MICTURITION-INDUCED REFLEX EPILEPSY: A PEDIATRIC CASE AND REVIEW OF THE LITERATURE

Objectives: Reflex seizures are epileptic events triggered by specific stimuli. They may occur individually, or as part of a focal or generalized epilepsy syndrome. Flashing lights are common triggers, however thinking, reading, bathing and somatosensory phenomena may also induce seizures. Micturition as a trigger is rare, and the localization for this reflex epilepsy has not been reported.

Methods: We present a pediatric case of partial complex seizures provoked by micturition and review the available literature.

Results: A 12 year-old left-hand dominant girl with moderate developmental delay of unknown etiology and refractory epilepsy since age two developed partial complex seizures with micturition at age ten. Electroencephalography (EEG) of micturition-induced seizures disclosed initial low-voltage fast activity at Cz with spread to the bifrontal regions. Magnetic resonance imaging was normal. Comparison of ictal and interictal single photon emission computed tomography (SPECT) images showed ictal hyperperfusion in the right anterolateral frontal lobe as well as the cingulate region. Video and EEG recordings confirmed that micturition preceded and precipitated seizures, thus ruling out more common phenomena such as micturition syncope and loss of bladder control due to seizure.

Conclusion: Micturition is a complex event coordinated by multiple levels of the central and peripheral nervous systems. Reflex seizures induced by micturition are exceedingly rare, with only three available cases in the literature. We report a patient with probable deep midline onset and rapid spread to the right anterolateral frontal lobe, and suggest involvement of the right frontal lobe as a possible common localization. This finding is in keeping with experimental positron emission photometry (PET) data showing similar active areas during urination in normal subjects.