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.

Reflex epilepsy

Seizures triggered by sensory stimulation are termed [reflex epileptic seizures]. Since the nerve structures responsible for seizures are situated between the sensory afferent pathway and the efferent tract responsible for epilepsy, thus acting as a reflex centre. The concept of reflex epilepsy was widespread in the 19[th] century, when it was considered that among the major causes of epilepsy was chronic sensory stimulation e.g. teething, intestinal worms, refractive error, or chronic constipation

Self induced photosensitive epilepsy.

The authors report a case of a 12-year-old girl who had rare self induced photosensitive epilepsy. She used to move her right hand over the right eye while simultaneously rubbing the forehead since the age of 8. During these episodes she was lost in herself. Lately these episodes were followed by brief spell of unconsciousness. The EEG examination, in its third attempt, revealed bilateral multiple symmetric spikes on photic stimulation. She admitted that she often induced the episode herself and derived pleasure out of it. She responded well to Sodium valproate.

Video game epilepsy.

Reflex epilepsy is the commonest form of epilepsy in which seizures are provoked by specific external stimulus. Photosensitive reflex epilepsy is provoked by environmental flicker stimuli. Video game epilepsy is considered to be its variant or a pattern sensitive epilepsy. The mean age of onset is around puberty and boys suffer more commonly as they are more inclined to play video games. Television set or computer screen is the commonest precipitants. The treatment remains the removal of the offending stimulus along with drug therapy. Long term prognosis in these patients is better as photosensitivity gradually declines with increasing age. We present two such case of epilepsy induced by video game.

Lorazepam: an adjuvant therapy in patients with seizure and heliotaxis.

Photosensitive epilepsy is a type of reflex epilepsy. Five percent of epileptics are photosensitive, i.e. they show photoconvulsive response (PCR) during intermittent photic stimulation. Patients with photogenic or photosensitive epilepsy have seizures with flickering light. They also exhibit heliotaxis. Sodium valproate and ethosuximide are the common drugs used. Even though benzodiazepines are useful, the specific effect of lorazepam is not mentioned. We report 5 cases of photosensitive epilepsy with inadequate response to usual antiepileptic drugs who had complete or near complete remission with lorazepam.