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PubMed1981

Musicogenic epilepsy.

Musicogenic epilepsy is a form of temporal lobe epilepsy, and belongs to the group of reflex epilepsies. Convulsions are generally triggered by a specific passage of music. It is not as rare as is generally assumed, and physicians and neurologists were aware of the condition as early as the latter part of the 19th century. Many of its sufferers have above-average musicality. In some patients autonomic manifestations are conspicuous, but their role as preciptation factors is not clear. Electro-encephalographic studies have shown conclusively that musicogenic epilepsy is not hysterical. Most but not all of its victims respond well to anti-ictal medication. Psychotherapy has a place in the treatment of some patients.

Acoustic Stimulation↗
PubMed1993

Hot water epilepsy with pineal cyst and cavum septi pellucidi.

A case of reflex epilepsy accompanied by pineal cyst and cavum septi pellucidi induced by hot water bathing is presented. The patient is a 25-year-old male who has had six episodes of convulsions during the last three years. The seizures were diagnosed as a complex partial epilepsy followed by generalized tonic seizures. We have succeeded in recording his electroencephalogram (EEG) during convulsions. Moreover, a magnetic resonance imaging (MRI) study revealed a pineal cyst and cavum septi pellucidi. This is quite a rare form of adult hot water epilepsy accompanied by intracranial malformations.

Adult↗
PubMedDate not supplied

[The delta-sleep inducing peptide and its effect on the electroencephalogram and power spectrum density in rats with metaphit-induced epilepsy].

INTRODUCTION: Sleep has many common features with epilepsy (spontaneously, recurring event and EEG hypersynchrony including EEG potentials that look very similar to epileptiform sharp waves) [1]. Monnier et al. [4] reported the presence of a sleep-inducing factor inducing sleep with predominant EEG activity in the 8 band (1-4 Hz), and it was the reason for the term delta sleep-inducing peptide (DSIP). Metaphit was synthesized by Rafferty et al. (1985) [7] and was shown to increase general brain excitability and induce audiogenic seizures in small rodents. The effects of a natural somnogenic nonapeptide DSIP on metaphit-induced audiogenic epilepsy in rats were studied with the aim of shedding more light on answering the question whether DSIP could be included in the list of antiepileptic agents. MATERIALS AND METHODS: Adult, 2-month-old male Wistar rats (170-200 g) were used. None of the animals screened for audiogenic susceptibility showed seizure activity. Audiogenic stimulation was used for 60 s using an electric bell (100 +/- 3 dB 5-8 kHz). Rats were divided into four groups: 1. Control, saline-injected (n = 6); 2. metaphit administered (10 mg/kg; n = 12); 3. metaphit + DSIP (1 mg/kg), (n = 14) group, DSIP administered after 8th to investigate blocking effect on fully developed metaphit seizure. 4.DSIP alone (1 mg/kg, n = 6). RESULTS: In control saline-injected animals AGS provoked no convulsive response. Metaphit injection produced after 30 min initial EEG changes in the form of synchronized spikes and fast high-voltage activity that are typical seizure manifestations, power spectra increased and became more intense in the period of sound onset and seizure events. Our results demonstrate that DSIP acted increasing the EEG output in the 8 range and significantly elevated the mean power spectra in all checked experimental points. Besides, DSIP decreased the incidence and duration of convulsive component, as well as mean seizure grade in metaphit-induced seizures. DISCUSSION: Metaphit induces a generalized, reflex epilepsy thus providing an experimental model of choice for the studies of the mechanism of epilepsy development and blockade of NMDA/PCP receptors. In our previous studies a competitive NMDA antagonist CPP [9] and a noncompetitive antagonist MK-801 [8] were used. Non-competitive, selective NMDA antagonists MK-801, PCP and ketamin expressed a partial agonist motor action (myoclonic jerks, ataxia and tremor of the whole body) in audiogenic epilepsy prone mice. DSIP produced no harmful effects even when overdosed or any effect over "normality" [4, 5]. DSIP has a capacity of suppressing various forms of convulsive activity in different animal species. It was suggested that it exerts an anticonvulsant action by influencing neurotransmitter (dopaminergic, adrenergic, GABA-ergic) and neuromodulator (peptidergic) brain systems [12, 13]. CONCLUSION: Our results, together with the fact that DSIP penetrates through the blood brain barrier after systemic administration and that overdoses of this natural peptide produce no harmful effects, strongly suggest that it could be an important therapeutic agent for the treatment of sleep disturbances. Also, our data demonstrating reduction in incidence, severity and duration of seizure components, suggest that this agent might be a suitable candidate as an antiepileptic drug.

