The clinical features of different types of photic-induced seizures and epileptic syndromes characterized by visual sensitivity are reviewed from the University of Pisa, Italy, and Centre St Paul, Marseille, France. Seizure types associated with clinical photosensitivity include eyelid myoclonus, generalized myoclonic jerks, tonic-versive seizures, absence, generalized tonic clonic, and focal seizures. Epileptic syndromes with photic-induced seizures include benign myoclonic epilepsy in infancy, absence epilepsy, juvenile myoclonic epilepsy, epilepsy with myoclonic-astatic seizures, primary reading epilepsy, severe myoclonic epilepsy of infancy, photosensitive occipital lobe epilepsy, and progressive myoclonus epilepsies (PME). PME with photic sensitivity are symptoms of neuronal ceroid lipofuscinosis, Lafora’s disease, Unverricht-Lundborg disease, and myoclonus epilepsy and ragged red fibers (MERRF). Visually induced seizures can be generalized or focal, idiopathic or symptomatic, or represent a pure reflex photosensitive epilepsy. [1]
COMMENT. The treatment of photosensitive epilepsies involves preventive measures and antiepileptic medications (AED) [2, 3]. Preventive measures include the following: avoid stimuli (eg TV, videogames); use small TV, 100-Hz screen, remote control, sit >2 m away from screen, wear spectacles, avoid stress and fatigue. Usually a combination of avoidance of stimuli and an AED is necessary. Valproate (VPA) is the AED of first choice, and lamotrigine is second choice. Other drugs recommended are clobazam, levetiracetam, ethosuximide, and topiramate.