Reflex epilepsies: experience in Sri Lanka

Reflex epilepsy (RE) is characterised by seizures that are regularly elicited by some specific stimulus or event mediated by neural pathways. In a prospective study of 1287 epileptic patients seen at Peradeniya, 223 (17.3%) were found to have RE, eating being the commonest stimulus (191 patients, 85.7%). Photosensitive epilepsy (PSE) was relatively rare. Intermittent photic stimulation on 874 unselected epileptic patients produced a positive photoconvulsive response in 60 (6.9%). None had photosensitive seizures, but 3 had a higher frequency of seizures while watching television. Eating epilepsy (EE) had the highest prevalence at Peradeniya (148/1000 epileptic patients). This group was male predominant, and the onset of epilepsy in most cases was in the second decade. The majority experienced partial complex seizures. Repetitive and chronic stimulation of the amygdala during eating is suggested as the mechanism underlying EE. Twenty-one patients had seizures evoked by calculation, problem solving or spatial tasks. Juvenile myoclonic epilepsy was the commonest form of seizure disorder in them. Although PSE itself is rare, self-induced epilepsy (SIE) was common. There were 8 patients who self-induced seizures. The majority were photosensitive and they induced seizures by gazing at the sun and waving a hand in front of the eyes. In the management of REs, clobazam produced impressive results. As for possible seizure-inhibitory mechanisms, our studies on a "Sathi" mediator showed definite EEG changes during mediation. Can mediation increase the seizure-threshold and abort or prevent the propagation of the epileptic discharge? The answer, apart from its possible therapeutic applications, may provide insight into the mechanisms of seizure generation.