Clinical and electrographic features of sunflower syndrome

Abstract

Valproate monotherapy continues to be the most effective treatment for Sunflower Syndrome and should be considered early. For patients who cannot tolerate valproate, higher doses of lamotrigine or polypharmacy should be considered. Levetiracetam monotherapy, even at high doses, is unlikely to be effective.

Sunflower syndrome: a poorly understood photosensitive epilepsy

“…Baumer and Porter, and Barnett et al summarized key clinical findings for the patients with Sunflower syndrome they reported, which were similar to what had been described in the earlier literature; namely, that females were more often afflicted and that age at onset for the handwaving or prior eyelid myoclonia was between 2 and 8 years 2,8,10 . Patients are often initially misdiagnosed with tics, leading to a delay in diagnosis 8,10 .…”

“…Individuals with Sunflower syndrome often develop eyelid myoclonia, including exhibiting symptoms of eye fluttering and eye rolling, often years before the onset of handwaving episodes 2,5,8,10 . In this way, Sunflower syndrome shares kinship with Jeavons syndrome.…”

Photosensitive Epilepsy Syndromes Mimicking Motor Tics

“…Most patients with Jeavons syndrome respond well to valproic acid monotherapy, however, 30% to 40% require adjunctive antiepileptic treatment, including levetiracetam, topiramate, or lamotrigine. Valproic acid has also been used with success in sunflower syndrome, although the sample sizes are small 17 . Because these epilepsies typically require lifelong therapy, levetiracetam or lamotrigine may be preferred in affected women because of valproic acid's potential teratogenicity 18 .…”

Treatment of Childhood Reflex Epilepsies

“…Some AEDs like VPA and levetiracetam (LEV) significantly reduce the spreading of posterior discharges, thereby limiting paroxysmal activity to the posterior cortex. 13 Eyelid myoclonia seen in EMA should be considered a myoclonic rather than an absence seizure. This concept has therapeutic consequences, supporting the good clinical efficacy of antimyoclonic drugs such as LEV 14 and zonisamide.…”

“…This highlights the importance of EEG, which should be used in conjunction with clinical reports, in assessing therapy in these patients. 13,21 Idiopathic Photosensitive Occipital Lobe Epilepsy Photosensitive seizures are usually generalized clinically and by EEG pattern (absence, myoclonus, and tonic-clonic seizures), except for focal occipital onset rarely seen in IPOE. 22 Patients with IPOE may respond better to carbamazepine.…”