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CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / Conselho Nacional de Desenvolvimento CientÃfico e TecnolÃgico / Levetiracetam (LEV), nova droga antiepilÃptica, apresenta eficÃcia na terapia adicional das convulsÃes e em modelos experimentais. Clonazepam (CNZP) à um benzodiazepÃnico utilizado no tratamento de convulsÃes mioclÃnicas e crises generalizadas. Melatonina (MEL), hormÃnio pineal, demonstra atividade anticonvulsivante em diversos modelos animais. Objetivando investigar novos mecanismos relacionados aos efeitos dessas drogas, foi realizado estudo comparativo, a partir da anÃlise da influÃncia do prÃ-tratamento com LEV, CNZP ou MEL sobre o estresse oxidativo neuronal e sobre a modulaÃÃo de sistemas de neurotransmissÃo (colinÃrgico e dopaminÃrgico) durante as convulsÃes induzidas por pilocarpina (400mg/Kg; P400). Camundongos Swiss, machos, 25-30g receberam LEV, 200 mg/Kg, CNZP, 0,5mg/Kg ou MEL, 25mg/Kg, i.p., (doses escolhidas à partir de curvas dose-resposta) 30min antes de P400. Hipocampo e corpo estriado foram removidos para as anÃlises neuroquÃmicas. Experimentos in vitro, onde homogenatos cerebrais foram incubados com as drogas em estudo (50, 100 ou 200g/mL), tambÃm permitiram analisar alteraÃÃes no estresse oxidativo apÃs a induÃÃo de choque tÃrmico e, ainda, a densidade de receptores muscarÃnicos no hipocampo. Os estudos sobre os efeitos sobre o sistema de neurotransmissores colinÃrgicos demonstraram que o prÃ-tratamento com LEV, CNZP ou MEL causou reduÃÃo nos tremores induzidos por oxotremorina e elevou a atividade da acetilcolinesterase no hipocampo. LEV e CNZP alteraram o binding dos receptores muscarÃnicos hipocampais in vivo, revertendo a downregulation induzida por P400, e ensaios in vitro demostraram alteraÃÃo no binding muscarÃnico hipocampal pela prÃvia incubaÃÃo com LEV, CNZP ou MEL. Os ensaios de binding demonstraram, ainda, a downregulation dos receptores D2 hipocampais nos animais tratados LEV, CNZP ou prÃ-tratados com MEL antes de P400. As anÃlises para investigaÃÃo da atividade antioxidante de LEV e CNZP e do papel da aÃÃo antioxidativa da MEL na proteÃÃo contra as convulsÃes permitiram observar que a associaÃÃo com vitamina E potencializou os efeitos anticonvulsivantes de todas as drogas estudas. A administraÃÃo prÃvia de LEV, CNZP ou MEL, antes de P400, reverteu o aumento nos nÃveis de peroxidaÃÃo lipÃdica e nitrito-nitrato e normalizou a atividade da catalase e os nÃveis fisiolÃgicos do antioxidante glutationa em hipocampo e/ou corpo estriado. Nos experimentos de stress oxidativo in vitro, o aumento da peroxidaÃÃo lÃpÃdica, dos nÃveis de nitrito-nitrato e da atividade da catalase nos homogenatos cerebrais submetidos ao choque tÃrmico, foram alterados de forma significativa pela incubaÃÃo prÃvia com LEV, CNZP ou MEL, onde estas drogas foram capazes de reduzir os nÃveis de MDA, de nitrito-nitrato e, ainda, estabilizar a atividade da catalase, potencializando, assim, a atividade enzimÃtica antioxidante endÃgena e a capacidade de inativaÃÃo de radicais livres. Dessa forma, o estudo sugere uma aÃÃo moduladora, exercida por LEV, CNZP e MEL sobre o funcionamento dos sistemas muscarÃnico e dopaminÃrgico, em nÃvel central, como mecanismo alternativo para a proteÃÃo contra as convulsÃes no modelo de P400, bem como a participaÃÃo de propriedades antioxidantes diretas ou indiretas dessas drogas, atravÃs da capacidade de modificar a resposta ao estresse oxidativo neuronal. / Levetiracetam (LEV), nova droga antiepilÃptica, apresenta eficÃcia na terapia adicional das convulsÃes e em modelos experimentais. Clonazepam (CNZP) à um benzodiazepÃnico utilizado no tratamento de