Intractable ictal vomiting: a new form of reflex epilepsy?

Sureshbabu, Sachin; Nayak, Dinesh; Aggarwal, Vikash; Peter, Sudhir; Khanna, Laxmi; Mittal, Gaurav

doi:10.1684/epd.2017.0917

Cited by 3 publications

(3 citation statements)

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“…89 Some patients can have a clinical course with persistent and protracted vomiting along with occasional loss of consciousness and subtle motor manifestations (including some features of Panayiotopolous 90 syndrome), and in this case the differential diagnosis can include also photosensitive epilepsy. 91 Seshia 17 points out that seizures also can be triggered by negative stimuli, such as intermittent darkness. Driving past trees blocking the sunlight provides a potent example of interrupted-light stimulation.…”

Section: Syndromes Imitating Photosensitivitymentioning

confidence: 99%

“…Thus, if the continuous occipital spikes and photosensitivity are presented in a patient with refractory seizures and developmental regression, PME should be considered 89 . Some patients can have a clinical course with persistent and protracted vomiting along with occasional loss of consciousness and subtle motor manifestations (including some features of Panayiotopolous 90 syndrome), and in this case the differential diagnosis can include also photosensitive epilepsy 91 . Seshia 17 points out that seizures also can be triggered by negative stimuli, such as intermittent darkness.…”

Section: Differential Diagnosis Of Photosensitivitymentioning

confidence: 99%

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Visually sensitive seizures: An updated review by the Epilepsy Foundation

et al. 2022

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Light flashes, patterns, or color changes can provoke seizures in up to 1 in 4000 persons. Prevalence may be higher because of selection bias. The Epilepsy Foundation reviewed light-induced seizures in 2005. Since then, images on social media, virtual reality, three-dimensional (3D) movies, and the Internet have proliferated. Hundreds of studies have explored the mechanisms and presentations of photosensitive seizures, justifying an updated review. This literature summary derives from a nonsystematic literature review via PubMed using the terms "photosensitive" and "epilepsy." The photoparoxysmal response (PPR) is an electroencephalography (EEG) phenomenon, and photosensitive seizures (PS) are seizures provoked by visual stimulation. Photosensitivity is more common in the young and in specific forms of generalized epilepsy. PS can coexist with spontaneous seizures. PS are hereditable and linked to recently identified genes. Brain imaging usually is normal, but special studies imaging white matter tracts demonstrate abnormal connectivity. Occipital cortex and connected regions are hyperexcitable in subjects with light-provoked seizures. Mechanisms remain unclear. Video games, social media clips, occasional movies, and natural stimuli can provoke PS.

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Section: Syndromes Imitating Photosensitivitymentioning

confidence: 99%

Section: Differential Diagnosis Of Photosensitivitymentioning

confidence: 99%

Visually sensitive seizures: An updated review by the Epilepsy Foundation

et al. 2022

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“…In ictal vomiting/retching, interictal EEG can be normal, and abundant movement artefacts may prevent the recognition of seizure onset (Shuper and Goldberg‐Stern, 2004; Sureshbabu et al ., 2017; Russo et al ., 2019).…”

Section: Discussionmentioning

confidence: 99%

Vomiting and retching as presenting signs of focal epilepsy in children

Depermentier

Mercier

Santalucia

et al. 2020

Epileptic Disorders

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Ictal vomiting is a rare condition easily misdiagnosed as a common disease. We report two children presenting with retching and vomiting as the main ictal manifestation. Patient 1 was a four‐year‐old girl with a history of daily nocturnal vomiting for two months, first interpreted as a functional disorder, then as a viral infection. She presented with vomiting accompanied by focal right‐sided hemifacial clonic jerking, occurring multiple times per day. Video‐EEG demonstrated ictal discharges associated with the retching and vomiting, over a normal background, and occasional interictal focal spikes. MRI was normal. PET demonstrated left‐sided opercular hypometabolism. Patient 2 was a girl with a history of focal epilepsy, secondary to a right central dysembryoplastic tumour, first resected with subsequent seizure freedom at the age of three years. At five years of age, she presented with recurrent episodes of retching and vomiting initially diagnosed as migraine. Video‐EEG showed ictal discharges, clinically correlating with retching, vomiting and clonic facial jerking, with normal interictal activity. Brain MRI showed a progression of the tumour. A second resection resulted in seizure freedom. Ictal vomiting often goes undiagnosed, especially in children, causing treatment delays. An ictal origin should be considered, particularly when the episodes are recurrent and stereotyped. [Published with video sequences].

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