Epileptiform Discharges Presenting as Isolated Episodes of Semen Emission: A Case Report

Abstract

Epilepsy is a multifaceted disorder, whose presentation varies from person to person. Semen leakage is observed in instances such as nocturnal emission (nightfall), prostatitis, nerve injury, side-effects of medications, and sexual arousal. The emission of semen as a manifestation of epilepsy is rare. The authors present the case of a 28-year-old male, married for the past two years, with complaints of involuntary passage of semen in sleep which began one month back. The frequency was 3-4 times a week. Following this event, the patient observed that he had a splitting headache that was generalised in nature which would persist for the next few hours and would not even subside after taking a painkiller like paracetamol. An Electroencephalogram (EEG) was advised, showing generalised slowing with increased frequency of delta waves, which were suspected to be characterising post-epileptic changes. The patient was started on Tab Lamotrigine 25 once at night, which was eventually up-titrated to 105 mg per day on a divided dosage. The patient is well maintained now for three months on this medication and no repeat episode of involuntary seminal discharge has occurred. So, while encountering such a presentation a diagnosis of underlying seizure activity should be kept in mind.