388:
seizures. In reflex epilepsy, these changes in the brain result in a small area that is capable of interrupting normal firing patterns and is more likely to produce the synchronous firing patterns that characterize a seizure. These hyper-excitable areas may then be activated by certain stimuli resulting in a reflex seizure. Reflex seizures are thus notable because the presentation of a particular stimulus, that activates the hyper-excitable areas of the brain, directly overcomes the seizure threshold, and results in a reflex seizure.
185:. Myoclonic jerks are the most common generalized seizures seen among reflex seizures and can be located in the limbs, trunk, or in specific regions of the body (e.g., in the muscles of the jaw or the eyelids). Reflex absence seizures are also common, especially in response to certain kinds of triggering stimuli such as light, proprioceptive, cognitive, emotional, or linguistic. Generalized tonic-clonic seizures are less common and can occur independently or more commonly after a cluster of myoclonic jerks or absence seizures.
228:
associated with that melody or rhythm. Seizures can also be triggered when people with the condition think about certain kinds of music without actually hearing the music. In addition, musicogenic epilepsy may occur with sounds that one would not usually associate with music, the sounds of machinery for example. While certain types of music may induce a seizure in a certain person, listening to other kinds of music may prevent or terminate the epileptic activity.
438:. Specific treatment depends both on the person as well on the kind of reflex triggers. For example, in photosensitive epilepsy, some people may rely only on managing exposure to their triggers, while others, may benefit greatly from anti-epileptic drugs. In addition, different anti-epileptic medications may be used in order to treat a given person's reflex epilepsy depending on the kind of seizures that they experience.
197:
involve impairment or loss of consciousness. Focal seizures are usually only seen in certain types of reflex epilepsies such as occipital lobe seizures in photosensitive occipital lobe epilepsies or temporal lobe seizures in musicogenic epilepsies. Focal seizures can be located only in the area of the brain responsible for the stimulus, spread to other areas of the brain, or even develop into a generalized seizure.
221:
specific patterns for visual stimuli. Visual stimuli of a particular frequency (15-25 flashes/second), wavelength (red light at 660-720 nm), and high contrast have been shown to have a higher risk of inducing seizures in people who are photosensitive. In addition, emotional excitement, fatigue, or length of exposure can all effect the risk of seizures.
638:(ILAE) identified epilepsy caused by a specific stimuli in 1989 in their official definition of epilepsy and more recently, has updated this definition to recognize new types of focal and generalized seizures. Currently reflex epilepsies are classified as miscellaneous types of epilepsy and are identified by the type of triggering stimulus.
447:
least 2 meters, and avoiding television or video games when tired. LCD TV screens or
Televisions with higher refresh rates (100 Hz) cause less flickering and thus lower the likelihood of a seizure. In addition, special blue lens Z1 glasses have been shown to reduce seizures in many people with photosensitive reflex epilepsy.
