Over 10 years ago, Verghese (Reference Verghese1989) reported on spontaneous orgasms, stating that in the absence of gynaecological, hormonal, or overt psychological disturbances such symptoms might be caused by epileptic seizures as part of an organic brain disease (Reference RuffRuff, 1980, Reference Remillard, Andermann and TestaRemillard et al, 1983, Reference Reading and WillReading & Will, 1997). Only a few individual reports have been published on this condition, giving accounts of structural lesions in the temporal or parietal lobe. Erotic manifestations in these papers so far were described as unpleasant sensations.
We describe the case of a 37-year-old female patient who experienced her first generalised tonic-clonic seizure at the age of 28. Not until five years later, when she had her second generalised seizure, did other ‘funny’ symptoms appear, which she did not recognise as epileptic manifestations. She described epigastric feelings, sensations of déjà vu, déjà vécu and depersonalisation as well as spontaneous orgasms, the latter of which was experienced as a pleasant, although embarrassing, sensation. These feelings could occur anywhere, at home, at work or on entering a bus. During those events she often was able to continue in her work or in her conversations, paleness being the only noticeable symptom. The frequency of such episodes ranged between one to six per month. Full diagnostic work-up was only performed three years later when she had had her third generalised seizure. As on the previous occasions her general, neurological and psychiatric examinations were normal. Computed tomography scan, magnetic resonance and electroencephalogram (EEG) were found free of structural lesions and focal signs, but a long-term EEG revealed a right temporal sharp-wave focus lasting five seconds, indicating that the symptoms of our patient could be identified as part of an epileptic aura pointing towards partial seizures with an origin in the right temporal lobe. This diagnosis was confirmed by the fact that all symptoms ceased after initiating antiepileptic treatment with lamotrigine.
This case suggests that neuroimaging might not always be sensitive enough to reveal structural lesions, and that long-term EEG recordings should be included in the diagnostic work-up. In doubtful cases a trial with antiepileptics can prove helpful. A thorough history-taking should always include questions about other concomitant epileptic symptoms. Whether erotic manifestations during partial epileptic seizures are experienced as being pleasant or unpleasant, they still are embarrassing and a burden for the patient and therefore warrant pharmacological treatment.
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