Abstracts

To report two cases of reflex seizures in two patients with focal seizures, one with probably symptomatic focal epilepsy and the other with generalized epileptiform EEG pattern. Two patients with reflex seizures were analyzed, one with video EEG and SPECT, and the other with routine EEG. Patient 1: girl, 7 yrs., started having seizures at the age of two months characterized by elevation or the arms; EEG, brain CT, metabolic screen were all normal.
The seizures were controlled with CBZ but the patient presented a mild slowing of developmental milestones acquisition. At the age of 4 yrs. she stop CBZ, which was reinitiated at 6 yrs. when she started having generalized clonic movements, controlled with this AED. After six months she started having micturation seizures characterized by tremors in legs, arm elevation, generalized hypertonia and fall to the floor. Video-EEG showed micturation seizures and spontaneous seizures after AED reduction, accompanied by diffuse rhythmic slowing in anterior regions and interictal EEG, focal epileptiform activity in right median parietal area; brain MRI, normal; interictal SPECT revealed hypoperfusion in right parietal region and ictally, hyperperfusion in the same area. She received several AED and presented status epilepticus twice. Now the patient is receiving LTG, OCBZ, CLB and presents short seizures only during micturation. Patient 2: healthy woman, 29 yrs., had one convulsion at two yrs. of age and at age 10 yrs. focal complex seizures followed by hypertonic posture once a week, at times precipitated by hot water showering. All exams were normal (brain MRI, EEG, CSF). She received several AED, including PB, CBZ, and VPA. Recently she has been using CBZ and VPA, and when CBZ was increased (600-1200mg/d) and VPA reduced (1000-750mg/d), the frequency of the seizures increased and the EEG showed generalized irregular spike-wave discharges during hyperventilation. Now she is taking VPA 2gxd and LTG 25mgxd, and avoiding hot hater showers and she is seizure free. Focal or generalized reflex seizures are precipitated often or even exclusively by specific stimuli. Seizures at micturation are rare, as well as precipitated by hot hater. The finding of focal seizures dos not preclude diagnosis of reflex seizures, that may reflect abnormal focal cortical activity superposed to generalized hyperexcitability. Hence, it is important to search for precipitating factors in patients with refractory seizures in order to improve diagnosis and treatment.