446:
Photosensitive reflex epilepsy is usually treated with both lifestyle changes and anti-epileptic medications. Some lifestyle modifications that may be recommended are limiting the amount of time one is exposed to television or screens, watching television in a bright well-lit room at a distance of at
196:
are seizures that arise from a small area of the brain in one hemisphere. Focal seizures are divided into simple or complex focal seizures. Simple focal seizures do not involve the impairment of consciousness but instead may have motor, sensory, or autonomic manifestations. Complex focal seizures do
240:
Thinking epilepsy is a rare form of reflex epilepsy that is triggered by a specific cognitive task. This can include thinking, calculations, solving problems, abstract reasoning, or making decisions. Thinking epilepsy does not occur in response to reading, writing, or verbal communication. Reading
497:
In 2015 epilepsy was present in about 1.3% of the population of the United States, approximately 3 million adults and 470,000 children. Reflex epilepsy is found in approximately 5% of people who have epilepsy. Photosensitive epilepsy is the most common type of reflex epilepsy, accounting for 75-80%
213:
Extrinsic stimuli are sensory stimuli that originate from the person's environment. Similar to intrinsic stimuli, extrinsic stimuli can be divided into two categories, either simple or complex. Examples of simple extrinsic stimuli include flashing lights or touch while complex extrinsic stimuli can
391:
The activation of the hyper-excitable areas of the brain is additionally regulated by facilitating factors that may increase the likelihood of eliciting a seizure. Most commonly these include fatigue, sleep deprivation, or stress. Facilitating factors are different for each individual. Due to the
236:
Intrinsic stimuli are specific actions or activities performed by the person that result in a reflex seizure. Intrinsic stimuli can be divided into two categories, either elementary or elaborate. Elementary intrinsic stimuli are usually simple motor movements while elaborate intrinsic stimuli can
227:
is a rare reflex epilepsy that is thought to be an abnormal sensitivity of the brain to musical stimuli, however, the exact mechanism of these seizures is unknown. People with musicogenic epilepsy may have seizures triggered not just by musical stimuli but also by the emotional content or memory
387:
Epileptic seizures occur due to changes in the brain that result in the lowering of the seizure threshold in a particular individual making that person vulnerable to recurring seizures. These changes can be a result of a structural abnormality, brain lesions, or simply a genetic disposition to
220:
is an abnormal sensitivity of the brain to visual stimuli and is the most common trigger in reflex seizures. Reflex seizures can be induced by both flickering or non-flicking light, television, video games, or other visual patterns. Most people who have photosensitive epilepsy are sensitive to
498:
of cases. In addition, reflex epilepsies may show preferential distribution between the two sexes or certain age groups. Photosensitive epilepsy, for example, is more common in females (60% of cases) and is also more common in younger people (7–19 years old).
241:
epilepsy is recognized as another distinct kind of reflex epilepsy. Thinking epilepsy usually results in generalized seizures which manifest as bilateral monoclonus, absence seizures, or generalized tonic-clonic seizure that are preceded by myoclonic jerks.
1163:
Italiano, Domenico; Striano, Pasquale; Russo, Emilio; Leo, Antonio; Spina, Edoardo; Zara, Federico; Striano, Salvatore; Gambardella, Antonio; Labate, Angelo (March 2016). "Genetics of reflex seizures and epilepsies in humans and animals".
890:
Fisher RS, Acevedo C, Arzimanoglou A, Bogacz A, Cross JH, Elger CE, Engel J, Forsgren L, French JA, Glynn M, Hesdorffer DC, Lee BI, Mathern GW, Moshé SL, Perucca E, Scheffer IE, Tomson T, Watanabe M, Wiebe S (April 2014).
79:
that are consistently induced by a specific stimulus or trigger, making them distinct from other epileptic seizures, which are usually unprovoked. Reflex seizures are otherwise similar to unprovoked seizures and may be
127:
in origin. The inheritance pattern is dependent on the type of reflex epilepsy, with some types lacking specific genetic inheritance patterns. For example, photogenic epilepsy is thought to follow an
162:
may cause myoclonic jerks in the jaw or may cause focal seizures in the regions of the brain responsible for reading. In reflex epilepsy generalized seizures are more common than focal seizures.
1109:
Striano, Salvatore; Coppola, Antonietta; del Gaudio, Luigi; Striano, Pasquale (June 2012). "Reflex seizures and reflex epilepsies: old models for understanding mechanisms of epileptogenesis".
205:
Stimuli that cause reflex seizures can be categorized as either intrinsic or extrinsic. For a given person, the stimulus that triggers may be intrinsic, extrinsic, or a combination of both.
454:
is usually the first line medication of choice in people with photosensitive reflex epilepsy with many people becoming seizure free. Second line anti-epileptic medications include
158:
Reflex seizures can be either generalized or focal seizures or both. However, for any given stimulus there may be a large variation in the kind of elicited seizure. For example,
1232:
Italiano, Domenico; Ferlazzo, Edoardo; Gasparini, Sara; Spina, Edoardo; Mondello, Stefania; Labate, Angelo; Gambardella, Antonio; Aguglia, Umberto (August 2014).
