Blog #133: Reflex Epilepsy

Have you experienced seizures associated with specific experiences? These are reflex epilepsies.

Reflex epilepsies are seizures that are initiated reflexively by a stimulus to which a person is exceptionally sensitive. These specific stimuli include: flashing lights; reading various phrases or word combinations; detecting particular tastes and odors; a sudden noise, touch or motion; and, rarely, laughter. Specific musical tunes can induce seizures, and seizures may even be specific to hearing a performance by a certain artist. Bathing epilepsy and hot water epilepsy are forms of reflex epilepsy that are more common in children who are sensitive to showering and bathing. Most reflex epilepsies have genetic etiologies with genetic mutations found in the SYN1 gene. In some cases, just pouring water can initiate a seizure in these susceptible people.¹

For example, a 61-year-old woman reports a seizure can be triggered if her right leg accidentally hits an object. Her right leg would start to tingle, twitch, shake and then becomes paralyzed for up to half a minute. “It’s almost as if I’m startled.” This does not occur if she purposely touches her right foot to a leg of a chair. Her seizures date back to childhood but were only recently explained after a neurological evaluation at an epilepsy monitoring unit. She’s now on anticonvulsant medications and is more careful to avoid hitting her right foot.² This is an example of a specific sensory stimulus that in susceptible people can bring on a seizure—a REFLEX SEIZURE.

Musicogenic epilepsy is demonstrated in another instance when one woman began having seizures when she heard highly emotional hymns during church services. She would blank out and drop her hymnal. Slow, emotional songs triggered seizure activity in her temporal lobe, while faster tunes did not. When she was exposed to melancholic music in the lab she exhibited fear, rapid heartbeat, crying, confusion, and lip smacking: classical features of complex partial seizures which usually emanate from the temporal lobe. EEG electrodes applied to her scalp as she listened demonstrated the epileptiform abnormality. This suggests a relationship with how our emotional brains can be affected by music. This woman drowns out any slow, emotional music that could bring on a musicogenic-seizure in restaurants, malls, stores, etc.  by walking around with an iPod playing up-tempo songs in her ears which seems to prevent her musicogenic seizures. 

In a third example, a man had seizures induced by laughing but this occurred only while watching funny programs on TV. He would start laughing, his arms would shake, and he developed clouded consciousness. He reported no seizures at any other time. ¹

Does this blog suggest to you that you may have reflex seizures associated with specific experiences?

1.     Accogli A, Wiegand G, Scala M. Clinical and Genetic Features in Patients with Reflex Bathing Epilepsy. Neurology. 2021;97:e577-e586. Doi:10.1212.

2.     Symphony of Reflexes reported by Susan Fitzgerald in Brain & Life: December 2019/January 2020; page 36.

Lance Fogan, M.D. is Clinical Professor of Neurology at the David Geffen School of Medicine at UCLA. “DINGS” is a family medical drama told from a mother’s point of view. It is his first novel. It teaches epilepsy. DINGS is now available in eBook, audiobook, and soft and hard cover editions.