Animals↗
PubMed1982

Epilepsy evoked by eating: the role of peripheral input.

A 13-year-old boy with documented epilepsy evoked by eating, a rare form of reflex epilepsy, experienced only partial control with anticonvulsant medication. Repetitive peripheral sensory input was necessary to evoke seizures in this patient. The seizures remitted completely after he lost several fingers in an accident. Decreased sensory input presumably altered the seizure threshold so that the seizures were eliminated.

Amputation, Traumatic↗
PubMed1975

Neurophysiology of photically induced epilepsy in Papio papio.

This chapter critically reviews arguments supporting the role of the frontal cortex in light-sensitive epilepsy of the baboon Papio papio in the light of the most recent neurophysiological research. In particular, it is known that spontaneous or ILS-induced paroxysmal discharges, as well as generalized seizures, originate in the frontorolandic cortical region. In this region during ILS, neurons behave in the same manner as hyperexcitable neurons in focal epileptogenic lesions of animals and man. Aso, section of the corpus callosum causes deterioration or even destruction of the synchronization that exists naturally between the two frontorolandic areas. Lastly experimental focal irritative lesions enhance light sensitivity if they are located in the frontorolandic region and inhibit it if they are located in the occipital cortex. Opposing these arguments are those that support the important role the occipital cortex plays, since its ablation makes excessive light sensitivity in the baboon disappear. Studies of the primary and nonprimary visual messages and pathways have also contributed evidence. In particular, demonstration of the existence of large numbers of direct occipitofrontal connections may help reconcile the two opposing arguments. Other evidence favoring the role of the frontal cortex is furnished by the still fragmentary studies on activation of the motor pathways and by studies in neuropharmacology. The significance and value of this type of epilepsy as an animal model of the generalized reflex epilepsies of man are discussed.

Aluminum↗
PubMed1997

[Photosensitive epilepsy].

Photosensitive epilepsy (PE) is the most frequent form of reflex epilepsy. Authors picked out two PE forms based on the analysis of the 16 own observations. The first form is PE with environmental factors of the process' provocation, which is characterised by genuine character of disease, pre- and pubertal period of its beginning, considerable prevalence of males among the patients, rare generalized tonic and clonic fits and favorable prognosis. The second form of PE is significantly rarer PE form -with self-induction of the fits. It is characterized by the beginning of the disease in preschool period, even sex distribution, quite frequent evaluated organic damages of brain, nonconvulsive fits, non-efficiency of antiepileptic drugs. The mechanisms of pathogenesis and the ways of fits' prophylaxis were discussed.

Adolescent↗
PubMed2004

Tooth-brushing epilepsy with ictal orgasms.

We report a 41-year-old woman with complex reflex epilepsy in which seizures were induced exclusively by the act of tooth brushing. All the attacks occurred with a specific sensation of sexual arousal and orgasm-like euphoria that were followed by a period of impairment of consciousness. Ictal EEG demonstrated two events of epileptic seizure that were provoked after tooth brushing for 38 and 14 seconds, respectively. The interictal EEG showed epileptiform discharges over the right anterior temporal region and interictal single photon emission computed tomography (SPECT) scan showed relative hypoperfusion in the uncus of right temporal lobe. Brain magnetic resonance imaging (MRI) revealed right hippocampal atrophy. We suggest that tooth-brushing epilepsy, especially with sexual ictal manifestations, may provide insight into the cerebral pathophysiology at the right temporolimbic structure.

Adult↗
PubMed1992

The facilitation and evocation of seizures.

Despite the fact that environmental factors have been demonstrated to be important in the genesis of seizures in people with epilepsy, such factors have received scant attention in the education of clinicians or in the provision of services for managing patients with epilepsy. This paper reviews the history of, and literature about, reflex epilepsy, with particular reference to seizures which occur in response to psychological states or stimuli, and discusses the possible implications for management, and the rationale for the use of psychological interventions which may complement drug treatments in the management of epilepsy.

