The
Sunflower Syndrome was described in a recent BrainAndLife by Susan
Fitzgerald 1 It is a rare photosensitive type of seizure disorder. The
common Petit Mal form of epilepsy is characterized by loss of awareness for
seconds, some eyelid fluttering without falling or significant limb jerking nor
incontinence. Its EEG is characteristically identifiable with the classic
“3/second spike-wave complexes”. But unlike petit mal epileptic seizures which
can be induced by flashing lights or by driving under trees whose branches
intermittently block the sun causing “flashing”, the EEG abnormality in
sunflower epilepsy occurs simultaneously by bright sun or other light. It does
not seem to be triggered by the light as the hand waving and EEG abnormality
are simultaneous.2
A
sunflower seizure
is a rare stereotypical form of epileptic seizure consisting of eye fluttering
with a hand waving before the eyes as the person irresistibly turns toward the
sun or some other bright light accompanied with altered awareness. This turning
toward the sun, like a sunflowers’ heliotropism, is due to the strong desire to
face the sun or light while wiping the hands before the eyes. It lasts seconds
and can occur up to a hundred times a day. Additionally, generalized
convulsions often occur. Other neurological disorders usually don’t occur.
Victims
are made fun of by others in schools because of this strange, uncontrollable misunderstood
behavior. Diagnosis is commonly delayed because of ignorance that this is a specific
form of epilepsy. “He would be outside, facing the sun and waving his hand.”
The patient cannot explain what and why he is doing this. People often exhibit
these behaviors a long time before they seek medical evaluation.
The
EEG shows cerebral hemispheric involvement on both sides similar to the spike
and wave pattern with 3 complexes/second of petit mal epilepsy. It does not
appear to be a focal type of epilepsy. The EEG test should include bright light
exposure, a routine part of EEGs. Sunflower epilepsy generally begins in
childhood and mostly in girls. No blood tests are diagnostic. The diagnosis can
be difficult and is based on the clinical seizure features of hand-before eyes
and simultaneously attending to the sun.
Physicians
should be aware of this syndrome. The first report of SS is likely by H.
Gastaut in 1951 who described two children that seemed to seek out the light
and induce seizures by rapidly passing their hands in front of their eyes (HW).
Treatment:
There haven’t been enough trials to evaluate treatment yet. Valproate is
helpful. Wearing dark glasses or blue-tinted lenses or contact lenses, favor
shaded rooms
1)
Brain and Life. Pages 35-37; December 2024/January 2025
2) Sourbron J, Neishay A, Yancheng L, Thiele EA. Ictal EEG in sunflower syndrome:
Provoked or unprovoked seizures? Epilepsy
& Behavior Volume
113,
December 2020, 107470
Lance Fogan, M.D. is Clinical Professor of Neurology at the David Geffen School of Medicine at UCLA. His hard-hitting emotional family medical drama, “DINGS, is told from a mother’s point of view. “DINGS” is his first novel. Aside from acclamation on internet bookstore sites, U.S. Report of Books, and the Hollywood Book Review, DINGS has been advertised in New York Times Book Reviews, the Los Angeles Times Calendar section and Publishers Weekly. DINGS teaches epilepsy and is now available in eBook, audiobook, soft and hard cover editions.
