John Libbey Eurotext

Defecation reflex seizures: a case report with long-term VEEG monitoring, neuroimaging and comprehensive epilepsy evaluation Volume 21, numéro 6, December 2019

Vidéo

  • Defecation reflex seizures: a case report with long-term VEEG monitoring, neuroimaging and comprehensive epilepsy evaluation

Illustrations

  • Figure 1
  • Figure 2
Auteurs
1 Department of Neurosciences and Behavioural Sciences,
2 Section of Nuclear Medicine, Internal Medicine Department, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
* Correspondence: Renata Pina Rocha CIREP - Centro de Cirurgia de Epilepsia - HCFMRP-USP, Avenida Bandeirantes 3900 Monte Alegre, CEP 14049-900 - Ribeirão Preto - SP, Brazil

Reflex seizures are consistently elicited by a specific afferent sensory stimulus or an activity undertaken by the patient. Among many known stimuli, defecation has rarely been reported. We describe the case of a child with reflex seizures triggered by defecation, considering the diagnostic challenge, epilepsy evaluation with video-EEG monitoring, as well as impact on neuropsychology, behaviour and quality of life. The child was a 10-year-old boy with seizure onset at age four with epilepsy diagnosis established one and a half years later. Seizures were focal with impaired awareness triggered by defecation. Video-EEG and structural and functional neuroimaging were performed and all pointed to the left temporal region. The patient became seizure-free with carbamazepine and valproic acid. Neuropsychological and quality of life assessments suggested global impairment, both before and after seizure control. This is the third case of epilepsy induced by defecation reported in the literature. The rarity of this entity may be a diagnostic challenge and postpone specific treatment. Reporting of cases of defecation reflex epilepsy may provide a better understanding of its physiopathology and optimize effective treatment, avoiding cognitive, behavioural and poor social consequences. [Published with video sequence]