By: Natalie L. Boehm, MBA, RBLP-T
What is Reflex Epilepsy?
Reflex epilepsy (RE) is defined as a specific syndrome in which all epileptic seizures are precipitated by sensory stimuli (Hanif and Musick, 2021). Reflex seizures can take a variety of forms, comprising either general or focal onset, with or without secondary generalization (Hanif and Musick, 2021). The term “reflex” dates back to Marshall Hall, who differentiated seizures precipitated by peripheral stimuli (eccentric) from central causes, yet being very broad (Trenite, 2012).
Types of Reflex Epilepsy
There are numerous different types of reflex seizures that can be triggered by simple or complex situations. A simple flashing light to reading a book can trigger a reflex seizure. Listed in this section, are different types of rare epilepsies that are tied to reflex epilepsy.
Photosensitivity epilepsy is defined as abnormal clinical and/or electroencephalographic (EEG) responses induced by visual stimulation (Yalcin et. al., 2000). According to the Epilepsy Foundation of America, examples of triggers are:
- Television screens or computer monitors due to the flicker or rolling images
- Certain video games or TV broadcasts containing rapid flashes or alternating patterns of different colors
- Intense strobe lights like visual fire alarms
- Natural light, such as sunlight, especially when shimmering off water, flickering through trees or through the slats of Venetian blinds
- Certain visual patterns, especially stripes of contrasting colors
- Some people wonder whether flashing lights on the top of buses or emergency vehicles may trigger seizures in people with photosensitive epilepsy too.
(Epilepsy Foundation, 2019)
Finding ways to prevent a seizure being triggered is essential. Avoiding environments that have flashing lights, limiting how much you watch television or play video games, and taking a break away from the computer are a few ways to prevent a seizure.
Cell phones have become part of everyday life for so many of us. People enjoy taking “selfies” or pictures of themselves. In the article, “Selfie-epilepsy”: A novel photosensitivity, the authors explain a case in which a patient experienced having a seizure while taking a “selfie” with a cellphone. During testing, the patient started demonstrating a photo-paroxysmal response when flash rates at 2, 4, 12, and 14Hz occurred (Brna and Gordon, 2017). Generalized spikes were also noted when an iPhone 5 was used to take “selfies” with flash and red eye reduction in a dimly lit room (Brna and Gordon, 2017).
What was very interesting in this study was the fact that the researchers brought to attention that people are warned about possible photosensitivity with strobe lights and video games. However, the LED lights with our cell phones do not carry the same warning, even with many having pulsed LED lights. The researchers acknowledged that this study was focused on one patient and at that point, no action was being taken to put any warning labels on cell phones regarding photosensitivity. It is definitely a very interesting study and with the advancements in technology, it is possible we will see more of it in the future.
Telephone-Induced seizures fall under the category of hearing-induced seizures. Hearing-induced seizures are defined as a rare and heterogeneous group of reflex epilepsies in which the attacks are almost constantly triggered by elaborate and complex stimuli, such as music, voices, and other sounds (Michelucci, et. al., 2004). In the article, Telephone-induced Seizures: A New Type of Reflex Epilepsy, the authors researched three cases and found that the onset of the discharge for seizure activity occurred in the temporal lobe.
Toothbrushing epilepsy is defined as an extremely rare form of reflex epilepsy caused by specific stereotypical stimuli (Chan et. al., 2016). In the article, Epileptic seizures triggered by the use of a powered toothbrush, the authors presented a case in which a patient was having seizures triggered by the use of an electric toothbrush. The patient had already been diagnosed with epilepsy twenty years prior. When first using the electric toothbrush, the patient was experiencing auras, which over time because partial complex seizures. As the patient continued to use the toothbrush, seizure activity increased. When the patient stopped using the electric toothbrush, the seizures stopped. The patient tried to start using it again, and seizure activity started up again. The patient was finally advised not to use the electric toothbrush, to use a manual one, and to brush less vigorously.
In the article, Tooth-brushing epilepsy: A case report and literature review, another case was presented of a patient experiencing facial and arm numbness, twitching, and led to generalized tonic-clonic seizures (Chan et. al., 2016). Because of the seizures, the patient stopped brushing his teeth all together. An MRI later disclosed a lesion located on the inferior motor strip, consistent with the orofacial motor cortex (Chan et. al., 2016). The lesion was removed, and seizure activity stopped, resulting in the patient being able to practice good oral hygiene.