convulsÃes mioclÃnicas e crises generalizadas. Melatonina (MEL), hormÃnio pineal, demonstra atividade anticonvulsivante em diversos modelos animais. Objetivando investigar novos mecanismos relacionados aos efeitos dessas drogas, foi realizado estudo comparativo, a partir da anÃlise da influÃncia do prÃ-tratamento com LEV, CNZP ou MEL sobre o estresse oxidativo neuronal e sobre a modulaÃÃo de sistemas de neurotransmissÃo (colinÃrgico e dopaminÃrgico) durante as convulsÃes induzidas por pilocarpina (400mg/Kg; P400). Camundongos Swiss, machos, 25-30g receberam LEV, 200 mg/Kg, CNZP, 0,5mg/Kg ou MEL, 25mg/Kg, i.p., (doses escolhidas à partir de curvas dose-resposta) 30min antes de P400. Hipocampo e corpo estriado foram removidos para as anÃlises neuroquÃmicas. Experimentos in vitro, onde homogenatos cerebrais foram incubados com as drogas em estudo (50, 100 ou 200g/mL), tambÃm permitiram analisar alteraÃÃes no estresse oxidativo apÃs a induÃÃo de choque tÃrmico e, ainda, a densidade de receptores muscarÃnicos no hipocampo. Os estudos sobre os efeitos sobre o sistema de neurotransmissores colinÃrgicos demonstraram que o prÃ-tratamento com LEV, CNZP ou MEL causou reduÃÃo nos tremores induzidos por oxotremorina e elevou a atividade da acetilcolinesterase no hipocampo. LEV e CNZP alteraram o binding dos receptores muscarÃnicos hipocampais in vivo, revertendo a downregulation induzida por P400, e ensaios in vitro demostraram alteraÃÃo no binding muscarÃnico hipocampal pela prÃvia incubaÃÃo com LEV, CNZP ou MEL. Os ensaios de binding demonstraram, ainda, a downregulation dos receptores D2 hipocampais nos animais tratados LEV, CNZP ou prÃ-tratados com MEL antes de P400. As anÃlises para investigaÃÃo da atividade antioxidante de LEV e CNZP e do papel da aÃÃo antioxidativa da MEL na proteÃÃo contra as convulsÃes permitiram observar que a associaÃÃo com vitamina E potencializou os efeitos anticonvulsivantes de todas as drogas estudas. A administraÃÃo prÃvia de LEV, CNZP ou MEL, antes de P400, reverteu o aumento nos nÃveis de peroxidaÃÃo lipÃdica e nitrito-nitrato e normalizou a atividade da catalase e os nÃveis fisiolÃgicos do antioxidante glutationa em hipocampo e/ou corpo estriado. Nos experimentos de stress oxidativo in vitro, o aumento da peroxidaÃÃo lÃpÃdica, dos nÃveis de nitrito-nitrato e da atividade da catalase nos homogenatos cerebrais submetidos ao choque tÃrmico, foram alterados de forma significativa pela incubaÃÃo prÃvia com LEV, CNZP ou MEL, onde estas drogas foram capazes de reduzir os nÃveis de MDA, de nitrito-nitrato e, ainda, estabilizar a atividade da catalase, potencializando, assim, a atividade enzimÃtica antioxidante endÃgena e a capacidade de inativaÃÃo de radicais livres. Dessa forma, o estudo sugere uma aÃÃo moduladora, exercida por LEV, CNZP e MEL sobre o funcionamento dos sistemas muscarÃnico e dopaminÃrgico, em nÃvel central, como mecanismo alternativo para a proteÃÃo contra as convulsÃes no modelo de P400, bem como a participaÃÃo de propriedades antioxidantes diretas ou indiretas dessas drogas, atravÃs da capacidade de modificar a resposta ao estresse oxidativo neuronal. / Levetiracetam (LEV), a new antiepileptic drug, shows efficacy in the treatment of additional seizures and in experimental models. Clonazepam (CNZP) is a benzodiazepine used to treat myoclonic seizures and generalized seizures. Melatonin (MEL), the pineal hormone, shows anticonvulsant activity in several animal models. To investigate new mechanisms related to the effects of these drugs, comparative study was conducted, from the analysis of the influence of pretreatment with LEV, CNZP or MEL on the oxidative stress and neuronal modulation of neurotransmitter