Nattsumi's Epilepsy Diary

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As to why some patients with epilepsy deliberately evoke seizures remains a puzzle. Most of these patients are compulsively attracted to sunlight. They cannot offer a good explanation for their abnormal behavior, although some admit that it gives them a pleasurable or relaxing feeling. Many authors, including Radovici,71 have thought that psychological factors and stressful situations influenced the frequency of self-induced seizures. Associated behavioral abnormalities leading to social isolation and learning problems are also seen in these patients. Mental retardation was found in 30% of patients with self-induced epilepsy.82

Hand waving and blinking are the commonest techniques employed to evoke seizures.4 In our patient, rubbing the forehead was the maneuver and EEG (Fig. 1) clearly shows an eye movement artifact before the onset of epileptiform activity. This may suggest that the epileptiform activity is probably related to slow eye clo-sure.76 Seizures induced by eye closure are not rare.75,76 They may occur in patients who have a history of seizures induced by techniques such as hand waving. Hand waving provides an intermittent retinal stimulation.76 Some authors have suggested that the hand movement is part of an ictal phenomenon rather than the stimulus.1,83 In our patient, movement of hand in the absence of a bright light failed to induce epileptiform activity. This suggests that hand movement is voluntary, and this view is supported by intensive monitoring.82

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Figure 1A. EEG recording while patient rubbing the forehead- light switched on. Reproduced with permission from Senanayake N. Self-induction of seizures in photosensitive patients in a tropical country. Epilepsy Res 1988; 2:61-64.

Figure 1B. EEG recording while patient rubbing the forehead- light switched off and then switched on. Reproduced with permission from Senanayake N. Self-induction of seizures in photosensitive patients in a tropical country. Epilepsy Res 1988; 2:61-64.

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