1
|
Fisher RS, Acharya JN, Baumer FM, French JA, Parisi P, Solodar JH, Szaflarski JP, Thio LL, Tolchin B, Wilkins AJ, Kasteleijn-Nolst Trenité D. Visually sensitive seizures: An updated review by the Epilepsy Foundation. Epilepsia 2022; 63:739-768. [PMID: 35132632 DOI: 10.1111/epi.17175] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 01/10/2022] [Accepted: 01/12/2022] [Indexed: 12/19/2022]
Abstract
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. Virtual reality and 3D images so far appear benign unless they contain specific provocative content, for example, flashes. Images with flashes brighter than 20 candelas/m2 at 3-60 (particularly 15-20) Hz occupying at least 10 to 25% of the visual field are a risk, as are red color flashes or oscillating stripes. Equipment to assay for these characteristics is probably underutilized. Prevention of seizures includes avoiding provocative stimuli, covering one eye, wearing dark glasses, sitting at least two meters from screens, reducing contrast, and taking certain antiseizure drugs. Measurement of PPR suppression in a photosensitivity model can screen putative antiseizure drugs. Some countries regulate media to reduce risk. Visually-induced seizures remain significant public health hazards so they warrant ongoing scientific and regulatory efforts and public education.
Collapse
Affiliation(s)
- Robert S Fisher
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California, USA
| | - Jayant N Acharya
- Department of Neurology, Penn State Health, Hershey, Pennsylvania, USA
| | - Fiona Mitchell Baumer
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California, USA
| | - Jacqueline A French
- NYU Comprehensive Epilepsy Center, Epilepsy Foundation, New York, New York, USA
| | - Pasquale Parisi
- Department of Neuroscience, Mental Health, and Sensory Organs, Sapienza University, Rome, Italy
| | - Jessica H Solodar
- American Medical Writers Association-New England Chapter, Boston, Massachusetts, USA
| | - Jerzy P Szaflarski
- Department of Neurology, Neurobiology and Neurosurgery, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, USA
| | - Liu Lin Thio
- Department of Neurology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Benjamin Tolchin
- Department of Neurology, Yale School of Medicine, New Haven, Connecticut, USA
| | | | | |
Collapse
|
2
|
Määttä S. Giant VEPs in children at increased risk of raised intracranial pressure. Eur J Paediatr Neurol 2021; 34:A2. [PMID: 34538734 DOI: 10.1016/j.ejpn.2021.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Sara Määttä
- Department of Clinical Neurophysiology, Diagnostic Imaging Center, Kuopio University Hospital, Finland
| |
Collapse
|
3
|
Brinciotti M, Mittica A, Matricardi M. Characteristics of visual evoked potentials related to the electro-clinical expression of reflex seizures in photosensitive patients with idiopathic occipital lobe epilepsy. Epilepsy Res 2020; 164:106345. [DOI: 10.1016/j.eplepsyres.2020.106345] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 03/30/2020] [Accepted: 04/22/2020] [Indexed: 11/24/2022]
|
4
|
Sharawat I, Panda P. Auditory- and visual-evoked responses in children and adolescents with epilepsy. J Pediatr Neurosci 2020; 15:347-348. [PMID: 33531970 PMCID: PMC7847118 DOI: 10.4103/jpn.jpn_118_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 05/18/2020] [Accepted: 05/18/2020] [Indexed: 11/04/2022] Open
|
5
|
Algin Dİ, Erdinç OO. Impaired Visual Habituation in Idiopathic Generalized Epilepsy with Photosensitivity Patients. ACTA ACUST UNITED AC 2018; 57:108-112. [PMID: 32550775 DOI: 10.29399/npa.23047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 03/16/2018] [Indexed: 11/07/2022]
Abstract
Introduction In this study, our goal was to analyze further the cortical excitability levels in idiopathic generalized epilepsy (IGE) patients with and without photosensitivity. Methods Forty-two patients (16 men and 26 women; mean age 30±8 years; range: 18-43 years) with IGE and thirty healthy age-matched control subjects (15 men and 15 women; mean age 35±3 years; range: 20-45 years) were enrolled for the investigation. We investigated the following two groups: 18 subjects with IGE with photosensitivity (IGE+PS), and 24 patients with IGE without photosensitivity (IGE-PS). Pattern reversal and potential inter-peak amplitudes, N75-P100 and P100-N145, as well as the corresponding latencies (N75, P100, and N145) for one hundred responses were measured 6 times. A linear regression slope was used for N75-P100 and P100-N145. Results Statistical analysis showed difference between groups where the IGE+PS had reduced N75-P100 compared to IGE-PS and controls. In IGE+PS group, the amplitude of N75-P100 was drastically reduced receiving antiepileptic therapy compared to those not receiving any anti-epileptic treatment (p=0.035). Conclusion These results show that the IGE+PS group has a different photoparoxysmal response phenotype driven by an unknown and distinct molecular mechanism. Pre-activation cortical excitability may be increased in IGE+PS patients compared to the IGE-PS or in healthy group. PR-VEP habituation may project the pathophysiological mechanisms underlying photosensitivity and it may be potential biomarker in patients with IGE+PS.