Adolescent↗
PubMed1997

Musicogenic epilepsy: review of the literature and case report with ictal single photon emission computed tomography.

PURPOSE: We report a case of musicogenic epilepsy with ictal single photon emission computed tomography (SPECT) study and discuss the findings of this patient in the context of 76 cases with musicogenic epilepsy described in the literature and seven other cases followed in Zurich. METHODS: We analyzed the 83 patients according to the precipitating musical factors, type of epilepsy, presumed localization of seizure onset, and demographic data. RESULTS: Fourteen of 83 patients (17%) had seizures triggered exclusively by music. At time of examination, music was the only known precipitating stimulus in 65 of 83 patients (78%). Various characteristics of the musical stimulus were significant, e.g., musical category, familiarity, and instruments. CONCLUSIONS: Musicogenic epilepsy is a particular form of epilepsy with a strong correlation to the temporal lobe and a right-sided preponderance. A high musial standard might predispose for musicogenic epilepsy. Moreover, the majority of cases do not fall into the category of a strictly defined "reflex epilepsy," but appear to depend on the indermediary of a certain emotional reaction mediated through limbic mesial temporal lobe structures.

Acoustic Stimulation↗
PubMed1989

Photosensitivity in epilepsy. Electrophysiological and clinical correlates.

Photosensitivity is a rare phenomenon found, often more or less accidentally, in approximately 5% of epileptic patients. Its pathophysiology still remains largely unsolved and the clinical significance of photosensitivity is controversial. The literature on the subject is impressive, yet predominantly anecdotal. In this thesis we describe the results of an extensive and standardized study of 100 consecutive photosensitive patients with special emphasis on the clinical history, the seizure history and the electrophysiological findings. These are then compared to identical data of an age and sex matched control group, obtained from the same population of epileptic patients, referred to a special (tertiary care) epilepsy clinic. In chapter I, the literature is reviewed and photosensitivity as a special form of "reflex epilepsy" is discussed. A distinction is made between normal and abnormal reactions on intermittent photic stimulation (IPS) during electroencephalographic (EEG) registrations and the criteria of true photosensitivity are formulated. The relation between the presence of photosensitivity during EEG examination and the occurrence of visually-induced epileptic seizures in daily life is discussed. As self-induction of seizures has been associated with photosensitivity, an extensive review, including a special reference list (see appendix A), is given concerning such self-inducing behaviour in photosensitive patients. A review of photosensitivity as a genetic marker and model of epilepsy concludes this chapter. In chapter II the aims of this study are outlined. Some general conceptions about photosensitive epilepsy have become widely accepted in clinical practice without much scientific support, i.e., the idea that the finding of photosensitivity is synonym with the diagnosis of primary generalized epilepsy. Furthermore, photosensitivity is generally believed to be a genetically determined, benign type of epilepsy in childhood and adolescence but when associated with self-inducing behaviour is interpreted as a sign of mental subnormality. Whether or not these conceptions are valid and whether photosensitivity is or is not a special subtype of epilepsy remains unsolved. In this study we thus set out to answer the following questions: A. Are photosensitive epileptic patients different from non-photosensitive patients with epilepsy, with respect to clinical history and, more specifically, to seizure history and family history for seizures? B. Is the degree of photosensitivity, established as photosensitivity range, predictive for the liability to visually-induced seizures in daily life? Are detailed laboratory findings concerning sensitivity to television and black-and-white striped patterns of clinically predictive value, e.g. can patients, liable to TV epilepsy or pattern-induced seizures, be identified by EEG investigations?

Adolescent↗
PubMed2002

The role of nonpharmaceutic conservative interventions in the treatment and secondary prevention of epilepsy.

