Genital Automatisms in Pediatric Focal Epilepsy Misdiagnosed as a Gratification Disorder: A Case Report

Genital manifestations in pediatric epilepsy are rare and may be misinterpreted as behavioral disorders, particularly gratification disorder, resulting in delayed diagnosis. We report a 10-year-old girl with normal psychomotor development and no significant medical history, presenting since the age of 3 years with recurrent stereotyped episodes initially considered as a gratification disorder. On reevaluation, she described paroxysmal genital tingling associated with a sensation of pleasure, occasionally accompanied by unexplained vaginal discharge, followed by involuntary pelvic movements characterized by rhythmic thrusting and pedaling. Episodes lasted 2-3 minutes and occurred spontaneously. Neurologic examination was normal. Video-electroencephalography did not capture clinical events but revealed interictal epileptiform discharges arising from the right frontotemporal region with secondary generalization on a normal background. Brain magnetic resonance imaging was unremarkable, whereas fluorodeoxyglucose positron emission tomography demonstrated right mesial temporal hypometabolism. The semiology was consistent with a genital aura followed by hypermotor automatisms, suggesting a mesial temporal onset with propagation to fronto-median networks. This case highlights an unusual presentation of pediatric focal epilepsy with genital semiology, frequently misdiagnosed as gratification disorder. Recognition of this entity is essential to avoid diagnostic delay and to ensure appropriate management.