489:
Photosensitive reflex epilepsy tends to decrease with age, especially in one's thirties. In 25-50% of people, seizures may spontaneously subside or disappear.
400:
The diagnosis of reflex epilepsy usually includes a comprehensive medical and family history as well as a variety of tests. These tests may include a
249:
Although reflex seizures are thought to have a genetic component, the exact genes involved are unclear. As of 2016, some genes of interest include:
634:
described the role of specific stimuli on causing seizures. Since then, many types of stimuli that can trigger seizures have been identified. The
1349:
635:
214:
include music, language, reading, or stimulation from eating. Some of the more common types of reflex epilepsy include light and music.
139:
stimuli do not follow an observable inheritance pattern. The underlying mechanism involves the stimulation of existing network of
182:
173:
are seizures that arise in large areas of the brain, including both hemispheres. Generalized seizures can take the form of
392:
large variance between the different kinds of reflex epilepsies, the specific mechanism causing reflex seizures may vary.
1284:
Ferlisi, Monica; Shorvon, Simon (April 2014). "Seizure precipitants (triggering factors) in patients with epilepsy".
1055:"Do reflex seizures and spontaneous seizures form a continuum? - triggering factors and possible common mechanisms"
435:
405:
147:
56:
892:
1367:"National and State Estimates of the Numbers of Adults and Children with Active Epilepsy — United States, 2015"
450:
If the above lifestyle modifications do not manage the condition, anti-epileptic medications may also be used.
995:
Tamber, Mandeep S.; Mountz, James M. (November 2012). "Advances in the diagnosis and treatment of epilepsy".
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217:
120:
119:
Triggers may include various stimuli with the most common (75 to 80%) being flickering lights resulting in
434:
The treatment of reflex epilepsy generally involves decreasing exposure to a person's triggers as well as
401:
146:
The treatment of reflex epilepsy generally involves decreasing exposure to a person's triggers as well as
132:
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Triggering seizures in epilepsy has been a phenomenon that has been observed since ancient times. The
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917:
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681:
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Determining if this seizure or seizures are a part of a specific epilepsy syndrome or disease.
97:
89:
27:
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records instances of a spinning potter's wheel causing seizures in epileptic slaves. In 1850
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150:. Reflex epilepsy is relatively rare, making up approximately 5% of epilepsy syndromes.
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837:
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136:
105:
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1008:
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471:
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193:
113:
81:
1321:
1201:
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972:
929:
956:
479:
475:
1250:
1233:
1071:
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104:. Photosensitive seizures are often myoclonic, absence, or focal seizures in the
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467:
419:
Determining if the seizure or seizure like event is truly an epileptic seizure.
745:
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1016:
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32:
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1024:
964:
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685:
943:
Xue LY, Ritaccio AL (March 2006). "Reflex seizures and reflex epilepsy".
627:
44:
854:
140:
912:
415:
The procedure for diagnosing epilepsy generally follows three steps:
893:"ILAE official report: a practical clinical definition of epilepsy"
1053:
Irmen, Friederike; Wehner, Tim; Lemieux, Louis (February 2015).
237:
include emotions, thoughts, calculations or decision making.
1342:
A Clinical Guide to
Epileptic Syndromes and their Treatment
100:
characterized by repeated reflex seizures are known as
1234:"Generalized versus partial reflex seizures: a review"
422:
Determining what kind of seizure that someone has had.
945:
American
Journal of Electroneurodiagnostic Technology
838:"Reflex epilepsy: triggers and management strategies"
660:"Provoked and reflex seizures: surprising or common?"
62:
51:
38:
26:
21:
299:Overlaps with Idiopathic Generalized Epilepsies
123:. Reflex epilepsies are generally thought to be
1279:
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658:Kasteleijn-Nolst Trenité DG (September 2012).
