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Reflex seizures induced by defecation, with an ictal EEG focus in the left frontotemporal region
Michael G Harbord1, Carmel Mitchell
1Neurology Department, Flinders Medical Centre, Bedford Park, South Australia, Australia.
Insights
This study details a rare case of reflex seizures triggered by defecation in a child. Ictal EEG monitoring confirmed a left frontotemporal polyspike wave discharge during these episodes.
Area of Science:
- Neurology
- Epileptology
- Clinical Neuroscience
Background:
- Reflex epilepsy is characterized by seizures precipitated by specific stimuli.
- Defecation-induced seizures are exceptionally rare, with limited electroencephalographic (EEG) documentation.
- Understanding seizure triggers is crucial for accurate diagnosis and management.
Observation:
- A 9-year-old boy experienced seizures 1-2 minutes post-defecation.
- Seizures presented as staring, gagging, drooling, followed by generalized tonic-clonic activity.
- Normal interictal EEG and magnetic resonance imaging (MRI) findings were noted.
Findings:
- Ictal EEG with concurrent video monitoring revealed a left frontotemporal polyspike wave discharge during seizures.
- The seizures were specifically linked to the act of defecation, not straining or immediate post-standing.
- This case provides the first ictal EEG evidence of defecation-induced reflex seizures.
Implications:
- Highlights the importance of considering specific autonomic functions as potential seizure triggers.
- Demonstrates the utility of ictal EEG and video monitoring in diagnosing rare reflex epilepsies.
- Contributes to the understanding of the neurophysiological basis of defecation-related seizures.
Abstract:
We report a 9-year-old boy with seizures induced by defecation. The episodes occurred 1-2 min after passing a bowel action and consisted of initial staring, gagging, and drooling followed by a secondarily generalized tonic-clonic seizure. The interictal EEGs were normal, but an ictal EEG with concurrent video monitoring demonstrated a polyspike wave discharge in the left frontotemporal region. There was no evidence of syncope, and the seizures did not occur while straining to empty his bowels or immediately on standing afterward. His magnetic resonance imaging scan was normal. This is the first reported case in which ictal EEG monitoring has demonstrated reflex seizures induced by defecation.