Summary:Purpose: Pharmacotherapy for photosensitive epilepsy is not always effective and is associated with wellrecognized toxicities. Nonpharmacologic approaches to the management of photosensitive epilepsy have included the use of sunglasses of various types. Blue lenses have been shown to suppress the photoparoxysmal response more effectively than lenses of other colors with similar overall transmittances. Recently, cross-polarized glasses have shown promise. The axes of polarization of the two lenses of such glasses are perpendicular to one another. We tested the effect of combining the use of blue and cross-polarized lenses in three patients with photosensitive epilepsy.Methods: We recorded the EEG response to photic stimulation, television screens, and computer monitors in three patients with photosensitive epilepsy. If photoparoxysmal responses were provoked in any of these scenarios, testing was repeated with the patient wearing nonpolarized, parallel-polarized, and blue crosspolarized sunglasses.Results: One of our patients had clinical seizures that were inadequately suppressed with moderate doses of valproate (VPA) but completely suppressed with blue cross-polarized lenses. The second patient's photoparoxysmal response was suppressed by both parallel-polarized and blue cross-polarized glasses, whereas the third patient's photoparoxysmal response was not suppressed by either.Conclusions: These preliminary data suggest that blue crosspolarized lenses may be useful in the treatment of photosensitive epilepsies and that their efficacy can be predicted in the EEG laboratory. Key Words: Polarization-Photic stimulationPhotoparoxysmal.Nonpharmacologic approaches to the management of photosensitive epilepsy (PSE) have included the use of optical filters of various types. The effectiveness of sunglasses, in particular, is known to depend on both the overall transmittance and the color of the lenses. Capovilla et al. (1) reported that Z1 lenses, a particular type of blue lens with relatively low transmittance at the deep-red end of the visible spectrum, abolished the photoparoxysmal response (PPR) in 64 (77%) of 83 patients and attenuated it in 16 (19%).Cross-polarized glasses also have shown promise. The axes of polarization of the two lenses of such glasses are perpendicular to one another. Jain et al. (2) with lenses that had independently variable polarization axes, they found that the PPR was most effectively suppressed when the axes were at right angles. The glasses were least effective when the polarization axes were parallel. The glasses were well tolerated and prevented further seizures. Jain et al. (3) subsequently compared the effects of parallel and cross-polarized lenses in 19 patients. Both types of polarized glasses attenuated the PPR in 17 patients, and the cross-polarized glasses were more effective in 10. We report the effect of combining the use of blue and cross-polarized lenses in three patients with PSE.