2024 American Academy of Neurology Abstract Website

Objective:

Reflex, or stimulus-sensitive, seizures are characterized by the consistent occurrence of seizures with specific modes of stimulation that may be intrinsic or extrinsic in nature. Of all patients with epilepsy, about 4-7% have reflex seizures. There have been some reports of rub evoked reflex epilepsy (RERE), which describe clinical seizures elicited by cutaneous stimulation of a circumscribed area of the body.

The following case, in which a patient experienced seizures elicited by tickling undefined sensitive areas of the skin, has clinical features that distinguish it from other reflex epilepsies.

Background:

A four-year-old male presented following a six-month history of paroxysmal episodes of right-sided extremity paresthesia and paralysis without change in awareness or speech that occurred almost exclusively while being washed by a cloth in the bathtub or being tickled and resolved within minutes. This occurred irrespective of water temperature or area of the body stimulated.

Design/Methods:

Workup, including electrolytes and electrocardiogram, within two hours of the event was unremarkable, as were acetylcholine receptor antibodies and genetic epilepsy panel. Magnetic resonance imaging of the brain and magnetic resonance angiogram of the head and neck were also normal.

Ambulatory electroencephalography exhibited frequent independent interictal epileptiform discharges in the left centrotemporal region and right central region and rare bursts of generalized irregular epileptiform discharges. One electroclinical seizure was provoked by tickling, arising from the left centrotemporal head region.

Results:

The patient was initiated on oxcarbazepine, though seizures continued and progressed to convulsive events. Seizures have been refractory to trials of levetiracetam, lamotrigine, clobazam, lacosamide and topiramate. Treatment trials are ongoing. As the patient has aged, he has learned to bathe himself, which has led to less seizures.

Conclusions:

This is a rare case of "tickling" epilepsy confirmed with EEG. The pathophysiology of "tickling" epilepsy is unknown. Behavior modification may be a necessary intervention to avoid seizures.