systems (cholinergic and dopaminergic) during seizures induced by pilocarpine (400mg/Kg; P400). Male Swiss mice, 25-30g received LEV, 200 mg / kg, CNZP, 0.5 mg / kg or MEL, 25mg/kg, ip (doses chosen from the dose-response curves) 30min before P400. Hippocampus and striatum were removed for neurochemical analysis. In vitro experiments, where brain homogenates were incubated with drugs under study (50, 100 ou 200g/mL) also allowed us to analyze changes in oxidative stress after induction of heat shock and also the density of muscarinic receptors in the hippocampus. Studies on the muscarinic modulation demonstrated that pretreatment with LEV, CNZP or MEL resulted in lower oxotremorina induced tremors and increased acetylcholinesterase activity in the hippocampus. LEV and CNZP altered the binding of hippocampal muscarinic receptors in vivo, reversing the P400-induced downregulation and in vitro tests showed changes in hippocampal muscarinic binding by previous incubation with LEV, CNZP or MEL. The binding assays also showed a downregulation of hippocampal D2 receptors in treated animals LEV, CNZP or pretreated with MEL before P400. Analyses to investigate the antioxidant activity of LEV and CNZP and role of antioxidative action of MEL in the protection against seizures propose that the association with vitamin E increased the anticonvulsant effects of all studied drugs. The prior administration of LEV, MEL or CNZP before P400, reversed the increased levels of lipid peroxidation and nitrite-nitrate and normalized the activity of catalase and the physiological levels of the antioxidant glutathione in the hippocampus and / or striatum. According to in vitro experiments, increased lipid peroxidation, levels of nitrite-nitrate and catalase activity in brain homogenates subjected to thermal shock were significantly altered by incubation with LEV, CNZP or MEL, where these drugs were able to reduce the levels of MDA, nitrite-nitrate, and also stabilize the activity of catalase, enhancing thus the endogenous antioxidant enzyme activity and the ability to inactivate free radicals.Thus, the study suggests a modulatory action exerted by LEV, CNZP and MEL on the functioning of muscarinic and dopaminergic systems in the central nervous system as an alternative mechanism to protect against seizures in the model P400, and the participation of direct and indirect antioxidant properties of these drugs, through the ability to modify the neuronal response to oxidative stress. / Levetiracetam (LEV), a new antiepileptic drug, shows efficacy in the treatment of additional seizures and in experimental models. Clonazepam (CNZP) is a benzodiazepine used to treat myoclonic seizures and generalized seizures. Melatonin (MEL), the pineal hormone, shows anticonvulsant activity in several animal models. To investigate new mechanisms related to the effects of these drugs, comparative study was conducted, from the analysis of the influence of pretreatment with LEV, CNZP or MEL on the oxidative stress and neuronal modulation of neurotransmitter systems (cholinergic and dopaminergic) during seizures induced by pilocarpine (400mg/Kg; P400). Male Swiss mice, 25-30g received LEV, 200 mg / kg, CNZP, 0.5 mg / kg or MEL, 25mg/kg, ip (doses chosen from the dose-response curves) 30min before P400. Hippocampus and striatum were removed for neurochemical analysis. In vitro experiments, where brain homogenates were incubated with drugs under study (50, 100 ou 200g/mL) also allowed us to analyze changes in oxidative stress after induction of heat shock and also the density of muscarinic receptors in the hippocampus. Studies on the muscarinic modulation demonstrated that pretreatment with LEV, CNZP