بسم الله الرحمن الرحيم. Reflex epilepsies Presented by Prof. Abdulrahman Sallam Professor of Neurology Sana’a university

الله بسمالرحيم الرحمن

Reflex epilepsies

Presented by

Prof. Abdulrahman SallamProfessor of Neurology

Sana’a university

Introduction

Introduction

Epileptic seizures can arise in a ‘spontaneous’

fashion with no detectable precipitating factors, or

they can be provoked by certain recognizable

stimuli.

Stimuli that contribute towards the initiation of a

seizure are provided by the individual’s internal and

external environment.

Introduction

Internal factors as hormones, electrolytes, state of

consciousness and body temperature.

External factors may be sensory, electrical or

biochemical.

Introduction

Reflex seizures have a 4–7% prevalence

among patients with epilepsies.

Their aetiology may be idiopathic or

symptomatic.

Classification of reflex epilepsies


With reference to the classifications of the

epileptic syndromes of the International League

Against Epilepsy (ILAE) (1989), reflex

epilepsies can be recognized with among

generalized and focal epileptic syndromes, and

with among idiopathic and symptomatic.


Reflex seizures can be either generalized or

focal, with or without impairment of

consciousness.

It may be genetically inherited or acquired

supported by a brain lesion.


List of reflex epileptic seizures

.11 -Induced by simple stimuli

Visual induced epilepsy

- Photosensitive epilepsy

- Television-induced epilepsy

- Pattern-induced epilepsy

-Video-games induced epilepsy

- On closing the eyes epilepsy

- Visual exploratory epilepsy



1 -Induced by simple stimuli

Somatosensory-evoked epilepsy

-Movement-induced epilepsy

- Startle-induced epilepsy

-Tooth-brushing epilepsy

- Amputees’ epilepsy

- Auricular epilepsy

- Rubbing epilepsy



2 .Induced by complex stimuli

-Eating epilepsy

-Hot-water epilepsy

-Water-immersion epilepsy

Classification of reflex epilepsiesList of reflex epileptic seizures

3 .Induced by higher cerebral

functions -Language induced epilepsy

- Reading epilepsy - Writing (graphogenic)

epilepsy - Speaking-induced epilepsy

- Musicogenic epilepsy - Voice-induced epilepsy - Playing-music epilepsy

Telephone-induced epilepsy-- Epilepsia Arithmetices

- Games-induced epilepsy- Decision-making epilepsy

- Thinking epilepsy - Praxis-induced epilepsy

Classification of reflex epilepsiesList of reflex epileptic seizures

4 .With self-induced seizures

- Photosensitive epilepsy with self-induced seizures.

- Sunflower epilepsy.

Reflex epilepsy related to visual stimuli


Photosensitivity is the susceptibility to

produce epileptic seizures in response to light

stimuli.

It has higher prevalence in females and in

the adolescence.


Photosensitivity can be found in a wide range

of epilepsies.

It is very frequent in idiopathic generalized

epilepsies, in particular in juvenile myoclonic

epilepsy.


Photosensitivity is also found in some

idiopathic focal epileptic syndromes, in

particular, (idiopathic photosensitive occipital

lobe epilepsy).

In some symptomatic generalized epilepsies, in

particular, (progressive myoclonic epilepsies).


The most frequently found EEG pattern is

the photoparoxysmal response, usually

easily provoked in laboratory with

intermittent light stimulation .


Seizures can be triggered by natural

flickering light such as rays of sunlight

filtering through the trees, or reflected by

the waves of the sea or snow.


The development of artificial light stimulation

(television, video-games, and so on) has much

increased the occurrence of seizures.

These seizures are usually clinically and EEG

generalized in type (absence, myoclonus, tonic—

clonic seizures).


Reflex epilepsy by calculation or other higher-level cortical

processes

Reflex epilepsy by calculation or other higher-level cortical processes

Epilepsia Arithmetices is idiopathic in nature

and generalized in type.

Triggered by mental calculation or by other

complex mental processes (thinking epilepsy),

with the pressure to decide (decision-making

epilepsy).

Primary reading epilepsy


Reading epilepsy is a rare form of reflex epilepsy in

which almost all seizures are precipitated by reading.

Generalized seizures were always preceded by a

clicking sensation or actual jerks in the jaws (i.e., jaw

or tongue clicking) with generalized or focal

(temporo-parieto-occipital areas) paroxysmal activity.




Startle epilepsy

Startle epilepsy

Startle epilepsy is seizures triggered by a

sudden and unexpected auditory stimulus.

Patients have usually large brain lesions, mostly

perinatal hypoxic injury (Little syndrome,

congenital hemiparesis), and frequently they

show also enhanced startle reaction.

Startle epilepsy

Startle seizures have been reported also in

large or focal dysplasias, in Lennox Gastaut

syndrome and in Down syndrome.

Eating epilepsy

Eating epilepsy

Eating-induced seizures are rare seizures,

exclusively triggered by eating (eating

epilepsy).

Seizures are generally partial, more often

complex partial, generalized seizures may

coexist, in particular atypical absences.

Eating epilepsy

Amygdala play an important role as an

integrative centre, particularly in temporo-

mesial focal seizures.

Bulky meals rich in carbohydrates have been

postulated as possible triggering factors.

Eating epilepsy

Musicogenic epilepsy


Musicogenic epilepsy is a form of temporal

lobe epiIepsy and belongs to the group of

reflex epilepsies.

Musicogenic epilepsy is a seizure induction

by listening to the music.


The musicogenic epilepsy has a strong

correlation to the temporal lobe mainly mesial

side.

The majority of cases appear to depend on a

certain emotional reaction mediated through

limbic mesial temporal lobe structures.


Seizures are typically complex partial, with

possible secondary generalization, and

more rarely simple partial.

Autonomic symptoms and signs may occur

before onset of the ictal behavior.

Hot-water epilepsy

Hot-water epilepsy

Hot-water epilepsy is triggered by contact or

immersion in hot water.

This type of epilepsy is frequent in southern of India.

This form of geographically specific reflex epilepsy is

age related, more frequent in males, usually self-

limited and frequently familial.

Hot-water epilepsy

Other unusual seizure triggers


Seizures may be elicited by particular

stimulations such as skin friction (rubbing

epilepsy), touching or tapping, tooth

brushing (tooth-brushing epilepsy),

stimulation of external ear conduct

(auricular epilepsy).


Usually these reflex seizures are linked to brain

lesions of various type (dysplastic,

inflammatory as in Rasmussen syndrome).

Involving the parietal and sensorimotor cortex

or supplementary motor area, but other

regions may be involved, namely temporal lobe.

Importance of reflex seizures and reflexepilepsies

Importance of reflex seizures and reflexepilepsies

Reflex epilepsies represent an interesting

topic that has always aroused curiosity in

epileptologists.

The recognition of provocative stimuli may

contribute to the management of epilepsy.

Thank youThank youThank you

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بسم الله الرحمن الرحيم. Reflex epilepsies Presented by Prof. Abdulrahman Sallam Professor of Neurology Sana’a university