Reflex epilepsy: triggers and management strategies

Figures & data

Table 1 Summary of the main epidemiological, clinical, genetic, therapeutic, and prognostic features of reflex seizures^10,31

Type of reflex epilepsy	Sex, prevalence	Genetics	Identified loci or genes	Seizure type	Epileptic syndromes or associated conditions	Prognosis	Treatment
Photosensitivity	1/4,000 (2%–10% of PWE) female > male (60%)	Likely autosomal dominant with reduced penetrance, independent from seizures disorder	6p21, 7q32, 13q31, 16p13	– Absence, myoclonia – GTCS – Focal (mainly occipital)	– GGE (especially JME) – IPOE – PME – DS Rarely with acquired lesions	Usually favorable response, may remit in 25% after age 30 years	Preventive measures (stimulus avoidance, lens, etc.) VPA first choice, LTG and LEV as the second choice
Musicogenic epilepsy	1:10,000,000	Usually none reported in patients with ADTLE	LGI1/Epitempin SCN1A	Usually temporal lobe seizures	Epilepsies with epileptogenic lesions also in patients with ADTLE	Variable, usually refractory	Stimulus avoidance Medication for focal seizures
Reading epilepsy	Rare, male/female: 1.8/1	Autosomal dominant inheritance with incomplete penetrance	None	Jaw jerks that may progress to GTCS if reading continues Rare: focal seizures, with alexia and variable degree of dysphasia	Considered a variety of GGE; described in patients with JME	Benign, thus well responding to treatment	Stimulus avoidance (interruption of reading) VPA first choice LEV and CLN as the second choice
Eating epilepsy	1/1,000–2,000 PWE, male/female: 3/1	Unknown familial cluster in Sri Lanka	MECP2	Focal seizures with or without impairment of awareness	Usually epilepsies with epileptogenic lesions	Variable	Stimulus modification, medication for focal epilepsy CLB before meal Surgery
Hot water or bathing epilepsy	Rare (more common in India and Turkey), male predominance (70%)	Likely autosomal dominant	10q21.3–q22.3 and 4q24–q28 Synapsin 1 GPR56	Focal seizures	None	Relatively benign	Stimulus avoidance/modification (shortened bath times, decreasing the bath water temperature) BZD as needed
Seizures induced by somatosensory stimuli	Rare, unknown	Unknown	Unknown	Sensory aura followed by a sensory Jacksonian seizure with tonic motor manifestations. Secondary generalization may occur	With MCD and post-santral cortical lesions	Variable	As for other symptomatic or focal epilepsies
Seizures induced by proprioceptive stimuli	Rare, unknown	Usually none	Unknown	Myoclonic or somatomotor or somatosensorial seizures Evolvement focal to bilateral may occur	Acquired brain lesions non-ketotic hyperglycemia acute diffuse encephalopathies	Variable	Medication for focal seizures
Seizures induced by orgasm	Very uncommon, female predominance	None	Unknown	Focal seizures	Usually with acquired lesions	Variable	Medication or surgery
Seizures induced by thinking or praxis	Usually overlapping with JME	Usually overlapping with GGE	Unknown	Myoclonia, absence, GTCS	GGE	Benign (as JME)	Same medication as GGE

Abbreviations: ADTLE, autosomal dominant temporal lobe epilepsy; BZD, benzodiazepines; CLB, clobazam; CLN, clonazepam; DS, Dravet syndrome; GGE, genetic generalized epilepsies; GTCS, generalized tonic-clonic seizures; IPOE, idiopathic photosensitive occipital lobe epilepsy; JME, juvenile myoclonic epilepsy; LEV, levetiracetam; LTG, lamotrigine; MCD, malformations of cortical development; PME, progressive myoclonus epilepsies; PWE, patients with epilepsy; VPA, valproic acid.

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