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Neurological Rehabilitation

Toilet Seat Syndrome: A Case Report

Thursday, October 23, 2025
12:45 PM - 2:15 PM MT
Location: Kiosk 6

    Primary Author(s)

  • Aslihan P. Sahin, DO (she/her/hers)

    Resident Physician
    Albert Einstein Healthcare Network/MossRehab PM&R Program
    Elkins Park, Pennsylvania

    • Co-Author(s)

  • SA

    Shahrear Ahmed, DO

    Resident Physician
    Albert Einstein Healthcare Network/MossRehab PM&R Program

  • SR

    Shireen Rabiei, DO

    Resident Physician
    Albert Einstein Healthcare Network/MossRehab PM&R Program
    Elkins Park, Pennsylvania

  • CS

    Channarayapatna Sridhara, MD

    Director Moss Rehab Electrodiagnostic center, Associate Chair PM&R Jefferson Einstein Moss
    Albert Einstein Healthcare Network/MossRehab PM&R Program
    Elkins Park, Pennsylvania

Disclosure(s):
Aslihan Sahin, DO: No financial relationships to disclose
Channarayapatna Sridhara, MD: No financial relationships to disclose
Case Diagnosis: Bilateral sciatic neuropathy secondary to prolonged sitting

Case Description or Program Description: A 36-year-old male presented to the electrodiagnostic laboratory for evaluation of his lower limbs. Five years earlier, he was hospitalized with bilateral leg weakness, paresthesia and foot drop following a heroin overdose. He was found unresponsive after reportedly sitting on the toilet for two hours. Magnetic resonance imaging (MRI) showed cervical and lumbar paraspinal myositis, but no epidural abscess or cord pathology. A cervical paraspinal muscle biopsy showed no myositis.

Setting: Outpatient electrodiagnostic laboratory

Assessment/Results: One month after the injury, electrodiagnostic testing showed bilateral sciatic neuropathy with total axon loss at mid-thigh. The patient was advised to avoid ankle muscle strengthening to prevent hindering reinnervation and ambulate with ankle-foot orthoses. At 7 months, testing showed reinnervation of the right more than left tibial nerve innervated muscles. At 2 years, there was improvement of tibial muscles and new reinnervation of the right more than left peroneal muscles. At year 3, there was distal reinnervation of both peroneal and tibial muscles on the right more than left. At year 4, there was improvement in the distal left peroneal nerve. Electrodiagnostic findings were stable 5 years after initial injury, but the final study showed diminished compound muscle action potential amplitude in bilateral tibialis anterior recording likely from overuse, with limited prognosis for further recovery.

Discussion (relevance): Bilateral sciatic neuropathy has been linked to surgical positioning and gluteal compartment syndrome. Known as toilet seat neuropathy, only two other cases of bilateral sciatic neuropathy from drug overdose in a prolonged seated position have been documented. This case provides a unique perspective on the progression of recovery over five years.

Conclusions: Bilateral sciatic neuropathy can lead to severe and disabling sequelae, but patients may make functional gains years after injury. Electrodiagnostic testing is a valuable tool for guiding exercise recommendations to optimize reinnervation.