Blog #101: FLASHING LIGHTS AND EPILEPSY

 

            It’s been known for more than a century that flickering sunlight, as with driving under leafy trees, can trigger epileptic seizures in susceptible people. Currently, flashing and flickering lights in video games and television can do the same. Warnings about the potential for seizures have been added to these games. This is PHOTOSENSITIVE EPILEPSY. Some people, usually children, can convulse or have a brief staring spell (petit mal or absence seizure) with rhythmic jerky movements of the arms lasting 5-10 seconds or have an involuntary limb jerk or have eyelid movements by looking at a television screen, a computer screen, or an electronic screen game. It is estimated that 3-10 percent of all persons with new-onset epilepsy, especially in the age range 7-19 years, are found to be susceptible to visually-induced seizures; two-thirds of photosensitivity-associated-epilepsy patients are female. Photosensitive epilepsy is reported to be familial in eight percent of cases. ¹ Forty percent of siblings of photosensitive patients with epilepsy are photosensitive as well.²

            Physical exams and CT and MRI scan results are usually normal. The EEG, however, reveals epileptogenic changes (spike-and-wave and multiple-spike abnormalities) when the patient is exposed to flickering photic stimulation, usually at 9-, 10-, and 25 Hertz/second with the EEG’s own lights. During this exposure the patient will demonstrate altered consciousness as demonstrated by ceasing to count or talk accompanying the flickers with some jerks of the arms. This photo-paroxysmal response is diagnosed as Photosensitive Generalized Epilepsy. It is sensitive to the photic flicker frequency in the EEG lab. 

            The eyes may be open or closed during the test and the EEG will still demonstrate the epileptiform changes; the response does not occur if a light-occlusive patch covers one eye. A susceptible patient could cover one eye with a hand when near such light exposure to lessen chances of a seizure. Sensitivity to television stimuli can also be reduced by wearing blue eyeglasses or by not getting close to the screen, by watching under bright ambient lighting or having a table lamp on top of the TV set or computer screen. One hundred Hertz-TV screens are effective in reducing these seizures.³  Antiepileptic medications helpful for photosensitive epilepsy include valproic acid (Depakote), lamotrigine (Lamictal) and topiramate (Topamax).

            Normal individuals can develop a repetitive waveform on the EEG that is at the same flash rate of the flashing light over the patient in the EEG lab called photic following. These waves are not disorganized multi-spike complexes seen in photosensitive epilepsy. This is an EEG Photoparoxysmal Response, or “Photosensitivity,” and is not associated with physical seizure activity or loss of awareness.

 

1. Wilkins AJ, Darby CE, Binnie CD et. al. Television epilepsy—the role of pattern. Electroencepalogr Clin Neurophysiol. 1979;47:163-171.
2. Doose H, Gerken H. On the genetics of EEG-anomalies in childhood: IV. Photoconvulsive reaction. Neuropadiatrie. 1973;4:162-171.
3. Ricci S, Vigevano F, Manfredi M et.al. Epilepsy provoked by television and video games: Safety of 100-Hz screens. Neurology. 1998;50:790-793.

 
 
Lance Fogan, M.D. is Clinical Professor of Neurology at the David Geffen School of Medicine at UCLA. “DINGS” is his first novel. It is a mother’s dramatic story that teaches epilepsy, now available in eBook, audio book and soft cover editions.

 

Blog#100: Official Review: Dings by Lance Fogan

Official Review: Dings by Lance Fogan       

Reviewer Page: onlinebookclub.org/reviews/by-reviewerdiksha.html

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Dings by Lance Fogan

 Post by ReviewerDiksha » 18 Nov 2018, 08:26

[Following is an official OnlineBookClub.org review of "Dings" by Lance Fogan.]