Collapse
Affiliation(s)
- Demet İlhan Algin
- Department of Neurology, Eskişehir Osmangazi University Faculty of Medicine, Eskişehir, Turkey
| | - Oğuz Osman Erdinç
- Department of Neurology, Eskişehir Osmangazi University Faculty of Medicine, Eskişehir, Turkey
| |
Collapse
|
6
|
Altered recovery from inhibitory repetitive transcranial magnetic stimulation (rTMS) in subjects with photosensitive epilepsy. Clin Neurophysiol 2016; 127:3353-61. [PMID: 27407061 DOI: 10.1016/j.clinph.2016.06.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Revised: 06/08/2016] [Accepted: 06/18/2016] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To investigate functional changes underlying photosensitivity, we studied the response of the visual cortex to low-frequency, inhibitory repetitive transcranial magnetic stimulation (rTMS) in drug-free patients with photosensitive seizures and healthy volunteers. METHODS Visual evoked potentials (VEPs) triggered by grating stimuli of different contrasts were recorded in both hemispheres before and after transient functional inactivation of the occipital cortex of one side via low-frequency rTMS (0.5Hz for 20'). VEPs were recorded before (T0), immediately after (T1) and 45' following the completion of rTMS (T2). RESULTS Baseline amplitudes of the early VEP components (N1 and P1) were enhanced in photosensitive patients. At T1, rTMS produced an inhibitory effect on VEPs amplitudes at all contrasts in the targeted side and a concurrent facilitation of responses in the contralateral hemisphere. Compared with PSE subjects, VEP amplitudes remained persistently dampened in the stimulated hemisphere of controls (Holm-Sidak post-hoc method, p<0.05). In the contralateral hemisphere, we found a clear enhancement of VEP amplitude in photosensitive subjects but not controls at T2 (Holm-Sidak test, p<0.001). CONCLUSIONS Visual responses recovered more quickly in the stimulated hemisphere, and disinhibition persisted in the contralateral side of photosensitive subjects. SIGNIFICANCE The rapid recovery of excitability and the persistent transcallosal disinhibition following perturbation of cortical activity may play a role in the pathophysiology of photosensitive epilepsy.
Collapse
|
7
|
Sayeur MS, Vannasing P, Tremblay E, Lepore F, McKerral M, Lassonde M, Gallagher A. Visual Development and Neuropsychological Profile in Preterm Children from 6 Months to School Age. J Child Neurol 2015; 30:1159-73. [PMID: 25414236 DOI: 10.1177/0883073814555188] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Accepted: 09/19/2014] [Indexed: 11/15/2022]
Abstract
The aim of this semilongitudinal study was to investigate the development of central visual pathways in children born preterm but without major neurologic impairments and to establish their cognitive and behavioral profile at school age. Ten children born preterm were assessed at 6 months and at school age, using visual evoked potentials at both time points and cognitive and behavioral tests at school age. We also tested 10 age-matched children born full-term. At 6 months' corrected age, we found no significant differences between preterm and full-term groups for either amplitude or latency of N1 and P1 components. At school age, the preterm group manifested significantly higher N1 amplitudes and tended to show higher P1 amplitudes than the full-term group. We found no significant differences in cognitive and behavioral measures at school age. These results suggest that preterm birth affects visual pathways development, yet the children born preterm did not manifest cognitive problems.