Nonpharmacologic conservative treatments receive too little attention. Depending on the clinical condition of the patients, they may be used alone or in conjunction with other therapies. Their target is the single seizure rather than the epileptic condition as such. They belong mainly to one of three domains. NONSPECIFIC PREVENTION OF SEIZURES: The first step is the identification of factors facilitating the occurrence of seizures. In the second step, strategies to control these factors are developed. Most common are disturbances of the sleep-wake cycle, especially reduction of sleep. Patients should follow a regular sleep schedule with deviations of not >2 h. Sometimes a sleep calendar is helpful. Night shifts are not compatible with seizure prevention in these cases. Sleep disturbances as a facilitating factor of seizures are particularly common in juvenile idiopathic generalized epilepsies, in which their avoidance is in many cases an indispensable part of the therapeutic regimen, along with appropriate drug treatment. They are the most common precipitating factor in adolescents and adults with a first epileptic [mostly generalized tonic-clonic (GTC)] seizure. In these instances, their avoidance is central to the secondary prevention of epilepsy developing from the single seizure, whereas the prescription of antiepileptic drugs (AEDs) is rarely effective. Other nonspecific facilitators of seizures include uncontrolled use of alcohol and extraordinary stress. Patients must learn how to cope with stressful events. SPECIFIC PREVENTION OF SEIZURES: In reflex epilepsies, specific precipitants of seizures are the targets of interventions. Thus, most patients with primary reading epilepsy begin to have, with prolonged reading, perioral reflex myoclonias, which enable them to stop reading and thus to avoid a GTC seizure. In photosensitive patients, seizures are often precipitated by television. These can be avoided by viewing from a distance and using a remote control, small screens in a well-lit room, and preferably with a 100-Hz line shift. Environmental flicker stimulation often comes unexpectedly, and it is advisable that the patients always wear sunglasses in brightly lighted surroundings. Polarized glasses seem to be more protective than plain sunglasses. If the patient has only photically induced seizures, treatment by specific prevention alone may be sufficient, but if spontaneous seizures also occur, drugs must be given in addition. ARREST OF SEIZURES: Focal seizures that develop sufficiently slowly to leave the patient time to react may be interrupted by "countermeasures." These, again, may be nonspecific (acting by relaxation, concentration, or a combination of both) or specific. The latter are individually tailored, based either on spontaneous experiences of the patient or on the anatomy of ictogenesis. Seizure propagation is blocked when a major part of the neurons involved is activated and not recruitable for spread of the epileptic discharge. Seizure arrest rarely is used alone but usually in combination with partially successful pharmacotherapy.

Adolescent↗
PubMedDate not supplied

Some excitatory and inhibitory factors involved in the epileptic state.

Many factors are involved in the determination of the epileptic threshold and the precipitation of epileptic seizures. The balance between the underlying excitatory and inhibitory mechanisms are often imperfectly understood. However, some of these factors must be fully considered if the management of those with epilepsy is to be effective. This applies especially to children. Certain types of epilepsy are genetically determined, and others are age-related. Development of the brain plays a crucial role in the changing liability to epilepsy. If these processes are disturbed by various lesions and diseases, such as metabolic and toxic disorders, protective mechanisms may suffer. Kindling and mirror foci, the role of the cerebellum, and reflex epilepsy will be discussed. There are some seizure-inducing factors which are susceptible to change, and can be as important as anti-epileptic drugs in controlling seizures. The use and limitations of these measures, and of drugs, will be considered.

Aging↗
PubMed1988

Epilepsy precipitated by bathing.

A case of epilepsy precipitated by bathing is described and previously reported cases are reviewed. The prognosis for this rare form of reflex epilepsy seems to be good, in that the seizures resolve with age and neurodevelopment remains normal.

Baths↗
PubMed1979

Effectiveness of clonazepan in startle-induced seizures.

Five cerebral-palsied children and adolescents with severe startle epilepsy became seizure-free after clonazepan was introduced into their existing anticonvulsant drug regimens. The drug was withdrawn in one case because of side effects. Two hemiparetic patients who had startle epilepsy as the only epileptic manifestation remained permanently controlled after a mean of 34 months of continuous therapy. Reappearance of startle-induced seizures occurred after 1 and 4 years in two other patients with the Lennox-Gastaut syndrome. A possible explanation for the effectiveness of clonazepan in this form of reflex epilepsy may involve inhibition of brainstem mechanisms mediating pathologically enhanced reactions in these patients, thus avoiding secondary activation of a discharging focus in the vicinity of the motor supplementary area.

Adolescent↗
PubMed1989

[A clinical and electroencephalographic study of juvenile myoclonic epilepsy: its pathophysiological considerations based on the findings obtained from neuropsychological EEG activation].

