Un caso di epilessia riflessa somatosentitiva (rub epilepsy)

Reflex seizures are rare forms of epilepsy in which seizures are triggered by different type of stimulus. Among these forms, the more frequent and known are those triggered by visual stimuli (intermittent light, patterns, eye closure), but there are other rare forms triggered by auditory stimuli, reading, chewing, hot water, higher cortical function, somatosensory or proprioceptive stimuli. In particular, somatosensitive evoked reflex seizures are rare conditions almost always found in patients with mental retardation or in those with severe brain damage in the perinatal or early infantile period. In 2001, Kanemoto reported three cases of rub epilepsy, a rare form of reflex epilepsy that typically occurs in patients with neither mental nor neurological deficits. These are often misdiagnosed like psychogenic seizures because of bizarre symptoms and the common unresponsiveness to the treatment with antiepileptic drugs. We report a case of a 49 year-old woman who began to have paroxysmal pinprick sensations at the age of 48. The sensation was initially localized in a limited area of the left half of her body and was followed by a sensory jacksonian march which spread to the entire left half of the body, including face and lips, without consciousness impairment. Sometimes this was followed by unilateral contraction of her left face muscles. The seizures may arise spontaneously or may be triggered by rubbing some parts of the left half of her body (shoulder, face, arms, thigh). Because of these strange symptoms which are not related to abnormal neurological examination and instrumental tests (MRI, EEG) and because of unresponsiveness to the treatment with antiepileptic drugs, she was diagnosed as having psychogenic seizures. A video-EEG recording with appropriate activation tests showed an ictal recording that lead to the diagnosis of “rub epilepsy”.