Visually sensitive seizures: An updated review by the Epilepsy Foundation

Fisher, Robert S.; Acharya, Jayant N.; Bäumer, F; French, Jacqueline A.; Parisi, Pasquale; Solodar, Jessica; Szaflarski, Jerzy P.; Thio, Liu Lin; Tolchin, Benjamin; Wilkins, Arnold J.; Trenité, Dorothee Kasteleijn‐Nolst

doi:10.1111/epi.17175

Cited by 52 publications

(57 citation statements)

References 277 publications

(568 reference statements)

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“…Thus, there is some concern about eliciting visually sensitive seizures when using VR setups for rehabilitation. However, the literature so far does not support this concern as long as extensive visual provocations such as bright or flashing lights are avoided [53]. Our developed system consisted of commercially available, off-the-shelf hardware with minimal modifications (3D printed camera mount, cut infrared absorbent cloth) and this type of low-cost setup was shown to be feasible in a clinical setting.…”

Section: Generalisabilitymentioning

confidence: 99%

Feasibility and psychophysical effects of immersive virtual reality-based mirror therapy

Heinrich

Morkisch²,

Langlotz³

et al. 2022

J NeuroEngineering Rehabil

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Background Virtual reality (VR) has been used as a technological medium to deliver mirror therapy interventions with people after stroke in numerous applications with promising results. The recent emergence of affordable, off-the-shelf head-mounted displays (like the Oculus Rift or HTC Vive) has opened the possibility for novel and cost-effective approaches for immersive mirror therapy interventions. We have developed one such system, ART-VR, which allows people after stroke to carry out a clinically-validated mirror therapy protocol in an immersive virtual environment and within a clinical setting. Methods A case cohort of 11 people with upper limb paresis following first time stroke at an in-patient rehabilitation facility received three interventions over a one week period. Participants carried out the BeST mirror therapy protocol using our immersive VR system as an adjunct therapy to their standard rehabilitation program. Our clinical feasibility study investigated intervention outcomes, virtual reality acceptance and user experience. Results The results show that the combination of an immersive VR system and mirror therapy protocol is feasible for clinical use. 9 out of 11 participants showed some improvement of their affected hand after the intervention. The vast majority of the participants (9/11) reported experiencing some psycho-physical effects, such as tingling or paraesthesia, in the affected limb during the intervention. Conclusions Our findings show that immersive VR-based mirror therapy is feasible and shows effects comparable to those of conventional mirror therapy. Trial Registration Trial was registered with the ISRCTN Registry (ISRCTN34011164) on December 3, 2021, retrospectively

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Section: Generalisabilitymentioning

confidence: 99%

Feasibility and psychophysical effects of immersive virtual reality-based mirror therapy

Heinrich

Morkisch²,

Langlotz³

et al. 2022

J NeuroEngineering Rehabil

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“… 60 Intriguingly, elegant studies on Fayoumi chimeras highlighted the importance of interactions between cortical and subcortical structures in nonmammalian species without a neocortex, 60 , 66 similar to previous studies in zebrafish. 15 , 25 Photic reflex seizures were shown to be initiated most typically in cortical areas in primates; in temporo‐occipital regions in humans, 20 , 51 , 52 whereas in the baboon a frontal origin was suggested. 53 , 54 The seizure semiology in the Papio papio baboon, Fayoumi chicken, and our zebrafish models is considered to be generalized.…”

Section: Discussionmentioning

confidence: 99%

“…Inspired by video‐electroencephalography (video‐EEG) and photic stimulation protocols that are commonly used in human patients, we performed complementary recordings of animal behavior and whole‐brain activity 16 . We delivered photic stimulation to trigger neural responses, because photosensitivity is an important physiological trait in epilepsy 16–20 . Spontaneous locomotor and neural activity displayed a hypoactive or hyperactive phenotype depending on the seizure or epilepsy model 15,21–26 .…”

Section: Introductionmentioning

confidence: 99%

“… 16 We delivered photic stimulation to trigger neural responses, because photosensitivity is an important physiological trait in epilepsy. 16 , 17 , 18 , 19 , 20 Spontaneous locomotor and neural activity displayed a hypoactive or hyperactive phenotype depending on the seizure or epilepsy model. 15 , 21 , 22 , 23 , 24 , 25 , 26 Photic stimulation evoked increased swim velocities and change in swim angle, in line with tonic–clonic seizure‐like behavior observed in zebrafish larvae.…”

