Reflex epilepsy: triggers and management strategies

Reflex epilepsies (REs) are epileptic events precipitated by external stimuli, internal

mental process, or both. Some external stimuli are simple such as light flashes, fixationoff, hot water, visual, vestibular, auditory or tactile stimuli, or complex such as reading

or listening to music. Intrinsic stimuli can be elementary or higher cerebral functions

such as movement, emotion, thinking, calculation, and cognitive functions. The role

of stimuli on seizures was first described by Marshall Hall in 1850 and since then

many stimulus types have been defined. Photosensitive epilepsy is the most common

among the various types of REs, which has been identified over the years. Gowers

noted in 1885 that epileptic seizures could be caused by sudden loudness, sudden light,

and sudden muscle contractions.1

For the first time in the 1989 International League

against Epilepsy (ILAE) classification, the definition of epilepsy with specific stimuli

has been established.2

Reflex seizures (RS) and RE definitions were mentioned in the

next classification of ILAE (2001), whereas in the later electroclinical syndrome classification, REs were considered among less age-related epilepsy groups.2

Recently,

the classification for epileptic seizures has been updated. It recognizes new types of

focal and generalized seizures, provides additional information on causes, and clarifies obscure or questionable words and terms used to name seizures with more meaningful ones. But there is no new classification proposal for epilepsies and epileptic

syndromes, which leaves RS to be identified according to seizure type and etiology

in an individual case.3,4

Electroclinically, the seizures may be either focal or generalized where etiology may

also be either idiopathic or symptomatic. RS are clinically very similar to unprovoked

seizures, except for the presence of specific stimuli.5

The prevalence of RE ranges