Monthly Case

An almost 4-year-old boy complains to his parents after every bathing saying “it’s burning, mom it hurts!”. The parents report that in the aftermath their son stares, he has a head version to the right, and a flection of this right arm. The legs become weak and he slumps down. The eyes are open, but the boy cannot speak, duration of the whole episode is 1 min. Thereafter, he is tired and falls asleep. The parents had documented such an event by mobile phone.

Variations of bathing, in particular regarding water temperature, did not stop manifestation of these events.

We performed video-EEG-recording while the boy was bathing in hospital. Here as well, the toddler developed a typical episode. Ictal EEG demonstrated a seizure pattern starting centro-temporally on the left, later under propagation, the whole left hemisphere was involved. The corresponding behavioural changes were the same as described by the parents before. Analysis of chronology of events showed that seizure onset did not correlate with the end of bathing but with hefty towelling (“rubbing”) of the boy by his father. Clinically, the boy suffered from an initial somato-sensory aura (pain) evolving into an automotor seizure.

Thus, we made the diagnosis of “rub epilepsy”, representing a rare form of reflex epilepsies. Trigger zone was the right arm or the right-sided thorax. Cranial MRI was normal. We refrained from antiepileptic drug treatment and recommended the parents a less courageous towelling of their son. Since then, the toddler did not suffer from any further seizures after bathing.

Cases of the months before