Reflex Epilepsies

Reviewed by: HU Medical Review Board | Last reviewed: November 2022

Specialists currently recognize dozens of epilepsy syndromes. These syndromes differ from one another in many ways. These ways include when the seizures begin, what kind of seizures the syndromes cause, and where the seizures occur in the brain.1

Reflex epilepsies (REs) are seizures that are caused by a certain stimulus or trigger. There are many things that can trigger an RE, such as:1

Flashing lights are the most common RE trigger. But not everyone living with REs has the same triggers. RE seizures can be focal (involving 1 area of the brain) or complex (involving multiple areas of the brain). It is common to have spontaneous seizures along with reflex seizures.1,2

Common types of reflex epilepsy

While there may be many types of RE triggers, there are only a few types of RE that have been studied well enough to be named. These include:2

  • Idiopathic photosensitive occipital lobe epilepsy – These are seizures in the back of the brain. Triggers include flickering lights, TV, and video games.
  • Other visual sensitive epilepsies – These are also triggered by light but may occur in any area of the brain.
  • Primary reading epilepsy – This is more common in young men. It appears as muscle jerks around the mouth and jaw when reading.
  • Startle epilepsy – This is most commonly diagnosed in childhood to early adolescence. It is often triggered by sudden noise. While startle epilepsy is rare overall, it is especially common in those living with Down syndrome.

What seizures does reflex epilepsy cause?

Because there are many kinds of reflex epilepsies, many different seizure types are seen. Focal seizures are the most common kind. However, REs can also cause, among others:1

Who develops reflex epilepsy?

About 4 percent to 7 percent of those living with epilepsy experience RE. It is more likely to occur in younger people, ages 7 to 19. Females are twice as likely as males to be diagnosed. However, certain REs occur in specific areas or age groups. For example, hot water epilepsy is often seen in southern India whereas thinking epilepsy is most likely to affect teen boys.2

How is it diagnosed?

Diagnosis starts with your doctor asking for a detailed history. They will ask about what triggers the seizures and what the seizures look like. They will likely order an electroencephalogram (EEG), which allows them to see brain activity. Finally, they may want images of the brain and may order magnetic resonance imaging (an MRI) to get them.3

How is it treated?

RE treatment varies slightly according to the trigger. But the overall advice is to avoid the trigger as much as possible. For those who are triggered by light, it is helpful to:2

  • Avoid flashing lights
  • Sit at least 6 feet away from the TV screen
  • Avoid watching TV in a dark room
  • If exposed to flashing lights, it may help to cover 1 eye. Blue light glasses or tinted lenses can also be helpful, particularly while playing video games.2

If preventive measures are not enough, your doctor may prescribe anti-seizure drugs. The most common drug is valproic acid. It is effective in most patients. If that does not work, your doctor may recommend levetiracetam.2

If you believe that you or your child may experience reflex epilepsy, reach out to your doctor or neurologist.

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