Emotional stress-induced seizures
Stress is a trigger for many who are battling epilepsy. In the article, Emotional stress-induced seizures: Another reflex epilepsy? the authors described a case study in which a nine-year-old child was having stress induced seizures due to a toxic relationship with a parent. While in the presence of the mother, the child had high levels of seizure activity. The physicians had the mother leave the room and the father enter. In the time he was with his child, no seizure activity occurred. When the mother would return, seizure activity would start up again. The child was separated from her parents and put into the pediatric psychiatry ward and within two weeks of therapy and treatment, became seizure free. Over the next four months the patient was monitored, and custody was granted to the father due to the concerns that seizure activity could start up again if left in the care of the mother.
What is so important about this case is it demonstrates the effect that abuse can have on a child. Stress induced seizures in children often take place when the environment is toxic. Long-term it can cause the person to develop conditions such as Post-Traumatic Stress Disorder and put them at higher risk for conditions such as dementia.
Treatment for Reflex Epilepsy
According to the Epilepsy Foundation, medication such as valproate, clonazepam, clobazam, lamotrigine, and phenobarbital can be used to control reflex seizures. It is best to understand what triggers the seizure to avoid it from occurring. Keeping a seizure journal can help some patients in finding a pattern on what is triggering their seizures to help prevent them.
Reflex epilepsy (RE) is defined as a specific syndrome in which all epileptic seizures are precipitated by sensory stimuli (Hanif and Musick, 2021). Reflex seizures can take a variety of forms, comprising either general or focal onset, with or without secondary generalization (Hanif and Musick, 2021). It is important to find out what someone’s triggers are to help prevent and reduce seizure activity. Along with learning what triggers someone’s seizures, certain anticonvulsant medication can help to control seizure activity as well.
Brna, P., & Gordon, K. (2017). “Selfie-Epilepsy”: A Novel Photosensitivity. Seizure (London, England), 47, 5–8. https://doi.org/10.1016/j.seizure.2017.02.009
Chan, D. Y. C., Chan, D. T. M., Zhu, C. X. L., Lau, C. K. Y., Leung, H., & Poon, W. S. (2016). Tooth-brushing epilepsy: A case report and literature review. Clinical Neurology and Neurosurgery, 145, 46–51. https://doi.org/10.1016/j.clineuro.2016.03.016
Destina Yalçin, A., Kaymaz, A., & Forta, H. (2000). Reflex occipital lobe epilepsy. Seizure (London, England), 9(6), 436–441. https://doi.org/10.1053/seiz.2000.0424
Epilepsy Foundation (2019). Photosensitivity and Seizures. Epilepsy Foundation. Retrieved from: https://www.epilepsy.com/learn/triggers-seizures/photosensitivity-and-seizures
Gilboa, T. (2012). Emotional stress-induced seizures: Another reflex epilepsy? Epilepsia (Copenhagen), 53(2), e29–e32. https://doi.org/10.1111/j.1528-1167.2011.03342.x
Hanif, S., & Musick, S. T. (2021). Reflex epilepsy. Aging and Disease, 12(4), 1010–1020. https://doi.org/10.14336/AD.2021.0216
Haytac, M.C., Aslan, K., Ozcelik, O., and Bozdemir, H. (2008). Epileptic seizures triggered by the use of a powered toothbrush. Seizure, 17(3), 288-291. https://doi.org/10.1016/j.seizure.2007.07.012
Joshi, C. (2019). Reflex Epilepsies. Epilepsy Foundation. Retrieved from: https://www.epilepsy.com/learn/types-epilepsy-syndromes/reflex-epilepsies
Michelucci, R., Gardella, E., De Haan, G., Bisulli, F., Zaniboni, A., Cantalupo, G., Alberto Tassinari, C., Tinuper, P., Nobile, C., Nichelli, P., & Kasteleijn‐Nolst Trenité, D. G. A. (2004). Telephone‐induced Seizures: A New Type of Reflex Epilepsy. Epilepsia (Copenhagen), 45(3), 280–283. https://doi.org/10.1111/j.0013-9580.2004.39703.x
Okudan, Z. V., & Özkara, Ç. (2018). Reflex epilepsy: Triggers and management strategies. Neuropsychiatric Disease and Treatment, 14, 327–337. https://doi.org/10.2147/NDT.S107669
Trenite, D. G. A. K.-N. (2012). Provoked and reflex seizures: Surprising or common? Epilepsia (Copenhagen), 53(s4), 105–113. https://doi.org/10.1111/j.1528-1167.2012.03620.x