An Unusual Case of Benign Reflex Myoclonic Epilepsy of Infancy

Abstract

A previously healthy one-year-old boy, the youngest child of unrelated parents, presented with a four-week history of episodes of myoclonus triggered only by tactile stimulation to his head. There had been no loss of developmental skills. The electroencephalogram (EEG) revealed generalised polyspike wave activity both with and without clinical correlate. The infant was started on sodium valproate, which resulted in cessation of the myoclonic episodes one week after starting therapy. At subsequent follow-up (at 18 months) the infant was seizure free and a repeat EEG was normal. This case of non-progressive reflex myoclonic epilepsy of infancy triggered only by head tapping (and not by acoustic stimuli) is an extremely rare phenomenon. Reflex myoclonic epilepsy of infancy represents a distinct subtype of myoclonic epilepsy in infancy. It should be considered as an age-dependent idiopathic generalised epileptic syndrome with an apparently good prognosis.

Key words

Reflex epilepsy - tapping epilepsy - myoclonus - infancy

References

• 1 Deonna T. Reflex seizures with somatosensory precipitation. Clinical and electroencephalographic patterns and differential diagnosis, with emphasis on reflex myoclonic epilepsy of infancy. Zifkin BG, Andermann F, Beaumanoir A, Rowan AJ Reflex Epilepsies and Reflex Seizures: Advances in Neurology. Vol. 75. Philadelphia; Lippincott-Raven 1998
• 2 De Marco P. Reflex petit mal absence?.  Clin Electroencephalogr. 1990;  21 74-76
• 3 de Falco F A, Majello L, Santangelo R, Stabile M, Bricarelli F D, Zara F. Familial infantile myoclonic epilepsy: Clinical features in a large kindred with autosomal recessive inheritance.  Epilepsia. 2001;  42 1541-1548
• 4 Hallett M, Chadwick D, Marsden C D. Cortical reflex myoclonus.  Neurology. 1979;  29 1107-1125
• 5 Hallett M. Myoclonus: Relation to epilepsy.  Epilepsia. 1985;  26 (Suppl 1) S67-S77
• 6 Harbord M G, Mitchell C. Reflex Seizures induced by defecation, with an Ictal EEG focus in the left frontotemporal region.  Epilepsia. 2002;  43 946-947
• 7 Ioos C, Fohlen M, Villeneuve N, Badinand-Hubert N, Jalin C, Cheliout-Heraut F, Pinard J M. Hot water epilepsy: a benign and unrecognised form.  J Child Neurol. 2000;  15 125-128
• 8 Kourtroumanidis M, Pearce R, Sadoh D R, Panayiotopoulos C P. Tooth-brushing induced seizures: a case report.  Epilepsia. 2001;  42 686-688
• 9 Obeso J A, Rothwell J C, Marsden D. The spectrum of cortical myoclonus. From focal reflex jerks to spontaneous motor epilepsy.  Brain. 1985;  108 193-224
• 10 Ricci S, Cusmai R, Fusco L, Vigevano F. Reflex myoclonic epilepsy in infancy: a new age dependent idiopathic epileptic syndrome related to startle reaction.  Epilepsia. 1995;  36 341-348
• 11 Rosén I, Fehling C, Sedgewick M, Elmqvist D. Focal reflex epilepsy with myoclonus; electrophysiological investigation and therapeutic implications.  Electroencephalography Clin Neurophysiol. 1977;  42 95-106
• 12 Salas-Puig J, Mateos V, Amorin M, Calleja S, Jimenez L. Reflex epilepsies.  Rev Neurol. 2000;  30 (Suppl 1) S85-S89
• 13 Shibasaki H, Ikeda A, Nagamine T, Mima T, Terada K, Nishitani N, Kanda M, Takano S, Hanazono T, Kohara N, Kaji R, Kimura J. Cortical reflex negative myoclonus.  Brain. 1994;  117 477-486
• 14 Sutton G G. Receptors in focal reflex myoclonus.  J Neurol Neurosurg Psychiatry. 1975;  38 505-507
• 15 Weiser H G. Seizure induction in reflex seizures and reflex epilepsy. Zifkin BG, Andermann F, Beaumanoir A, Rowan AJ Reflex Epilepsies and Reflex Seizures: Advances in Neurology. Philadelphia; Lippincott-Raven 1998 Vol. 75
• 16 Wilkins D E, Hallett M, Wess M M. Audiogenic startle reflex of man and its relationship to startle syndromes: A review.  Brain. 1986;  109 561-573
• 17 Zafeiriou D I, Kontopoulos E. Reflex myoclonic epilepsy in infancy: a benign age-dependent idiopathic startle epilepsy.  Dev Med Child Neurol. 2002;  43 (Suppl 90) 40-BPNA Abstracts
• 18 Zifkin B G, Andermann F, Beaumanoir A, Rowan J A. Reflex Epilepsies and Reflex Seizures: an Overview. Reflex Epilepsies and Reflex Seizures: Advances in Neurology. Vol. 75. Philadelphia; Lippincott-Raven 1998