Collapse
Affiliation(s)
- Mélissa Sue Sayeur
- Research Centre in Neuropsychology and Cognition, University of Montreal, Quebec, Canada Department of Psychology, University of Montreal, Quebec, Canada Research Centre, Sainte-Justine Hospital, Montreal, Quebec, Canada
| | | | - Emmanuel Tremblay
- Research Centre in Neuropsychology and Cognition, University of Montreal, Quebec, Canada Department of Psychology, University of Montreal, Quebec, Canada Research Centre, Sainte-Justine Hospital, Montreal, Quebec, Canada
| | - Franco Lepore
- Research Centre in Neuropsychology and Cognition, University of Montreal, Quebec, Canada Department of Psychology, University of Montreal, Quebec, Canada Research Centre, Sainte-Justine Hospital, Montreal, Quebec, Canada
| | - Michelle McKerral
- Research Centre in Neuropsychology and Cognition, University of Montreal, Quebec, Canada Department of Psychology, University of Montreal, Quebec, Canada
| | - Maryse Lassonde
- Research Centre in Neuropsychology and Cognition, University of Montreal, Quebec, Canada Department of Psychology, University of Montreal, Quebec, Canada Research Centre, Sainte-Justine Hospital, Montreal, Quebec, Canada
| | - Anne Gallagher
- Research Centre in Neuropsychology and Cognition, University of Montreal, Quebec, Canada Department of Psychology, University of Montreal, Quebec, Canada Research Centre, Sainte-Justine Hospital, Montreal, Quebec, Canada
| |
Collapse
|
8
|
Visual cortex hyperexcitability in idiopathic generalized epilepsies with photosensitivity: a TMS pilot study. Epilepsy Behav 2013; 27:301-6. [PMID: 23518608 DOI: 10.1016/j.yebeh.2013.02.010] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2012] [Revised: 02/11/2013] [Accepted: 02/13/2013] [Indexed: 11/22/2022]
Abstract
BACKGROUND The current understanding of the mechanisms underlying photosensitivity is still limited, although most studies point to a hyperexcitability of the visual cortex. METHODS Using transcranial magnetic stimulation, we determined the resting motor threshold (rMT) and the phosphene threshold (PT) in 33 patients with IGEs (8 with photosensitivity) compared with 12 healthy controls. RESULTS Eleven controls (92%) reported phosphenes compared with fifteen (46%) patients with idiopathic generalized epilepsy (p=0.015). Phosphenes were reported more frequently among patients with epilepsy with photosensitivity (87.5%) than in patients with active epilepsy without photosensitivity (30.8%) (p=0.038) and patients with epilepsy in remission without photosensitivity (33.3%) (p=0.054); no differences were found between patients with epilepsy with photosensitivity and controls (p=0.648). Resting motor threshold and phosphene threshold were significantly higher among patients with epilepsy (active epilepsy or epilepsy in remission without photosensitivity) compared to healthy controls (p<0.01). Conversely, patients with active epilepsy and photosensitivity had significantly lower values than controls (p=0.03). CONCLUSIONS The marked decrease in PT and the high phosphene prevalence in patients with IGE with photosensitivity indicate a regional hyperexcitability of the primary visual cortex. Results of this study also suggest that the PT may serve as a biomarker for excitability in patients with IGE and photosensitivity.
Collapse
|
9
|
Brazzo D, Di Lorenzo G, Bill P, Fasce M, Papalia G, Veggiotti P, Seri S. Abnormal visual habituation in pediatric photosensitive epilepsy. Clin Neurophysiol 2011; 122:16-20. [PMID: 20591728 DOI: 10.1016/j.clinph.2010.06.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2010] [Revised: 05/27/2010] [Accepted: 06/04/2010] [Indexed: 01/19/2023]
Affiliation(s)
- D Brazzo
- School of Life and Health Sciences, Wellcome Laboratory for MEG Studies, Aston University, Birmingham, UK
| | | | | | | | | | | | | |
Collapse
|
10
|
Báez Martín MM, del Carmen Pérez Téllez Y, Chacón LMM, Díaz BE, Trápaga-Quincoses O, Maeso IG, Bender JE, Galvizu R, García ME, Abreu IC, Rodríguez GS. Innovative evaluation of visual field defects in epileptic patients after standard anterior temporal lobectomy, using partial field visual evoked potentials. Epilepsy Res 2010; 90:68-74. [PMID: 20427151 DOI: 10.1016/j.eplepsyres.2010.03.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2009] [Revised: 03/10/2010] [Accepted: 03/12/2010] [Indexed: 01/16/2023]
Abstract
The purpose of this paper is to obtain an electrophysiological evaluation of visual field defects consecutive to the direct lesion of optic radiations in drug-resistant epileptic patients after a standard electrocorticographically adjusted lobectomy, and to correlate it with conventional perimetric results, and with the volume of resected tissue during surgical treatment. Twenty-four patients with temporal lobe epilepsy defined through long term EEG-video, ictal and interictal SPECT, as well as Magnetic Resonance Imaging were studied. Visual evoked potentials (VEPs) with partial and total visual field stimulation were carried out before and after 6, 12 and 24 months surgical treatment. A control group was also studied. No differences between patients and control subjects were observed during the evaluation of the full-field VEPs. However, there were statistical differences between groups in the half-field VEP recordings and in the VEP recordings of contralateral to resected side superior quadrant (CSQ) before lobectomy and 6 months later (Mann-Whitney's U-test, p<0.05). Significant associations were found between VEP abnormalities and perimetric results in CSQ. A close relationship between perimetry, VEPs and volume of the resected tissue in hippocampus, parahippocampus, medial and lower temporal giri was also found. Visual field defects consecutive to standard temporal lobe resection in epileptic patients could be objectively evaluated by partial stimulation VEPs corresponding to the size of resected tissue.