Juvenile myoclonic epilepsy (JME) is one of the idiopathic generalized epilepsies with age-related onset. Myoclonic seizures of JME often occur on awakening. On the other hand, patients with reflex epilepsy, whose seizures are particularly induced by activating higher cognitive functions, are thought to belong to the same category. As to the seizure precipitating factors of these patients with JME, however, few studies have ever been made. In this study, clinical and electroencephalographic findings of 25 patients with JME, on whom "neuropsychological EEG activation" (NPA) was performed, were carefully analyzed. After a routine EEG examination, NPA was carried out; this is a special method for EEG activation that requires the patients to speak, read, write, calculate and perform constructive acts (drawing figures and doing a block design test); in addition to EEG recording, simultaneous video-EEG monitoring was also made during these tasks. In the patients with JME, the sex ratio was about equal (11 males and 14 females). Eight patients (32%) had a family history of epilepsy but none of the patients had a positive past history responsible for epilepsy. The age at the onset of myoclonic seizures ranged between 10 and 20 years (mean: 15.3 years). A total of 18 patients (72%) had another type of seizures; 3 had absence seizures, 9 had generalized tonic-clonic seizures and 6 had both absence and generalized tonic-clonic seizures. Myoclonic seizures often occurred in the morning on awakening in 17 (68%) of 25 patients. As for EEG findings (all but one patient were receiving antiepileptic drugs when EEG was examined), paroxysmal discharges in a resting state were found in 12 patients (48%); most of them were either very brief generalized spike and wave complexes or bursts of generalized 3-5 Hz spike and wave complexes lasting for 1-3 seconds; generalized multiple spikes were observed only in 5 patients. These clinical and EEG findings were in accordance with those reported previously. Careful investigation of the histories obtained from the patients disclosed the following: Myoclonic seizures were induced (1) by mental activity associated with the use of hands in 20 patients (80%), (2) in a situation with psychic tension in 12 (48%), and (3) by decision making in 3 (12%). Interestingly, these findings could be confirmed by NPA with simultaneous video-EEG monitoring.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed1988

Self-induction of seizures: the ultimate non-compliance.

The most extreme form of non-cooperation in the treatment of epilepsy is seen in those patients who deliberately induce their own seizures. The overwhelming majority of these patients are photosensitive and make use of visual stimuli to induce either overt seizures or 'sub-clinical' epileptiform EEG discharges. Best documented is the use of flicker produced by waving one hand in front of the eyes, but much more frequent, if less easily recognised, is the use of a manoeuvre involving slow closure and forced upward deviation of the eyes. This is exhibited by a quarter of patients with photosensitive epilepsy, many of whom report that the manoeuvre gives a pleasant sensation or relieves feelings of stress. Other forms of reflex epilepsy are used less often for self-induction and for a variety of motives. Often there is clear social advantage such as avoidance of school or gaining attention. Some patients find that the risk of a spontaneous attack is lessened following a self-induced seizure and can therefore contrive their fits to occur only in situations which are safe and convenient. Self-induced seizures are notoriously resistant to antiepileptic therapy even if the patient is compliant. Preliminary trials suggest, however, that in some patients dopamine antagonists may reduce this behaviour, apparently by making self-induced discharges or seizures non-rewarding.

Adolescent↗
PubMed2000

Reflex occipital lobe epilepsy.

Photosensitivity is a typical feature of photosensitive epilepsy which is usually considered a form of idiopathic generalized epilepsy. Partial seizures featuring visual symptoms are rarely reported in photosensitive epilepsy. In this study, we describe 13 neurologically normal patients in whom daytime seizures were always induced by television and began with elementary visual hallucinations, followed frequently by vomiting, headache and then secondary generalization. Three patients additionally reported nocturnal seizures, which have not been described in previous studies. Two of these latter patients had generalized tonic-clonic seizures, the other always awoke from sleep and could describe typical visual hallucinations at the beginning of the seizure. EEG features included normal background activity and occipital spikes or spike-waves in all but two patients. Eight patients also showed generalized epileptiform activity during intermittent photic stimulation. Seizure frequency was low in all. Apart from two patients, who refused treatment, all patients received antiepileptic drugs. Only one patient continued to have rare seizures after treatment; in the others seizure control was achieved with monotherapy. We conclude that reflex occipital lobe epilepsy is an idiopathic form of the benign partial epilepsies, which may overlap with one another.

Adolescent↗