unresponsive during the event, but had no postictal confusion. Ictal EEG showed 6 Hz rhythmic theta activity in the left frontocentral area. Interictal EEG was normal. The findings of EEG suggest that this reflex epilepsy might have epileptic focus in the left frontocentral area. Reasonable precaution such as gargling or less vigorous brushing of his teeth with fingers effectively prevented seizure recurrence.

Reflex Epilepsy Provoked by Mental Activities Mainly Associated with Use of the Hands / 대한간질학회지

There have been very few reports on reflex seizures induced by writing. Complex precipitating behaviors such as calculation, writing, copying of complicated figure, and spatial construction have been recognized as triggering factor of epileptic seizures. We report a case of a patient with a very unusual form of complex reflex epilepsy in which seizures are usually induced by writing or spatial construction. Neurological examination was normal and brain magnetic resonance imaging showed mild brain atrophy without focal lesion. During long-term video-EEG monitoring, she was instructed to write a letter with the right hand. About 20 minutes after writing, she experienced similar aura and motion arrest and then showed an elevation of bilateral upper extremities like myoclonic jerk followed by generalized tonic clonic seizure. On ictal EEG, spike and wave complexes appeared from both centroparietal region followed by 10 Hz rhythmic activities for 20 seconds. Interictal EEG was normal. Ictal-interictal subtraction image of brain SPECT (99mTc-HMPAO) showed hyperperfusion in the middle frontal gyrus and precentral gyrus of left frontal lobe and superior and inferior frontal gyrus of right frontal lobe. We suggest that this reflex epilepsy might be originated from both central areas with maximum on the left side. Oxcarbazepine was effective in controlling this reflex epileptic seizure.

Musicogenic Epilepsy Provoked by Conversation through the Telephone after Encephalitis / 대한간질학회지

BACKGROUND: Seizure evoked by a variety of simple and complex sensory stimuli are called reflex epilepsy. Among the various sensory stimuli, musicogenic epilepsy is provoked exclusively by listening to music. Musicogenic epilepsy is typically of a complex partial type, with or without secondary generalization. EEG abnormalities are usually recorded from the temporal lobe and show a right-side preponderance. CASE: A 34-year-old male patient was admitted due to mental change. He was treated under the diagnosis of encephalitis and improved after several days. But complex partial and generalized tonic-clonic seizure was developed. His seizure was occurred spontaneously, but more often provoked when talking about by telephone. Brain MRI revealed no gross abnormality. Ictal brain SPECT (HMPAO) showed hyperperfusion in the right temporal region. EEG showed focal slowing in the right temporal region and no provocation by click sound through the BAEP and photic stimuli. CONCLUSION: This case is musicogenic epilepsy provoked by conversation through the telephone. Presumably, the primary auditory area of the temporal lobe was activated by encephalitis and these hyperexcitable cortical areas stimulated by only distorted voice through the telephone, but not by usual conversation, induce seizure.

Case Report of Reflex Epilepsy Induced by Micturition / 实用儿科临床杂志

To report a boy with reflex seizures induced by micturition.He suffered from seizures during micturition for four yesrs.The clinical symptoms consisted of head backwards,limbs dithering,sometimes accompanying tumble.During the episodes of the seizure,his consciousness did not lose.Few seizures showed only eyes up-staring for several seconds.The livelong process of micturition was often interrupted by seizures for several times.When he finished or stoped micturition,the seizures did not occur again.His seizures could not be induced by free of micturition or other stimulative factors.The interictal EEGs showed that background asymmetry manifested as the lower amplitude and irregular rhythm in the left hemisphere,sharp or sharp and waves in right hemisphere,especially mid and back temporal.There also had sharp,spike,and spike and waves in many regions of double spheres in interictal EEGs.The other assistant check-ups were normal.while this disease was infrenquncy,it would be worthy to regard.