Section: Introductionmentioning

confidence: 99%

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Elevated photic response is followed by a rapid decay and depressed state in ictogenic networks

et al. 2022

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Objective:The switch between nonseizure and seizure states involves profound alterations in network excitability and synchrony. In this study, we aimed to identify and compare features of neural excitability and dynamics across multiple zebrafish seizure and epilepsy models.Methods: Inspired by video-electroencephalographic recordings in patients, we developed a framework to study spontaneous and photically evoked neural and locomotor activity in zebrafish larvae, by combining high-throughput behavioral tracking and whole-brain in vivo two-photon calcium imaging.Results: Our setup allowed us to dissect behavioral and physiological features that are divergent or convergent across multiple models. We observed that spontaneous locomotor and neural activity exhibit great diversity across models.Nonetheless, during photic stimulation, hyperexcitability and rapid response dynamics were well conserved across multiple models, highlighting the reliability of photically evoked activity for high-throughput assays. Intriguingly, in several models, we observed that the initial elevated photic response is often followed by rapid decay of neural activity and a prominent depressed state. Elevated photic response and following depressed state in seizure-prone networks are significantly

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“…Those who have been told by a neurologist that they have photosensitivity or that they have had photoparoxysmal responses during an electroencephalogram will also be excluded from phase 3 [ 15 ]. Excluding people with photosensitivity from the study is not expected to significantly impact the sample size because only approximately 3% to 5% of people with epilepsy have photosensitive seizures [ 32 ].…”

Section: Methodsmentioning

confidence: 99%

Virtual Reality Therapy for People With Epilepsy and Related Anxiety: Protocol for a 3-Phase Pilot Clinical Trial

Gray¹,

Tchao²,

Lewis³

et al. 2023

JMIR Res Protoc

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Background Anxiety is one of the most common psychiatric comorbidities in people with epilepsy and often involves fears specifically related to the condition, such as anxiety related to the fear of having another seizure. These epilepsy- or seizure-related fears have been reported as being more disabling than the seizures themselves and significantly impact quality of life. Although research has suggested that exposure therapy (ET) is helpful in decreasing anxiety in people with epilepsy, no research to our knowledge has been conducted on ET in people with epilepsy using virtual reality (VR). The use of novel technologies such as an immersive VR head-mounted display for ET in this population offers several benefits. Indeed, using VR can increase accessibility for people with epilepsy with transportation barriers (eg, those who live outside urban centers or who have a suspended driver’s license owing to their condition), among other advantages. In the present research protocol, we describe the design of an innovative VR-ET program administered in the home that focuses on decreasing anxiety in people with epilepsy, specifically anxiety related to their epilepsy or seizures. Objective Our primary objective is to examine the feasibility of the study protocol and proposed treatment as well as identify suggestions for improvement when designing subsequent larger clinical trials. Our secondary objective is to evaluate whether VR-ET is effective in decreasing anxiety in a pilot study. We hypothesize that levels of anxiety in people with epilepsy will decrease from using VR-ET. Methods This mixed methods study comprises 3 phases. Phase 1 involves engaging with those with lived experience through a web-based questionnaire to validate assumptions about anxiety in people with epilepsy. Phase 2 involves filming videos using a 360° camera for the VR-ET intervention (likely consisting of 3 sets of scenes, each with 3 intensity levels) based on the epilepsy- and seizure-related fears most commonly reported in the phase 1 questionnaire. Finally, phase 3 involves evaluating the at-home VR-ET intervention and study methods using a series of validated scales, as well as semistructured interviews. Results This pilot study was funded in November 2021. Data collection for phase 1 was completed as of August 7, 2022, and had a final sample of 18 participants. Conclusions Our findings will add to the limited body of knowledge on anxiety in people with epilepsy and the use of VR in this population. We anticipate that the insights gained from this study will lay the foundation for a novel and accessible VR intervention for this underrecognized and undertreated comorbidity in people with epilepsy. Trial Registration ClinicalTrials.gov NCT05296057; https://clinicaltrials.gov/ct2/show/NCT05296057 International Registered Report Identifier (IRRID) DERR1-10.2196/41523

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Visually sensitive seizures: An updated review by the Epilepsy Foundation

Cited by 52 publications

References 277 publications

Feasibility and psychophysical effects of immersive virtual reality-based mirror therapy

Feasibility and psychophysical effects of immersive virtual reality-based mirror therapy

Elevated photic response is followed by a rapid decay and depressed state in ictogenic networks

Virtual Reality Therapy for People With Epilepsy and Related Anxiety: Protocol for a 3-Phase Pilot Clinical Trial

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