Abstracts

Rationale: Self-induced seizures by somatosensory stimulation are rare. We report two epileptic patients with self-induced seizures by peri-orbital somatosensory stimulation. Methods: We investigated ictal video-EEG, interictal EEG, neuroimaging and clinical charts in two epileptic patients with self-induced seizures by peri-orbital somatosensory stimulation in National Epilepsy Center, Shizuoka Institute of Epilepsy and Neulorogical Disorders. Results: Case 1: A 25-month-old girl was admitted to our hospital with a diagnosis of West syndrome. She had a history of acute subdural hemorrhage at 4 months of age and underwent two surgical excisions of the hematoma. MRI showed diffuse brain atrophy and her psychomotor development was severely delayed. From 7 months of age, she began to have serial seizures with flexions of both arms and head nodding. From 18 months of age, she started to rub her right eyelid with her right finger, and this behavior was followed by her habitual seizures. Ictal EEG showed right occipital sharp waves followed by diffuse low-voltage fast wave bursts after the eyelid rubbing behavior. These seizures stopped after she was prevented from rubbing her right eyelid. However, spontaneous habitual seizures relapsed. Case 2: A 5-year-11-months old boy was admitted to our hospital with a diagnosis of West syndrome. He had a history of acute subdural hemorrhage at 1 month of age and was treated conservatively. MRI showed diffuse brain atrophy and his psychomotor development was severely retarded. He developed West syndrome at 10 months. Seizures were temporarily controlled by ACTH therapy, but relapsed afterwards. From 2 years of age on, touching of his right eyebrow with the back of his left hand became evident. From 3 years of age, the above behavior was followed by serial seizures consisting of right arm flexion, left arm extension, and head nodding and deviated to the right. Ictal EEG showed bilateral occipital sharp waves followed by diffuse low voltage fast wave bursts after he touched his right eyebrow. Conclusions: Attention should be paid to the presence of self-induced seizures in patients with severe pathology.