Reflex anoxic seizures (RAS) during dry needling

Background: Trigger pain points are commonly found on the trunk, especially in the neck and shoulders. Dry needling is an effective treatment option in musculoskeletal pain caused by trigger pain points. Case description: A 28-year-old female patient who had persistent upper back pain underwent dry needling on both rhomboid and trapezius muscles for the first time. During the insertion of the sixth needle, the patient presented a tonic-clonic seizure lasting 20-30 seconds. After the seizure, her neurological examination without any findings, while her magnetic resonance imaging scan of the brain, electroencephalogram (EEG) of wakefulness, and sleep-deprived EEG showed no abnormal findings. Her condition was diagnosed as reflex anoxic seizure, which is a benign, self-limiting condition that is typically provoked and does not require medical treatment. Conclusion: Although it is an infrequent adverse event, healthcare professionals should be aware of reflex anoxic seizure, which could be triggered by dry needling, and therefore always perform this procedure with adequate first aid facilities available on site.