Precipitation and inhibition of seizures in focal epilepsies

ABSTRACT

Introduction: There is growing awareness that reflex epileptic seizures offer unique insight into natural seizure generation in humans. In the last years, focus has mostly been on reflex seizures in generalized epilepsies whereas a comprehensive review of their role in focal epilepsies has been missing.

Areas covered: This paper reviews reflex seizures strictly in focal epilepsies, not including focal reflex seizures in system epilepsies that also exist. They were categorized according to their triggers which can be sensory or cognitive, simple or complex. Numerous diverse conditions exist some of which are much better investigated than others. They required separate individual literature search in PubMed. Where recent review papers exist, it refers to these, but several conditions have never been reviewed, and here it refer to and discusses original reports. Miscellaneous case reports were only exceptionally included when they contributed aspects otherwise missing.

Expert commentary: Research on focal reflex seizures with advanced methods of imaging and neurophysiology to elucidate mechanisms of focal ictogenesis will probably be rapidly increasing and will soon provide much new insight. Sensory and cognitive inhibition, i.e. the counterpart of reflex ictogenesis, is promising but needs more structured and controlled research to establish robust therapeutic approaches.

KEYWORDS:

• Modification of ictogenesis
• system epilepsies
• epileptogenic networks
• sensory seizure triggers
• cognitive seizure triggers
• self control
• seizure arrest
• reflex epilepsy
• startle
• musicogenic epilepsy

Acknowledgments

The authors belong to the EpExMo cooperation, an open international research initiative for the study of epilepsies with external modulation (EpExMo) of ictogenesis.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Additional information

Funding

This paper was not funded.