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4 out of 4 stars

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This story starts on an unfortunate night when everything changes for the Golden family. Sandra Golden had a happy family. Her kids, Connor and Madison, were bright and playful. Her husband, Sam, was serving in Iraq. Even though she terribly missed him, she knew that, in a few months, he would be back for good and everything would go back to normal. However, before Sam’s return, she encounters some trouble with her son. She gets a call from his school where his teacher reports Connor’s inconsistent and reckless behaviour towards his studies. While this seems like a small problem, bit by bit, it starts to take shape and, after a few months, reveals itself as a monstrous crisis that changes the course of the Golden family’s life.

Dings by Lance Fogan is about a mother who has just discovered that her eight-year-old son suffers from epilepsy. Through the story of the Goldens, it covers a lot of ground about this disease, all the while, educating the audience about it. There are a lot of things that people don’t know about epilepsy, due to which, they tend to form many misconceptions about it. This book shatters such illusions and presents a clear picture, especially about the basic things. It also serves as an education for parents to keep a close eye on their children and take note of every abnormal activity, so that, if there is a problem, it can be diagnosed, and dealt with, as soon as possible. There are a handful of technical terms in the book, and some people might have difficulty understanding them. For this, the writer has added a glossary at the end of the book to give proper information about everything.

When it comes to the audience, some people might think about passing over the opportunity of reading Dings. I would strongly suggest against it. First of all, this book needs to be read because it has a very critical issue as its theme. People should know about the things that this book is talking about, and hence, they must read it. Another reason that might make people refrain from reading it is that they might think that this book is about a disease and hence, will not entertain them. I am glad to tell them that they’d be wrong in thinking this. Had the writer decided to simply write a book about epilepsy, perhaps, even I wouldn’t have read it. Non-fiction, especially about diseases, and those that don’t concern us, rarely catch our attention. Perhaps, Lance Fogan realised this and decided to add a twist to the book.

The writer has very cleverly embedded all the info about epilepsy into the story of a family. The storytelling is quite imaginative. It doesn’t follow a chronological order, and this is what makes it more interesting. At times, it feels like a crime thriller, in which the disease is the perpetrator and breadcrumbs are thrown throughout the story to reveal its identity! In truth, the writing style is the true hero of this novel. The story is told from the point of view of a mother which places its perspective at a very critical angle. There are a lot of emotions, both happy and sad, in it and parents will highly relate to the Goldens. In addition to epilepsy, this book also talks about things like PTSD, the situation of a single mother, and the struggles of raising children. So, there is a wide spectrum when it comes to the things that the author wants to focus on.

OnlineBookClub.org “My rating for this book is 4 out of 4 stars. There was absolutely nothing that I found lacking in it. It had great subject matter, its writing style was highly engrossing and its characters were acutely relatable. It wasn’t difficult to form a bond with the characters as they easily gained our sympathy with their situation, made us like them because of their strength and humanized themselves because of their flaws. It was very educational as well as an entertaining story, and I think everyone should read it.”

  

Lance Fogan, M.D. is Clinical Professor of Neurology at the David Geffen School of Medicine at UCLA. “DINGS” is his first novel. It is a mother’s dramatic story that teaches epilepsy, now available in eBook, audiobook and soft cover editions.

Blog #99 : REVISITING FALSE EPILEPTIC EVENTS

I recently attended a neurology conference at UCLA about Psychogenic Non-Epileptic Seizures (PNES). The discussion highlighted persons with uncontrolled seizures (szs). If patients do not respond to two anticonvulsant drugs (AEDs), a non-epileptic cause should be considered. As these PNES are not true seizures caused by epilepsy they should be considered Non-Epileptic Events (NEE). The term “psychogenic” for these non-epileptic events colors the diagnosis in an improper light which focuses on psychiatric causes. “My doctor thinks I’m crazy.” No! Unlike epileptic seizures, though, these non-epileptic events do not have an organic cause.

People do not consciously bring on these NEE “seizure-like events”; these events are not accompanied by electroencephalographic (EEG) changes. The psychological mechanism causing the event is referred to as a CONVERSION episode. NEEs can be serious as they interfere with jobs, driving, education, and etc. If a woman is pregnant and her “seizures” are actually NEE that are misdiagnosed the ineffective AED treatment can have serious side-effects on mother and fetus.

