Relationship among eye condition sensitivities, photosensitivity and epileptic syndromes

Electroencephalogram (EEG) activity in normal subjects and epileptic patients is often closely related to the eye's status such as eye opened (EO), eye closure (ECL) and eyes closed (EC). ECL is the period immediately after closing of the eyes and only lasts for less than 3 seconds if the eyes remain closed. EC is the period as long as the eyes are closed. Epileptiform changes on EEG induced by ECL or EC are called the changes of ECL sensitivity (ECLS) or EC sensitivity (ECS). ECLS occurs mainly but not exclusively in photosensitive patients and ECS has been seen rarely in photosensitive patients. This study aimed to investigate the relationships among ECLS, ECS, photosensitivity and epilepsy syndromes in children.

EEG records from child patients in the EEG Department of Peking University First Hospital during the period of May 2005 to May 2007 were examined for the presence of ECLS or ECS. Open-close eye tests and intermittent photic stimulations were carried out during video-EEG monitoring for examining ECLS, ECS and photosensitivity.

Based on ECLS and ECS on their EEGs, 30 patients were divided into ECLS group (16 cases) and ECS group (14 cases). There were more boys than girls in the two groups. The mean age of initial detection of ECLS and ECS was 10 years, and the average onset age of seizures was 9 years. The epilepsy syndromes in the ECLS group included idiopathic photosensitive occipital lobe epilepsy, Panayiotopoulos syndrome, symptomatic occipital lobe epilepsy, juvenile myoclonic epilepsy, juvenile absence epilepsy, eyelid myoclonia with absences, epilepsy with grand mal on awakening and pure photosensitive epilepsy with mainly generalized tonic clonic seizures. Those in the ECS group were juvenile myoclonic epilepsy, idiopathic photosensitive occipital lobe epilepsy, Panayiotopoulos syndrome and Gastaut type-idiopathic children occipital epilepsy. Photosensitivity was detected in 88% of patients with ECLS and 29% of patients with ECS.

ECLS and ECS are relatively common in females. Comparing with ECS, ECLS is found in more epilepsy syndromes. However, ECS and ECLS could exist in the same epilepsy syndrome. ECLS and ECS can be associated or dissociated with photosensitivity. The rate of ECLS with photosensitivity is higher than that of ECS with photosensitivity, suggesting that mechanisms for ECLS, ECS and photosensitivity may be different but correlated.