The Involvement of Sensory-motor Networks in Reflex Seizure

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  • Suzuki Hime
    Department of Neurosurgery, Sapporo Medical University, School of Medicine, Sapporo, Hokkaido, Japan
  • Enatsu Rei
    Department of Neurosurgery, Sapporo Medical University, School of Medicine, Sapporo, Hokkaido, Japan
  • Kanno Aya
    Department of Neurosurgery, Sapporo Medical University, School of Medicine, Sapporo, Hokkaido, Japan
  • Ochi Satoko
    Department of Neurosurgery, Sapporo Medical University, School of Medicine, Sapporo, Hokkaido, Japan
  • Murahara Takashi
    Department of Neurology, Sapporo Medical University, School of Medicine, Sapporo, Hokkaido, Japan
  • Yazawa Shogo
    Department of Systems Neuroscience, Sapporo Medical University, School of Medicine, Sapporo, Hokkaido, Japan
  • Shiraishi Hideaki
    Department of Pediatrics, Hokkaido University Graduate, School of Medicine, Sapporo, Hokkaido, Japan
  • Mikuni Nobuhiro
    Department of Neurosurgery, Sapporo Medical University, School of Medicine, Sapporo, Hokkaido, Japan

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<p>Reflex seizures are epileptic events triggered by specific external stimuli, or less commonly, internal mental stimuli. Understanding the characteristics of reflex seizures is important to elucidate the mechanisms underlying network abnormalities in epileptic conditions. This report details a patient with medically intractable reflex seizures provoked by sensory stimuli to the patient’s right foot. Single-photon emission computed tomography (SPECT) during the seizure induced by sensory stimulation showed hyperperfusion in broad sensory-motor networks (dorsal column-medial lemniscus pathway, left thalamus, bilateral postcentral gyri and posterior parietal cortices, left supplementary motor area (SMA), and left paracentral lobule) and left caudateputamen. The irritative zones and ictal onset zone were localized to the left medial frontoparietal (SMA, anterior and middle cingulate gyrus, and paracentral lobule) and lateral posterior parietal cortices, as evidenced by amelioration of reflex seizures following intracranial electroencephalography and surgical resection of these areas. The neuroradiological and electrophysiological findings in our case study illustrate that the mechanism of reflex seizures may be associated with hyperexcitability of the broad sensory-motor networks, including the basal ganglia. Disconnection of these networks is necessary to treat reflex seizures.</p>

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