Pattern Sensitivity and Photosensitivity in Epileptic Children with Visually Induced Seizures

Brinciotti, M.; Matricardi, M.; Pelliccia, A.; Trasatti, G.

doi:10.1111/j.1528-1157.1994.tb02521.x

Cited by 36 publications

(36 citation statements)

References 20 publications

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“…However, other authors have found a small proportion of pattern‐sensitive patients who were insensitive to intermittent photic stimulation. In a group of 67 children with visually induced seizures studied by Brinciotti et al (16), 51% exhibited sensitivity to both light and pattern, but 33% had isolated sensitivity to light and 16% to pattern. Among patients with television epilepsy and video‐game epilepsy, ∼20% are not responsive to intermittent light stimulation but are sensitive to patterns (6,32).…”

Section: Discussionmentioning

confidence: 98%

Pattern‐sensitive Epilepsy: Electroclinical Characteristics, Natural History, and Delineation of the Epileptic Syndrome

Radhakrishnan¹,

Louis²,

Johnson³

et al. 2005

Epilepsia

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Purpose: To elucidate the electroclinical features and long-term outcome of patients with pattern-sensitive epilepsy. Methods: We reviewed the clinical and electroencephalo-graphic (EEG) findings of 73 (43 female and 30 male) patients in whom pattern-sensitive epilepsy was diagnosed at Mayo Clinic (Rochester, Minnesota, U.S.A.) from 1950 through 1999. We contacted patients and their relatives by letter or telephone to obtain the latest seizure and quality-of-life outcomes. Results: The median age at onset of seizures was 12.8 years (range, 0.6-32.9 years). Most patients had absence, myoclonic, or generalized tonic-clonic seizures. Interictal epileptiform discharges in the EEG were detected in 61 (83.6%) patients and were generalized in 54 (74%). Paroxysmal epileptiform discharges in the EEG elicited with standard patterns were all generalized in two thirds of patients but were restricted to the posterior head region in one-third. Eight (11%) patients did not exhibit photosen-sitivity. Television was the most common precipitant [30 patients (41%)]. Twenty-nine patients gave a clear history of one or more seizures precipitated while viewing environmental patterns such as window screens, garments, tablecloths, and ceiling tiles; the rest of the patients admitted that they preferred to avoid looking at patterned objects because these objects made them uncomfortable. The electroclinical features suggested juvenile myoclonic epilepsy in 14 patients, progressive myoclonus epilepsy in three, progressive familial cerebellar ataxia with myoclonus in two, and severe myoclonic epilepsy of infancy in one. During a median follow-up period of 15.7 years, 25 (45.5%) of 55 patients who were followed up for ≥5 years achieved complete seizure remission. The median age at remission was 24.4 years. The absence of progressive neurologic disease was correlated significantly with remission; a family history of seizures showed a trend in favor of remission. More than two thirds of the patients did not consider the seizures an impediment to their family life or to educational and occupational achievements. Conclusions: Although pattern sensitivity as a trait occurs in various epileptic syndromes, pattern-sensitive epilepsy is a readily distinguishable subtype of the visually provoked reflex epilepsies. In our opinion, the location and extent of the excitable region or regions within the visual cortex concerned with different attributes of visual function dictate susceptibility to a specific trigger (intermittent light, pattern, or color) or closely related multiple triggers and the resultant electroclinical phenomenon.

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Section: Discussionmentioning

confidence: 98%

Pattern‐sensitive Epilepsy: Electroclinical Characteristics, Natural History, and Delineation of the Epileptic Syndrome

Radhakrishnan¹,

Louis²,

Johnson³

et al. 2005

Epilepsia

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“…Photosensitive seizures of partial onset have been increasingly reported in recent literature (14)(15)(16). Most of the reported cases had photosensitive partial seizures of occipital origin (17), if not exclusively (1 8). Some investigators suggested that photosensitive partial seizures may have been underestimated and that this type of seizure constitutes around one third of seizures induced by TV or videogames (14,16).…”

Section: Czmentioning

confidence: 99%

Epileptic Seizures Induced by Animated Cartoon, “Pocket Monster”