Non-epileptic events (NEE) can be difficult to diagnose. Five to ten percent of patients with non-epileptic events (NEE) also have true epileptic szs (some of their szs are accompanied by epileptiform-EEG changes while others are not). Non-epileptic events are best diagnosed in an epilepsy monitoring unit (EMU) where video recording is accompanied by simultaneous EEG recording. These patients are especially difficult to treat: is the AED a failure? Switch to another AED? Is this seizure epileptic or a NEE? Between 30-40 percent of patients in the Epilepsy Monitoring Unit at the Santa Barbara Cottage Hospital receive a diagnosis of NEE.¹  Malingering, or consciously faking “seizures” was ruled out by the medical team.

Some conditions can mimic epileptic seizures: fainting due to low blood pressure or due to heart abnormalities or due to emotional stress. Some faints can be accompanied by mild jerking that can be confused with a sz. Other mimics can be low blood sugar; breath-holding in children; and complex migraine.  

Characteristics of non-epileptic events:

1)      Eye closure at onset: present in about 80 percent of non-epileptic events. Eyes are usually open during actual epileptic szs.

2)      Crying: can occur prior to, during or after the event. Crying is rare during epileptic szs.

3)      Asynchronous movements with different timing on different sides of body are characteristic of non-epileptic events.

4)      Pelvic thrusting due to back muscle-contractions is not seen during epileptic seizures.

5)      Epileptic szs have a beginning, a middle phase and an end, e.g., they start with muscle-tightening contractions that progress to jerking before the sz ends. Absence of this progression suggests non-epileptic events.

6)      Long duration: average epileptic szs last a minute. If the “sz” lasts much longer, e.g. 30 to 60 minutes or more, it is likely to be a non-epileptic event.

                                          Characteristics of NEE Sufferers:

a)                  NEE patients are more frequently women (with mean onset age 31).

b)                  NEE in children is infrequent but there is no upper age limit.

c)            Anxiety or depression had been diagnosed in 46 percent of NEE sufferers and 57 percent of this population have at least one other medically unexplained symptom.

d)                  Post-Traumatic Stress Disorder (PTSD) has been diagnosed in 30 percent of people who have NEE.

e)                   Sexual abuse had occurred in 30 percent of people with NEE and physical abuse occurred in 25 percent.

f)   NEE is seen in a significant number of active and former military personnel who had been exposed to blast injuries.

                                  TREATMENT

A four-arm study² for treatment of NEE included: a) patients treated only with Sertraline, a psychiatric selective serotonin reuptake inhibitor (SSRI) antidepressant medication, b) patients treated only with cognitive talk/behavioral therapy (CBT), c) patients treated with Sertraline plus CBT, d) patients treated with standard medical care (with AEDs, etc.). This study’s results showed CBT alone was most successful. No reduction in szs was seen with Sertraline only or with standard medical care.

While treatment of any psychiatric condition is often difficult, prognosis is much better if a correct diagnosis can be made early and treated. People whose NEE have been ongoing for years are less likely to respond to CBT. Education of patients and their families is paramount.

1.      Gibbs M. Differentiating between psychogenic non-epileptic and epileptic seizures. Neurotransmitter. A publication of Santa Barbara Neuroscience Institute at Cottage Health. Fall 2018; p 4.

2.       LaFrance, Curt, et.al. Management of Psychogenic Nonepileptic Seizures. Epilepsy 4 Mar. 2013 onlinelibrary.wiley.com/doi/abs/10.1111/epi 12106.

Lance Fogan, M.D. is Clinical Professor of Neurology at the David Geffen School of Medicine at UCLA. “DINGS” is his first novel. It is a mother’s dramatic story that teaches epilepsy, now available in eBook, audiobook and soft cover editions.