or MEL resulted in lower oxotremorina induced tremors and increased acetylcholinesterase activity in the hippocampus. LEV and CNZP altered the binding of hippocampal muscarinic receptors in vivo, reversing the P400-induced downregulation and in vitro tests showed changes in hippocampal muscarinic binding by previous incubation with LEV, CNZP or MEL. The binding assays also showed a downregulation of hippocampal D2 receptors in treated animals LEV, CNZP or pretreated with MEL before P400. Analyses to investigate the antioxidant activity of LEV and CNZP and role of antioxidative action of MEL in the protection against seizures propose that the association with vitamin E increased the anticonvulsant effects of all studied drugs. The prior administration of LEV, MEL or CNZP before P400, reversed the increased levels of lipid peroxidation and nitrite-nitrate and normalized the activity of catalase and the physiological levels of the antioxidant glutathione in the hippocampus and / or striatum. According to in vitro experiments, increased lipid peroxidation, levels of nitrite-nitrate and catalase activity in brain homogenates subjected to thermal shock were significantly altered by incubation with LEV, CNZP or MEL, where these drugs were able to reduce the levels of MDA, nitrite-nitrate, and also stabilize the activity of catalase, enhancing thus the endogenous antioxidant enzyme activity and the ability to inactivate free radicals.Thus, the study suggests a modulatory action exerted by LEV, CNZP and MEL on the functioning of muscarinic and dopaminergic systems in the central nervous system as an alternative mechanism to protect against seizures in the model P400, and the participation of direct and indirect antioxidant properties of these drugs, through the ability to modify the neuronal response to oxidative stress.

Thesis (MA)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: The primary aim of this study was to explore a possible association between the coping styles and the health-related quality of life (HRQOL) of patients with psychogenic nonepileptic seizures (PNES) in the South African context. Twenty-two PNES patients (aged 14 years or older) with confirmed video EEG were recruited from Constantiaberg Medi-Clinic and Tygerberg Hospital. These participants were matched by age and gender with a healthy control group. Participants had to complete a demographic questionnaire as well as self-reported measures of HRQOL (SF-36v2 health survey) and coping strategies (the Ways of Coping (WOC) and the Coping Strategy Indicator (CSI)). Analyses of variances were performed to explore the differences between the PNES group and the healthy control group on the various measurement instruments. The association between specific coping strategies and HRQOL was investigated by calculating Pearson’s correlation coefficient. Multiple regressions were conducted to determine the extent to which HRQOL could be accounted for by each of the coping instruments. The results indicated that the HRQOL of the PNES group were significantly lower than the HRQOL of the healthy control group. The PNES participants utilised significantly more emotion-focused coping strategies, such as escape-avoidance and distancing coping strategies, in comparison to the healthy control group. The WOC and the CSI accounted respectively for 56% and 42% of the variance in the HRQOL of the sample. The results also indicated that the escape-avoidance coping strategies utilised by PNES participants had a significant negative effect on their HRQOL. The findings of this study provided greater insight into the coping strategies utilised by PNES participants, which have been identified as a risk