et al. 1999

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Summary:Purpose: A large number of children had fits while watching the animated cartoon television (TV) program "Pocket Monster." To elucidate the seizures associated with the TV program, we administered a questionnaire survey in Aichi Prefecture, Japan.Methods: The questionnaires were sent to 75 hospitals located in and around Aichi prefecture. The presence of epileptic seizures and the types of seizures were determined by three pediatric neurologists.Results: Sixty-one hospitals responded to the questionnaire survey. Among 95 patients living in Aichi prefecture for whom enough information on seizure manifestations and EEG was available, 5 9 3 patients were considered to have epileptic seizures while watching the TV program. Most seizures occurred at a scene in which red and blue frames alternated at 12 Hz.Sixty-nine (74%) patients had no history of epilepsy. Thirtynine patients had generalized seizures, and 49 patients had partial seizures. Partial seizures occurred more frequently in the younger age group than did generalized seizures. The EEG revealed a photoparoxysmal response (PPR) in 43% of patients. PPR was present not only in patients with a history of epilepsy (54%) but also in those with no history of epilepsy (38%).Conclusions: Almost all seizures induced by the TV program "Pocket Monster" were epileptic, and partial seizures were induced more frequently than generalized seizures. The incidence of this "Pocket Monster"-induced seizures was roughly estimated as 2 1 in 4,923 individuals aged 6-18 years. Key Words: Photosensitive seizure-Partial seizure-Generalized seizure-Photoparoxysmal response-Visual seizure.Almost at the same time in the evening of December 16, 1997, emergency calls for ambulances began to ring in fire stations all over Japan. The phone calls were from families whose children had fits while watching television. It soon appeared that, when seized, these children were watching the same animated cartoon series titled "Pocket Monster," which at the time was very popular among Japanese children as "Pokemon." In Aichi prefecture (population, 6.95 million) alone, ambulances brought 64 patients to the local hospitals. Some other children were reported to visit hospitals for symptoms associated with the TV program at the same night or later. Most of the episodes were considered to be due to visually induced epileptic seizures, but many questions have remained unanswered, including detailed information about the seizures, and the incidence and circumstances when the fits occurred. To elucidate the seizures Accepted December 7, 1998. Address correspondence and reprint requests to Dr. H. Takada at Department of Pediatrics, Nagoya University School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Japan 466-8550. associated with the animated TV program "Pokemon," we performed a questionnaire survey in Aichi Prefecture. METHODSOn December 22, 1997, 6 days after the incident, questionnaires were sent to 75 hospitals located in and around Aichi prefecture with at least one full-time pediatrician. T...

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“…Brinciotti et al39 also reported two families in which five members had pattern-sensitive epilepsy (three in one family and two in the other). In a group of children with visually induced seizures described by Brinciotti et al,40 two girls with both photosensitivity and pattern sensitivity were monozygotic twins.…”

Section: Discussionmentioning

confidence: 98%

“…Seven were female and five were male, with a female-to-male ratio of 1.4:1. Girls are reported to be nearly twice as likely to have pattern sensitivity as boys,9 however, Brinciotti et al10 noted a preponderance of males among patients with pattern sensitivity.…”

Section: Discussionmentioning

confidence: 99%

Pattern sensitivity: a missed part of the diagnosis

Shakankiry¹,

Kader²

2012

NDT

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RationalePattern sensitivity can be diagnosed by presenting a series of visual patterns to the subject in the electroencephalography (EEG) laboratory; however, testing for pattern sensitivity is not routinely done during EEG recording. This work aimed to highlight the incidence of pattern sensitivity among patients referred for routine EEG recording during a 1-year period, identifying the cause of referral, diagnosis, and the characteristics of pattern-sensitive patients.MethodsAll patients aged 4 years and older who were referred for routine EEG during a 12-month period and had no motor or visual impairment were enrolled in the study. Intermittent photic stimulation and pattern sensitivity were tested for each case. Pattern sensitivity was tested by scanning three different rhythmically moving patterns at reading distance with the patient seated in an illuminated room. A pattern evoking a paroxysmal response was reintroduced after exposure to a blank white card to confirm the findings.ResultsTwo hundred twenty-eight patients were studied; twelve patients (5.26%) had pattern sensitivity and their ages ranged from 5 to 12 years. Eight of these patients (66.7%) were referred for seizure disorders, two were referred with the diagnosis of migraine, one with headache and poor scholastic performance and one with recurrent attacks of dizziness for investigation. Seven of the twelve patients (58.3%) had a previous EEG done without testing for pattern sensitivity. Five patients (41.6%) had positive family history for epilepsy, three (25%) for migraine, and two (16.6%) for migraine and epilepsy. Two patients (16.6%) had pattern sensitivity without photosensitivity. Pattern stimulation provoked epileptiform discharges in eight patients (66.6%), focal discharges in one, and unilateral build-up of posterior discharge in three.ConclusionDiagnosis of pattern sensitivity is often missed as it is not routinely tested for during EEG recording. The result of the study challenges the concept of a consistent association between photosensitivity and pattern sensitivity; it also raises questions about the incidence of pattern sensitivity among children who do not suffer from epilepsy and in particular those with migraine, headache and scholastic difficulties. Further studies are therefore needed to clarify the phenotypic spectrum of this EEG trait.

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Pattern Sensitivity and Photosensitivity in Epileptic Children with Visually Induced Seizures

Cited by 36 publications

References 20 publications

Pattern‐sensitive Epilepsy: Electroclinical Characteristics, Natural History, and Delineation of the Epileptic Syndrome

Pattern‐sensitive Epilepsy: Electroclinical Characteristics, Natural History, and Delineation of the Epileptic Syndrome

Epileptic Seizures Induced by Animated Cartoon, “Pocket Monster”

Pattern sensitivity: a missed part of the diagnosis

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