Abstracts

Rationale: The incidence of photosensitive epilepsy is thought to be 1.1 per 100,000 person-years, representing approximately 2% of new epilepsy cases. The most common age range is from 7 to 19 with a higher prevalence of females. It is thought that the majority of photosensitive patients try to avoid seizures. However, in 1951, Gastaut described patients who "self-induce" absence seizures. These 2 patients would seek out light and perform movements such as waving a hand in front of the face or rock back forth in such a manner to induce flickering light stimuli to self-induce seizures. A case report in 1983 by Ames and Saffer, report 2 more cases of patients self-inducing seizures and coined the term "sun flowering." We have identified 4 female pediatric patients with photosensitive epilepsy and obsessive-compulsive hand waving that reliably precipitates seizures.There remains no definitive treatment for this rare condition and no reported genetic associations. Methods: Retrospective review of video-EEG and patient records. Results: Demographics and medications of the 4 patients are described in Table 1. Video-EEG findings are described below. Patient 1: 20 events of hand waving in front of her face. Electrographically, the hand waving stimulus were followed by bifrontal spike-wave with generalized paroxysmal fact activity. Patient 2: >30 events of abrupt disruption of activity and rapid waving of left hand in front of eyes for 2-4 seconds. Electrographically, event corresponded to generalized biposterior predominant spike or poly-spike wave discharges lasting 3-7 seconds. The left hand waving immediately precedes the discharges.(See Image 1) Patient 3: >40 events of abrupt disruption of activity and rapid waving of left hand in front of eyes for 2-4 seconds. Electrographically, event corresponded to generalized biposterior predominant spike or poly-spike wave discharges lasting 3-7 seconds. The left hand waving immediately precedes the discharges. Patient 4: No ictal events. During stage 2 sleep, high amplitude generalized spike-wave complexes noted. Conclusions: We have described 4 female patients with photosensitive epilepsy, all with seizures provoked by a peculiar obsessive-compulsive hand waving behavior, with a clear photoparoxysmal response documented in 3 cases. The age of onset was between 3 and 4.5 years. The behavioral components of the syndrome are much more devastating than seizures. These patients have been difficult to treat given that the OCD type behavior and the induced seizure is thought to be a pleasurable experience. Thus far, patients have not responded to traditional anti-epileptics and treating the OCD type behavior with SSRIs has only been marginally successful. We anticipate whole exome sequencing to better characterize our cohort.