factor in PNES. It also highlights that the type of coping strategies utilised by the PNES participants in our sample had a significant negative influence on their level of HRQOL. This is the first study of this nature on people with PNES in South Africa. / AFRIKAANSE OPSOMMING: Die primêre doel van hierdie studie was om te bepaal of daar 'n verband tussen spesifieke hanteringstyle en die gesondheidssverwante kwaliteit van lewe van pasiënte met psigogeniese nie-epileptiese aanvalle (PNEA) in die Suid-Afrikaanse konteks is. Twee-en-twintig PNEA-pasiënte (14 jaar of ouer) met 'n bevestigde video-EEG-diagnose was gewerf uit die Constantiaberg Medi-Kliniek en die Tygerberg Hospitaal. Hulle is ten opsigte van ouderdom en geslag gepaar met 'n gesonde kontrolegroep. Deelnemers moes 'n demografiese vraelys voltooi asook vraelyste wat die gesondheidssverwante lewenskwaliteit (die SF-36v2 gesondheidsvraelys) en hanteringstyle (die hanteringsmeganisme-vraelys (WOC) en die hanteringstrategie-aanduider (CSI)) meet. Analises van variansies is uitgevoer om die moontlike verskille tussen die PNEA-groep en die gesonde kontrolegroep op die verskeie metingsinstrumente te ondersoek. Die verwantskap tussen spesifieke hanteringsmeganismes en gesondheidssverwante lewenskwaliteit is ondersoek deur Pearson se korrelasie-koëffisiënt te bereken. Verskeie regressiewe analises is uitgevoer om te bepaal tot watter mate hanteringsmeganismes gesondheidssverwante lewenskwaliteit kan beïnvloed. Die resultate het aangedui dat die gesondheidssverwante lewenskwaliteit van die PNEA-groep beduidend laer was as dié van die gesonde kontrole groep. Die PNEA-deelnemers het beduidend meer gebruik gemaak van emosie-gefokusde hanteringsmeganismes, soos die ontvlugting-vermyding en distansiëring hanteringsmeganismes, as die gesonde kontrolegroep. Die WOC en die CSI het bygedra tot onderskeidelik 56% en 42% van die variansie in die totale gesondheidssverwante lewenskwaliteit-telling van die steekproef. Die resultate het ook aangedui dat die ontvlugting-vermyding hanteringsmeganisme wat deur PNEA-deelnemers gebruik word 'n beduidende negatiewe invloed op hul lewenskwaliteit gehad het. Die bevindings van die studie bied meer insig oor die hanteringsmeganismes wat die PNEA-deelnemers gebruik het, wat al voorheen as 'n risikofaktor vir die ontwikkeling van PNEA geïdentifiseer is. Dit lig ook uit dat die tipe hanteringsmeganismes wat die PNEA-deelnemers gebruik het, hul gesondheidssverwante lewenskwaliteit negatief beïnvloed het. Dit is die eerste studie van dié aard van persone met PNES in Suid Afrika.

The experiences of family caregivers of adults diagnosed with Non-Epileptic Attack Disorder (NEAD) are under-researched. To address this lack of research and the Department of Health’s (DOH) aim to focus on the experiences of caregivers to inform the development of appropriate services (DOH, 2010), this narrative inquiry focuses on the stories told by eight caregivers of adults diagnosed with NEAD. Each narrative, which was collected through loosely structured interviews, was analysed from both a content and performative perspective. Multiple readings of the narratives revealed that caregivers told two different story ‘types’ about their experiences: stories of ‘biographical continuity’ and stories of ‘biographical disruption’. These findings are discussed in relation to the relevant literature and clinical implications. Methodological limitations and directions for future research are also presented. The study provides a valuable insight for any professional working with caregivers of individuals with NEAD and it is hoped that this research will promote dialogue amongst professionals and readers.

