Abstracts

Rationale: Reflex epilepsy is a rare condition in which a stimulus consistently elicits abnormal paroxysmal electroencephalogram (EEG) activity associated with clinical events. A wide variety of stimuli have been described in the literature including photic stimuli, immersion in hot baths, reading, eating, micturition, as well as complex behaviors. Here, we describe a case of reflex epilepsy triggered by exiting the shower and not related to any specific temperature, patting dry or other previously described provocations.Methods: Video EEG during a 48 hour Pediatric Epilepsy Monitoring Unit (PEMU) admission was completed as well as Magnetic Resonance Imaging (MRI) Brain without contrast. Literature search was performed using PubMed for publications on reflex epilepsy as well as frontal lobe-onset reflex epilepsies.Results: A 12 year old Caucasian right handed male with a history of complex partial seizures with secondary generalization presented with new seizures for the past year triggered by exiting the shower. He also has a family history of a brother with frontal lobe epilepsy. The patient has seizures which begin approximately 30 seconds upon exiting a shower. He describes the start of his seizures as an aura of a cold sensation starting in his lower back and spreading towards his head. This is followed by a feeling of vertigo lasting approximately 30 seconds. This evolves into a convulsive event consisting of right head version and right eye deviation with subsequent generalized tonic-clonic activity lasting between 30 seconds to 1 minutes with post-ictal fatigue. The consistent stimulus to these events is the completion of showering, with no provocation due to the temperature of the water, time to drying, or sensation of dry patting. His clinical events during PEMU monitoring correlated electrographically with rhythmic delta activity arising from the left frontal lobe, followed by rapid spikes from the left temporal lobe, and secondary generalization. His inter-ictal background included rare spike transients during sleep, originating from the left frontal lobe, and normal awake background. His cardiac rhythm was normal throughout his stay. He was treated with oxcarbazepine, and an MRI of the brain showed no abnormalities. At 3 month follow up, he was noted to have continued reflex seizures and required titration of his anti-epileptic therapy.Conclusions: This case shows a previously unreported, reflex epilepsy occurring upon exiting the shower. To the best of our knowledge, there has been no prior report of seizures resulting in this manner, and we feel this case is distinct in separating it from a cardiogenic etiology. It is important for practitioners to be mindful of different patterns of reflex epilepsy as this condition can be treated and appropriate therapy can minimize if not eliminate disability.