I welcome back Dr. Frederick Strobl to discuss the odd syndrome of Reflex Epilepsy.
Epileptic attacks or seizures can have many causes and triggers. Most forms of epilepsy (recurrent seizures) are idiopathic, meaning that there is no identifiable cause. At times, the case involves a genetic predisposition to epilepsy.
Identifiable causes include brain tumors, strokes, head injuries, encephalitis, and various chemical abnormalities. The identifiable cause is often simple, provoked, and harmless–like the college student who doesn’t sleep for 72 hours studying for finals and then celebrates with alcohol.
One of the more fascinating and rare forms is reflex epilepsy. My first case involved a young boy who would sit at the kitchen table and periodically throw his fork with his right hand at his mother when eating. This was interpreted as defiance until one day the young man experienced a full-blown tonic-clonic (grand mal) seizure and was referred to the University of Minnesota. I supervised his EEG, which was normal. To the dismay of the technicians, however, I insisted that we keep him hooked up to the machine while I got him a sandwich. After a few seconds of chewing, the boy threw the sandwich with his right hand and then went on to have a tonic-clonic seizure.
My second case was even stranger. A young woman came in and explained that if she stepped on her left foot in a certain way she would have uncontrollable jerking. When examining her, I noticed that if I touched various points around her foot, she would jerk. To give her the benefit of the doubt, I repeated this while doing an EEG–she did, in fact, have reflex epilepsy. Even more bizarre, she would jerk even when she thought I was going to touch her foot!
At the time, we knew that certain stimuli could cause seizures. Photic (light) stimulation via a stroboscope was routinely done because it could trigger seizures in some and was highly frequency-dependent. I had never seen this outside of the lab until one day a Go-Go dancer was brought into the hospital after a strobe light hit her sensitive frequency while she was in a suspended cage and set off a seizure. (This was certainly the most unusual Workers’ Compensation case I had ever had!).
A few years later, I was doing some advanced EEG training at Mayo Clinic. One young patient experienced seizures when he visited his divorced father. His father would wear frequently wear ties with thin stripes that were tilted at thirty-degree angles. His son would have an epileptic seizure only when seeing that pattern with the stripes at that angle.
Since that time, many similar cases have been reported, including one patient who would seizure when simply thinking about specific mathematical equations. In such cases, patients have an area of the brain that is like a “bad chip”–when the neurons connect to it, the system crashes.
Overall, reflex epilepsy is a mysterious disease that explains some very strange behaviors.
Frederick (Fritz) Strobl, MD is a neurologist and a Director of the Minneapolis Clinic of Neurology, one of the largest private clinics in the world devoted entirely to neurology. His Dr. Jack Stevens series of medical thrillers includes Presidential Migraines and Greek Flu. His next book, Cyber Death, is due to be released in April 2012.
Visit Fritz’s website at: www.fritzstrobl.net.