Abstracts

Reflex epilepsy is defined as seizures that are objectively and consistently evoked by a specific afferent stimulus or by activity of the patient. The afferent stimuli or activity may be elementary or elaborate[1]. Reflex seizures can be characterized by either focal or generalized seizures seizures. They are classified according to the precipitating stimuli[2]. The commonest form of reflex epilepsy is seizures triggered by flickering light. However, numerous other triggers have been described including visual stimuli, flickering light, patterns, thinking, praxis, reading, somatosensory, eating, music, and startle. The prevalence is unknown but felt to be rare. We describe two patients with symptomatic epilepsy with seizures induced by eating with a spoon., Through the comprehensive epilepsy clinic, two patients were identified with reflex epilespy with a stimuli being a spoon. They were an 11 year-old left-handed male with a chromosome 15 duplication and MRI findings of frontoparietal periventricular white matter lesions and a 5 year-old right-handed male with lissencephaly type I., One patient had EEG/video monitoring performed and revealed a seizure from the left central region while being fed with a spoon., Eating epilepsy is characterized by seizures closely related to one or several actions of eating, and the triggers are specific and stereotyped for each patient. The seizures are typically focal motor seizures and almost always related to a symptomatic epilepsy. The epileptiform activity seen on EEG is typically localized to temporolimbic structures or suprasylvian regions. Generalized EEG activity is rare. Many patients have seizures activated by combinations of stimuli. Patients with suprasylvian lesions may be triggered by other oral activities induced by proprioceptive or by somatosenosory stimulation. These patients are, also, more likely to report that they prevent seizures by altering the characteristics of the stimulus.[3]
These two patients have a form of relex epilepsy induced by a combination of eating and the use of a spoon. Both had rapid habituation with only a transient reduction in seizures following a change in feeding utensils. Alteration of the stimulus did decrease the frequency of the events but only transiently. One patient with video EEG monitoring revealed a focal seizure onset. They are both poorly controlled with underlying symptomatic etiologies.
[1] Warren T. Blume[mdash]Chair, Hans O. Lüders, Eli Mizrahi, Carlo Tassinari, Walter van Emde Boas, Jerome Engel, Jr. [italic]Epilepsia [/italic]2001 Sep; 42(9): 1212-8. [ldquo]Glossary of Descriptive Terminology for Ictal Semiology: a report of the ILAE task force on classification and terminology[rdquo]
[2] Xue, LY, Ritaccio, AL [italic]Amreican Journal of Electrodiganostic Technology [/italic]2006 Mar; 46(1): 39-48. [ldquo]Reflex seizures and reflex epilepsy[rdquo].
[3] Zifkin, BG, Andermann, F. www.ILAE.com Mar 29,2003. [ldquo]Precipitating Stimuli for Reflex Seizures[rdquo].,