Collapse
|
11
|
Ishikawa T, Fujiwara A, Takechi K, Ago J, Matsumoto N, Rahman MA, Kamei C. Changes of visual evoked potential induced by lateral geniculate nucleus kindling in rats. Epilepsy Res 2008; 79:146-50. [DOI: 10.1016/j.eplepsyres.2008.01.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2007] [Revised: 01/25/2008] [Accepted: 01/28/2008] [Indexed: 01/16/2023]
|
12
|
Abstract
Photic stimulation is part of a typical EEG in most countries, especially to check on the photoparoxysmal response (PPR). Interest in this response was enhanced in 1997 when hundreds of Japanese children had attacks while viewing a TV cartoon called "Pokemon." The overall prevalence of the PPR among patients requiring an EEG is approximately 0.8%, but 1.7% in children and 8.87% in patients with epilepsy, more often in Caucasians and females. Autosomal dominant inheritance is indicated, and this response is seen especially at the wavelength of 700 nm or at the flicker frequency of 15-18 Hz. The PPR extending beyond the stimulus carries no increased risk of seizures. Prognosis is generally good, especially after 20 years of age. Attention to PPR has been increased with the advent of video games, and the evoked seizures from these games are likely a manifestation of photosensitive epilepsy. Drug therapy has emphasized valproic acid, but Levetiracetam has also been successful in eliminating the PPR.
Collapse
Affiliation(s)
- John R Hughes
- Department of Neurology, University of Illinois, Medical Center at Chicago, Illinois 60612, USA.
| |
Collapse
|
13
|
Fife TD, Blum D, Fisher RS. Measuring the effects of antiepileptic medications on balance in older people. Epilepsy Res 2006; 70:103-9. [PMID: 16675199 DOI: 10.1016/j.eplepsyres.2006.03.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2005] [Revised: 02/20/2006] [Accepted: 03/03/2006] [Indexed: 01/10/2023]
Abstract
BACKGROUND Dizziness and ataxia are among the most common adverse events associated with antiepileptic medications. Despite this, few studies have attempted to quantitatively assess the effects of antiepileptic therapies on equilibrium. This study was undertaken to prospectively compare quantitative measures of balance in older people taking carbamazepine, gabapentin and lamotrigine. METHODS Thirty patients on monotherapy for idiopathic partial or generalized epilepsy were enrolled after giving informed consent. Patients had to be at least 50 years old, able to give consent, and on a stable dose of carbamazepine, gabapentin or lamotrigine for at least 30 days. Since this was a study of asymptomatic patients, all patients had to be without complaint of dizziness or imbalance. Patients with a history of alcohol or drug abuse or any medical or neurological condition expected to adversely affect equilibrium were excluded. Each patient underwent a history and examination, computerized dynamic posturography, the activities-specific balance confidence (ABC) scale, Fregly ataxia battery, and the Berg balance scale. Serum drug levels of carbamazepine were obtained to eliminate patients with toxic levels upon enrollment. Two-tailed paired t-tests were used to determined statistical significance among those on each antiepileptic medication. RESULTS Thirty patients were enrolled: 10 on gabapentin, 10 on lamotrigine and 10 on carbamazepine monotherapy for epilepsy. There were no differences in age or sex among those in each treatment group. The average dosages were 1,120 mg/day for those on gabapentin, 335 mg for lamotrigine, and 640 mg for carbamazepine. There were no differences in the activities-specific balance confidence (ABC) or the Berg balance scale scores. All patients had normal vestibular function by quantitative testing. Posturography showed no statistically significant differences. The Fregly ataxia battery includes the sum of timed trials in the sharpened Romberg (SR) position, standing on one leg with eyes closed (SOLEC), and when walking in tandem with eyes closed (WITEC). The patients on lamotrigine exhibited ability to maintain balance in these positions significantly longer than did those on carbamazepine: SR (P<0.05), SOLEC (P<0.05) and WITEC (P<0.05). CONCLUSIONS The effects of antiepileptic medications on equilibrium in asymptomatic older people may require more dynamic and challenging measures of equilibrium than are commonly employed in physical therapy to monitor risk of falls. Although the sample size is small, this study suggests that lamotrigine may induce less disequilibrium than does carbamazepine in older people on monotherapy for epilepsy. Further study in this area is needed, particularly given the risks of falling from imbalance in the elderly.
Collapse
Affiliation(s)
- Terry D Fife
- Department of Neurology, Barrow Neurological Institute, Phoenix, AZ 85013, USA.
| | | | | |
Collapse
|