Case Studies

When she was nine, she became a little introvert & would like to be by herself, probably related to the approaching examinations. She would get nightmares & could not sleep well. After one such bad dream, she got out of her bed & came to the living room & turned the T.V set on without its sound, not to disturb anyone. She saw the T.V screen lighting up & next she knew were her mother & father fussing over her, bandaging her bleeding lip & cheek. Her tongue was sore & she had bitten it badly. She got a scolding from her parents for trying to watch TV at night & tripping & falling in the unlit room. Nothing further was made out of this & life went on.

One Sunday evening, the whole family sat down to watch a hit movie. After a few minutes Shefali let out a cry & fell down from her chair, writhing and frothing. Her mother put her to bed & realized that the child was not understanding anything said to her, but thought that she was probably “seeking attention” & family decided to show her to a psychiatrist before she became a “Problem Child” & after the interview, was sent over to the neurologist.

Her behaviour, general physical and neurological examinations were within normal limits. The EEG was normal till the photic stimulation was recorded. At 15-20 cycles/sec, there was slow wave build up and at times, there were spike & slow wave sequences. After the EEG, mother took her to a cinema hall & there while watching the movie, Shefali got another seizure. A diagnosis of photosensitive epilepsy was made.

Seizure of this type, induced by flickering lights are usually generalized Tonic clonic in nature & may be preceded by mild clonic jerks. The seizures usually begin in childhood & become less prominent in late twenties. Some subjects are also sensitive of stationary striped patterns in addition to flickering lights. Television viewing at close distances is probably the most potent stimulus.

Following steps can be taken to avoid such epileptogue episodes.

• Watch television with a small screen
• Sit at least 2 meters away from screen
• Use remote control
• Use of TV glasses – ( polariser ) to produce functional monocular occlusion which reduces the potency of the stimulus

Sodium valproate is the drug of choice above for the type of epilepsy.

Recently, an 11 year old boy from Kerala was brought with the history that he got convulsions & could bring them on at will.

On inquiring giving it was realized that initially the boy would get seizures on looking at sun rays through moving coconut tree leaves & had latched on to it. When he wanted to bring on an attack, he would move his fingers & across the field of vision while looking at the sun & could get an attack & avoid school & exams!