As crises não-epilépticas são definidas como crises, ataques ou acessos recorrentes que podem ser confundidos com epilepsia, devido à semelhança das manifestações comportamentais existentes entre ambas, mas difere da crise epiléptica por não ser conseqüente de descargas elétricas cerebrais anormais. Podem ter origem fisiogênica ou psicogênica. Os diagnósticos psiquiátricos que mais freqüentemente apresentam-se sob a forma de crises não-epilépticas psicogênicas são o transtorno conversivo e o transtorno de somatização. Na prática clínica, a diferenciação entre crises epilépticas e crises não-epilépticas desafia e confunde os clínicos, os neurologistas e os psiquiatras desde tempos remotos. A introdução da monitorização pelo vídeo-eletroencefalograma vídeo-EEG, considerado o padrão ouro para o diagnóstico diferencial, levou a um aumento significativo no número de diagnósticos de crises não-epilépticas psicogênicas. Apesar de se tratar de uma situação clínica de difícil manejo, com conseqüências médicas e sociais significativas, fica evidente que o conhecimento técnico e instrumental sobre as crises não-epilépticas psicogênicas são insuficientes para abordar este problema. O objetivo geral deste estudo é de o de enriquecer a compreensão das crises não-epilépticas psicogênicas, nos últimos quarenta anos. As condições de emergência histórica e as implicações práticas do conceito de crise não-epiléptica psicogênica foram investigadas. Para tanto, foram selecionados artigos que abordam o conceito de crises não-epilépticas psicogênicas em três periódicos de neurologia e em três de psiquiatria. Esta pesquisa partiu de projetos epistemológicos que possibilitam um pensamento reflexivo sobre a produção de conhecimentos científicos, no que diz respeito à formação, às mudanças e à formalização dos conceitos, teorias e práticas. Houve uma aproximação da metodologia histórico-epistemológica de Canguilhem e Bachelard, passando pela análise crítica de Foucault e alcançando o pensamento hermenêutico de Habermas e Gadamer. Foi verificado que os conceitos de histeria e epilepsia vêm sendo reformulados, ao longo do tempo. As crises não-epilépticas psicogênicas foram demarcadas em períodos. Na década de 1970, predominam os artigos que discutem a redução da prevalência da histeria e da personalidade histérica nas mulheres. Na década de 1980, existe uma preocupação com a formulação de diagnósticos através de instrumentos e entrevistas padronizadas e um aumento explosivo do número de artigos, dos periódicos de neurologia, que discutem o uso do vídeo-EEG. Na década de 1990, surgem os artigos que abordam os múltiplos diagnósticos psiquiátricos e as pesquisas sobre o abuso e a dissociação associados à crise não-epiléptica psicogênica. Conclui-se que as crises não-epilépticas psicogênicas, tal qual o conhecimento científico, tem uma história, que interage com outros tipos de conhecimento e que são influenciadas por variáveis sociais. Nesta direção, sugere-se que a possibilidade de abertura e diálogo entre as dimensões técno-científica e prática possam criar condições para um modelo de cuidado mais adequado e integrado junto aos pacientes com crises não-epilépticas psicogênicas / Psychogenic non-epileptic seizures are recurrent crisis, or attacks, or paroxysmal behavioral changes that can be misunderstood as epileptic seizure due to the behavioral similarity between both, however, these manifestations are not associated with abnormal electrical brain discharges that cause epileptic seizures. Non-epileptic seizures are classified into physiologic and psychogenic origin. The most common psychiatric diagnoses associated with psychogenic non-epileptic seizures are conversion disorder and somatization disorder. In clinical practice, the distinction between non-epileptic seizure and epilepsy challenges and confuses the clinicians, the neurologists and the psychiatrists, since ancient times. The long-term video-electroencephalographic monitoring video-EEG, considered as the gold standard for the differential diagnosis, has led to a significant increase in the number of cases of psychogenic non-epileptic seizures. Although being a clinical situation difficult to manage, with medical and social poor prognosis, it is evident that the instrumental and technological knowledge about non-epileptic seizures are insufficient to deal with this problem. The aim of this study is to enrich the comprehension of the psychogenic non-epileptic seizures in the last fifty years. The historical emergence conditions of the psychogenic non-epileptic seizure and its clinical practical implications were investigated. For this purpose, it was examined papers that discuss the concept of psychogenic non-epileptic seizure in three neurological journals and in three psychiatric journals. This research was guided by epistemological projects focused upon conditions of possibility for reflexive thinking about conceptualization, changing and formalization of the concepts, theories and practices. The methodological approach was influenced by Canguilhems and Bachelards historical epistemology, pursued by Foucault´s critical analysis and culminating in Habermas e Gadamers hermeneutics thought. The research pointed out that