By Alan Mozes

NEW YORK, Mar 15 (Reuters Health) - For some individuals, prolonged stimulation of a particular part of the skin--such as having their shoulder patted, their leg rubbed, or their hair cut--can initiate an epileptic seizure. And researchers now suggest that this so-called "rub epilepsy" is a unique condition, distinct from those seizures provoked by sudden noise and other stimuli.

"Initially, I myself could not believe easily what patients said, because seizures induced by rubbing sounded all too bizarre and like a product of the imagination," said study lead author Dr. Kousuke Kanemoto after reviewing several case studies. "However, we could find almost identical descriptions in the literature...and the patients were relieved to know that their sufferings were not psychological complications of their early infancy but of organic origin."

Kanemoto and his colleagues conducted their research while at Kansai Regional Epilepsy Center at Utamo National Hospital in Kyoto, Japan. The team reports on four cases of epilepsy--three of them examples of "rub epilepsy"--in the Journal of Neurology, Neurosurgery and Psychiatry.

Kanemoto and his team reviewed the pattern and nature of seizures induced by rubbing in two women aged 21 and 35, as well as in the case of another 44-year-old patient. After repeated rubbing pressure was applied to either a shoulder, a leg, or a part of the head, respectively, seizures in all three patients followed a similar pattern: starting with localized contractions near the trigger site that quickly spread to encompass the whole body.

The trigger spots were always located on only one side of the body, and seizure-provoking stimulation could be as short as 10 seconds--as was the case with the 44-year-old while receiving haircuts.

For comparison purposes, the investigators also outlined the case of a 45-year-old woman who could provoke a seizure by brushing the gums of her teeth--a stimulus they did not regard as an example of rub epilepsy because the seizure that resulted did not follow a pattern similar to that experienced by the other three patients.

Kanemoto and his colleagues concluded that all the cases of rub epilepsy were strikingly consistent--though in only one case the onset of such a seizure was followed by a several-hour period of respite, during which rubbing of the trigger area would not offset an additional seizure.

Testing--including EEGs and MRIs--showed that none of the rub epilepsy cases had any kind of intellectual or neurological damage. The researchers pointed out that such evidence is almost always present in cases of "startle epilepsy," where seizures are instigated by the provocation of sudden noise.

The investigators conclude that rub epilepsy is a distinct diagnosis that should involve both medicinal management and psychological therapy to aid patients who develop neuroses revolving around the desire to avoid stimulating their trigger sites.

Kanemoto told Reuters Health that even though rub epilepsy patients often need psychological attention to deal with lifestyle issues surrounding their illness, that does not mean that the source of their problems is psychological.

"It would be helpful to recognize this condition as a brain disease as soon as possible to avoid the secondary development of psychological complications," he noted. "A sudden withdrawal of the antiepileptic drugs leading to severe convulsions that would threaten lives could be avoided, if you recognize this condition as such."

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