340:Autosomal dominant with incomplete penetrance
286:None or overlaps with rare genetic epilepsies
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253:Inheritance patterns and genes of interests
1371:MMWR. Morbidity and Mortality Weekly Report
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1038:
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713:
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546:Overlaps with juvenile myoclonic epilepsy
112:are associated with focal seizures in the
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1390:
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1070:
911:
863:
853:
675:
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651:
500:
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647:
557:1 in 1000-2000 of people with epilepsy
842:Neuropsychiatric Disease and Treatment
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747:Reflex Seizures and Reflex Epilepsies
636:International League Against Epilepsy
7:
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986:
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836:Okudan ZV, Özkara Ç (2018-01-18).
14:
183:generalized tonic-clonic seizures
55:Decreasing exposure to triggers,
1365:Zack, Mathew (August 11, 2017).
1178:10.1016/j.eplepsyres.2016.01.010
1123:10.1016/j.eplepsyres.2012.01.013
1009:10.1053/j.semnuclmed.2012.06.005
677:10.1111/j.1528-1167.2012.03620.x
744:Panayiotopoulos, C. P. (2005).
957:10.1080/1086508X.2006.11079556
526:More common in younger people
135:, while seizures triggered by
1:
1251:10.1016/j.seizure.2014.03.014
1072:10.1016/j.seizure.2014.12.006
582:More common in males (1.8:1)
524:More common in females (60%)
1340:Panayiotopoulos, CP (2010).
997:Seminars in Nuclear Medicine
750:. Bladon Medical Publishing.
1298:10.1016/j.yebeh.2014.02.019
571:More common in males (70%)
560:More common in males (3:1)
1455:
513:Groups typically affected
436:anti-epileptic medications
406:magnetic resonance imaging
148:anti-epileptic medications
57:anti-epileptic medications
143:by the specific trigger.
47:due to a specific trigger
1418:Reflex Epilepsy Overview
1286:Epilepsy & Behavior
593:More common in females
535:1 in 10,000,000 people
442:Photosensitive epilepsy
218:Photosensitive epilepsy
121:photosensitive seizures
1383:10.15585/mmwr.mm6631a1
609:Somatosensory induced
402:electroencephalography
370:Somatosensory induced
133:incomplete penetrance
84:(simple or complex),
538:No sex predominance
328:4q24–q28 Synapsin 1
261:Inheritance pattern
225:Musicogenic epilepsy
171:Generalized seizures
166:Generalized seizures
110:musicogenic seizures
855:10.2147/NDT.S107669
670:(Suppl 4): 105–13.
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323:Autosomal dominant
272:Autosomal dominant
254:
1420:Medscape Reference
501:
408:(MRI), as well as
264:Genes of interest
252:
154:Signs and symptoms
129:autosomal dominant
98:Epilepsy syndromes
77:epileptic seizures
1351:978-1-84996-160-8
1166:Epilepsy Research
1111:Epilepsy Research
913:10.1111/epi.12550
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618:
598:Movement induced
521:1 in 4000 people
507:Type of epilepsy
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359:Movement induced
277:7q32 13q31 16p13
232:Intrinsic stimuli
209:Extrinsic stimuli
102:reflex epilepsies
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16:Medical condition
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1029:
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992:
977:
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833:
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741:
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160:reading epilepsy
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1377:(31): 821–825.
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1283:
1282:
1275:
1231:
1230:
1209:
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994:
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835:
834:
755:
743:
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518:Photosensitive
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460:benzodiazepines
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410:genetic testing
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383:Pathophysiology
269:Photosensitive
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175:myoclonic jerks
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73:Reflex seizures
66:Relatively rare
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12:
11:
5:
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1434:Epilepsy types
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1412:External links
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1407:
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1357:
1350:
1327:
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1244:(7): 512–520.
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1003:(6): 371–386.
978:
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1289:
1285:
1241:
1237:
1169:
1165:
1114:
1110:
1062:
1058:
1000:
996:
951:(1): 39–48.
