Familial rectal pain: A type of reflex epilepsy?


  • Dr Romaine Schubert MD,

    Corresponding author
    1. Division of Pediatric Neurology and the Department of Pediatrics, The Brookdale Hospital Medical Center and State University of New York, Health Sciences Center, Brookly, NY
    • The Brookdale Hospital Medical Center, 300 CHC, Linden Blvd at Brookdale Plaza, Brooklyn, NY 11212
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  • Joan B. Cracco MD

    1. Department of Neurology, State University of New York, Health Science Center, Brooklyn, NY
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We studied 2 members of a family suffering from paroxysmal attacks elicited by tactile stimuli. The attacks consist of burning pain of the stimulated body part, followed by either complete collapse or tonic posturing. Noxious stimuli provoke episodes regardless of their somatic location, whereas it is only necessary for nonnoxious stimuli to be applied to specific trigger zones, such as the rectum, to provoke attacks. Episodes are most commonly precipitated by bowel movement, leading to extreme fear of defecation and resultant fecal retention. An ictal electroencephalographic video recording revealed only slowing of the background; however, serum prolactin was significantly elevated postictally. The attacks were completely suppressed by carbamazepine and resumed on discontinuing the medication. These attacks may represent a form of reflex epilepsy manifested by autonomic nervous system dysfunction.