Reflex epileptic mechanisms in ictogenesis and therapeutic consequences

ABSTRACT

Recent studies of reflex epileptic mechanisms in human epilepsy using advanced methods of neurophysiology and functional neuroimaging have contributed much to elucidate pathophysiological processes of seizure generation. Whereas in lesional focal epilepsies reflex mechanisms usually relate directly to the anatomical focus, in system epilepsies they have helped to define which functional anatomical systems serving physiological function are recruited by the ictogenic mechanisms. Reflex epileptic seizures can often be prevented by avoidance or modification of triggers or by prophylactic benzodiazepine administration. Surgical options apply to focal cases. According to restricted experiences with pharmacotherapy, without controlled studies and little information on new AEDs, reflex seizures in system epilepsies appear to respond best to valproic acid and in focal epilepsies, to carbamazepine.

KEYWORDS:

• Reflex seizures
• system epilepsies
• ictogenesis
• epileptic networks
• non-pharmacological epilepsy treatment
• epilepsy treatment strategies

Acknowledgements

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

Declaration of interest

K Lin holds a CNPq (Brazilian Council for Scientific and Technologic Development, Brazil) PQ2 Research Fellowship (Process No. 307861/2013-9). P Wolf holds a Special visiting researcher - Fellowship in Brazil - Science Without Borders Program - Project MEC/MCTI/CAPES/CNPq/FAPs - Process No. 88,881.030478/2013-01 - from CAPES. The authors have no other 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 apart from those disclosed.