948:
944:
938:
903:
899:
845:
841:
746:
667:
663:
632:Marshal Hall
625:
532:Musicogenic
525:
496:
493:Epidemiology
488:
480:ethosuximide
476:brivaracetam
449:
445:
433:
414:
399:
390:
386:
329:
327:
313:
289:
283:Musicogenic
276:
248:
239:
235:
223:
216:
212:
204:
192:
169:
157:
145:
118:
101:
72:
71:
1292:: 101–105.
848:: 327–337.
502:References
468:lamotrigine
86:generalized
1439:Pediatrics
1428:Categories
642:References
565:Hot water
510:Frequency
484:topiramate
464:clonazepam
320:Hot water
96:seizures.
1306:1525-5069
1260:1532-2688
1186:1872-6844
1172:: 47–54.
1131:1872-6844
1081:1532-2688
1065:: 72–79.
1017:1558-4623
900:Epilepsia
664:Epilepsia
543:Thinking
462:(such as
452:Valproate
430:Treatment
396:Diagnosis
296:Thinking
290:LGI1SCN1A
90:myoclonic
63:Frequency
52:Treatment
33:Neurology
28:Specialty
1401:28796763
1322:21228396
1314:24632482
1268:24766826
1202:22040184
1194:26875109
1147:31436270
1139:22361339
1089:25645641
1025:23026360
973:10098600
965:16605171
930:35958237
922:24730690
874:29403278
686:22946728
628:Apologia
615:Unknown
604:Unknown
576:Reading
549:Unknown
373:Unknown
337:Reading
310:Unknown
201:Triggers
179:absences
108:, while
45:Seizures
40:Symptoms
1392:5687788
1238:Seizure
1059:Seizure
865:5779309
622:History
587:Orgasm
554:Eating
404:(EEG),
348:Orgasm
307:Eating
141:neurons
125:genetic
94:absence
1399:
1389:
1348:
1320:
1312:
1304:
1266:
1258:
1200:
1192:
1184:
1145:
1137:
1129:
1087:
1079:
1023:
1015:
971:
963:
928:
920:
872:
862:
684:
482:, and
258:Types
1318:S2CID
1198:S2CID
1143:S2CID
969:S2CID
926:S2CID
896:(PDF)
612:Rare
601:Rare
590:Rare
579:Rare
568:Rare
376:None
365:None
362:None
354:None
351:None
343:None
330:GPR56
314:MECP2
302:none
275:6p21
245:Cause
181:, or
92:, or
82:focal
1397:PMID
1346:ISBN
1310:PMID
1302:ISSN
1264:PMID
1256:ISSN
1190:PMID
1182:ISSN
1135:PMID
1127:ISSN
1085:PMID
1077:ISSN
1021:PMID
1013:ISSN
961:PMID
918:PMID
870:PMID
682:PMID
466:),
75:are
1387:PMC
1379:doi
1294:doi
1246:doi
1174:doi
1170:121
1119:doi
1115:100
1067:doi
1005:doi
953:doi
908:doi
860:PMC
850:doi
672:doi
1430::
1395:.
1385:.
1375:66
1373:.
1369:.
1330:^
1316:.
1308:.
1300:.
1290:33
1288:.
1276:^
1262:.
1254:.
1242:23
1240:.
1236:.
1210:^
1196:.
1188:.
1180:.
1168:.
1155:^
1141:.
1133:.
1125:.
1113:.
1097:^
1083:.
1075:.
1063:25
1061:.
1057:.
1033:^
1019:.
1011:.
1001:42
999:.
981:^
967:.
959:.
949:46
947:.
924:.
916:.
904:55
902:.
898:.
882:^
868:.
858:.
846:14
844:.
840:.
756:^
694:^
680:.
668:53
666:.
662:.
650:^
486:.
478:,
474:,
470:,
458:,
412:.
177:,
116:.
88:,
1403:.
1381::
1354:.
1324:.
1296::
1270:.
1248::
1204:.
1176::
1149:.
1121::
1091:.
1069::
1027:.
1007::
975:.
955::
932:.
910::
876:.
852::
688:.
674::
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