hysteria and epilepsy concepts have been reformulated over time, and uncovered fundamental concepts that organized psychogenic non-epileptic seizures in different historical periods. In the 1970s, there was a predominance of papers that discuss the reduction of hysteria and the hysterical personality in women. In the 1980s, there was a concern with the development of diagnostic instruments and structured interviews, and an explosive increase in the number of papers in the neurological journals discussing the use of video-EEG. In the 1990s and on, papers have been focused on the multiple psychiatric diagnoses and research on dissociation and abuse associated to psychogenic non-epileptic seizure. The conclusion is that psychogenic non-epileptic seizures, as scientific knowledge, have a history, which interact with various kinds of knowledge and it is influenced by social variables. In this sense, the possibility of openness and dialogue between technological and practical dimensions could provide underlying conditions to a better and more integral care model among patients with psychogenic non-epileptic seizures

Introdução: a epilepsia reflexa é uma condição na qual todas as crises são desencadeadas por um estímulo específico e, na grande maioria dos casos, apresenta-se com crises refratárias ao tratamento. São vários os fatores desencadeantes, entre os quais se destaca pela raridade a evacuação. Objetivos: realizar revisão de literatura sobre epilepsia reflexa, identificar a evacuação como possível fator desencadeador de crise epiléptica e relatar o caso de um paciente com crise reflexa evacuatória documentada à monitorização por vídeo-eletroencefalograma Métodos: revisão de literatura acerca de epilepsias reflexas e revisão de prontuário de um paciente com suspeita clínica de epilepsia reflexa evacuatória. Resultados: o paciente deste estudo, um menino de 10 anos de idade, com dominância manual esquerda, iniciou, aos 4 anos, crises associadas à evacuação. Na monitorização por vídeo-eletroencefalograma, durante episódio de evacuação, apresentou parada comportamental, desvio cefálico para a direita, automatismos em membro superior esquerdo e arresponsividade, coçando o nariz tardiamente com a mão esquerda. O EEG ictal demonstrou atividade rítmica teta em região temporal esquerda com posterior envolvimento frontal esquerdo e de áreas homólogas contralaterais. As ressonâncias magnéticas de encéfalo não evidenciaram alterações e o SPECT interictal identificou hipoperfusão discreta na porção anterior do lobo temporal esquerdo. Com uso de ácido valpróico e carbamazepina o paciente segue livre de crises. Avaliações neuropsicológicas e de qualidade de vida sugerem comprometimento global, tanto antes como após o controle da epilepsia. Conclusão: este é apenas o terceiro caso de epilepsia reflexa evacuatória descrito na literatura, e o segundo com crises dessa ordem documentadas por vídeo-eletroencefalograma. Ambos sugeriram lateralização e localização em região temporal esquerda, elegendo esta região como potencial zona epileptogênica. O tratamento com ácido valpróico e carbamazepina mostrou-se eficaz para controle de crises neste paciente, podendo ser uma opção de tratamento em outros pacientes com este tipo de epilepsia. / Background: Reflex epilepsy is a condition in which all seizures are triggered by a specific stimulus. There are many known stimulus, including defecation which has rarely been reported. In the majority of cases, it presents with refractory seizures. Objective: review the literature on reflex epilepsy, as well as identify defecation as a possible trigger and report a case of a patient with reflex seizures triggered by defecation documented by video-electroencephalogram monitoring. Methods: literature review on reflex epilepsies and review of medical records of a patient with reflex epilepsy triggered by defecation. Results: we present a 10-year-old-boy patient, left-handed, whose epilepsy onset was at the age of four. Its seizures were characterized by episodes of loss of consciousness and atonia during defecation. Video-electroencephalogram monitoring had shown a seizure triggered by defecation, characterized by right head deviation, left upper limb automatisms, associated with consciousness impairment and afterwards nose wiping with the left hand. The ictal EEG demonstrated theta rhythmic activity in the left temporal lobe. The brain magnetic resonance was normal. The interictal SPECT identified left anterior temporal lobe mild hypoperfusion. The patient became seizure free after the treatment with valproic acid and carbamazepine. Neuropsychological and quality of life assessments suggested global impairment, before and after seizure control. Conclusion: this is the third case of epilepsy induced by defecation, and the second with seizures documented by videoelectroencephalogram. Similar to this case, both had suggested lateralization and localization over the left temporal region, suggesting this region as a potential epileptogenic zone in patients with this type of reflex epilepsy. In our patient, the treatment with valproic acid and carbamazepine was effective for the seizure control and may be an option to other patients with this condition.