Self‐Induced Pattern‐Sensitive Epilepsy in Childhood

Matricardi, M.; Brinciotti, M.; Trasatti, G.; Porro, Gabriella Salvini

doi:10.1111/j.1651-2227.1990.tb11448.x

Cited by 19 publications

(19 citation statements)

References 7 publications

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“…This behavior is often exceedingly difficult to control. All five children with self‐induced pattern‐sensitive seizures reported by Matricardi et al (15) had multiple seizure types, medical refractoriness, and mental retardation. However, of our five patients who regularly self‐induced their seizures, four were neurologically and mentally normal.…”

Section: Discussionmentioning

confidence: 87%

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: 87%

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

Radhakrishnan¹,

Louis²,

Johnson³

et al. 2005

Epilepsia

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“…The literature results and our own clearly show that our previous recommendation (Jeavons and Harding, 1975) of testing for photosensitivity requires modification. Although pattern sensitivity occurs in 670% of photosensitive patients (Wilkins et al, , 1980, it is rare in isolation (Panayiotopoulos, 1979;Matricardi et al, 1990). Two of our patients (cases 3 and 8) clearly demonstrated laboratory sensitivity to specific patterns, however, and were not sensitive to IPS.…”

Section: Figmentioning

confidence: 53%

Video Material and Epilepsy

1994

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Nine patients who had epileptic attacks while playing computer games were studied in the laboratory. Patients had an EEG recorded as well as their response to intermittent photic stimulation (IPS) at flash rates of 1-60 fps. In addition, pattern sensitivity was assessed in all patients by a gratings pattern. Only 2 patients had no previous history of convulsions, and only 2 had a normal basic EEG. All but 1 were sensitive to IPS, and all but 1 were pattern sensitive. Most patients were male, but although this appears to conflict with previously published literature results regarding the sex ratio in photosensitivity, it was due to the male predominance of video game usage. We compared our results with those reported in the literature. Diagnosing video game epilepsy requires performing an EEG with IPS and pattern stimulation. We propose a standard method of testing.

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“…Self‐induction by heliotropism, defined as a compulsive attraction to the sun or to bright lights, is one of the most common maneuvers reported. Only two reports on self‐induced pattern‐sensitive seizures have been published, including a 13‐year‐old girl (5) and five children aged 3 to 10 years (6). These mentally retarded patients induced seizures by viewing vertical or horizontal striped or checked patterns or fixation on TV (5,6).…”

Section: Discussionmentioning

confidence: 99%

“…Among the epilepsies with reflex seizures due to visual stimuli, pattern‐sensitive seizures form a small subgroup (1,2). Whereas self‐induced seizures (SISs) precipitated by flickering light in photosensitive epilepsy are not uncommon (3,4), only rarely have patients with pattern‐sensitive seizures been reported who tend to induce these seizures themselves (5,6). Here we describe a child with a previously unreported type of pattern‐sensitive SIS.…”

mentioning

confidence: 99%

Visually Self‐induced Seizures Sensitive to Round Objects

Brockmann¹,

Huppke²,

Karenfort³

et al. 2005

Epilepsia

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Summary:Purpose: To describe a previously unreported type of self-induced pattern-sensitive seizures in a child.Methods: Evaluation of clinical and EEG features.Results: An 18-month-old boy was initially seen with series of short focal tonic seizures self-induced by gazing intermittently at round objects. Self-induction of these seizures had an obvious relieving effect on the child. Covering the round object foiled further seizures but resulted in a tantrum. Later in the course, an increasing variety of patterns proved to be capable of inducing seizures, which occurred with increasing frequency and severity, including secondarily generalized tonic-clonic seizures. Interictal EEG revealed multifocal sharp-and-slow-waves. Ictal EEG showed no abnormalities during short focal seizures and rapidly generalizing epileptic discharges during a secondarily generalized seizure. No photosensitivity was noted. Motor and mental development of the boy stagnated over a period of 2 years. Behavioral therapy as well as medical treatment, consisting of various combinations of antiepileptic drugs (AEDs) together with a selective serotonin-reuptake inhibitor, were of merely transient benefit. Only combined pharmacotherapy, including valproate, sulthiame, and clobazam, resulted in seizure control at age 3 years 9 months.Conclusions: Visual capture of geometric patterns other than stripes or gratings may trigger focal seizures with secondary generalization. Synchronization of cortical neurons responsible for pattern recognition may account for epileptogenesis in this child. Key Words: Self-induced seizures-Pattern sensitiveObsessive-compulsive disorder-Selective serotonin-reuptake inhibitor.Among the epilepsies with reflex seizures due to visual stimuli, pattern-sensitive seizures form a small subgroup (1,2). Whereas self-induced seizures (SISs) precipitated by flickering light in photosensitive epilepsy are not uncommon (3,4), only rarely have patients with patternsensitive seizures been reported who tend to induce these seizures themselves (5,6). Here we describe a child with a previously unreported type of pattern-sensitive SIS. CASE REPORTThis boy is the third child of unrelated, healthy parents. After an uneventful pregnancy and birth, initial development was slightly slower than that in his two healthy siblings. At 8 months, the first series of short tonic seizures with spreading and elevation of both arms and nodding of the head were observed. EEG showed hypsarrhythmia. At age 18 months, his parents observed renewed seizures similar to those seen earlier, but now always preceded by a particular behavior. He used to sit down on the kitchen floor and, usually accompanied by stereotypic movements, intermittently stare at the round thermostat of the radiator. After several minutes, a short tonic seizure with spreading of both arms, contraction of right-sided facial muscles, and closure of the right eye occurred. He would then continue to stare intermittently at the thermostat, resulting in further seizures over a period of a few mi...

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Self‐Induced Pattern‐Sensitive Epilepsy in Childhood

Cited by 19 publications

References 7 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

Video Material and Epilepsy

Visually Self‐induced Seizures Sensitive to Round Objects

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