Fiona M Baumer1, Brenda E Porter2. 1. Stanford University School of Medicine, Department of Neurology, Division of Child Neurology, United States. Electronic address: fbaumer@stanford.edu. 2. Stanford University School of Medicine, Department of Neurology, Division of Child Neurology, United States. Electronic address: brenda2@stanford.edu.
Abstract
BACKGROUND: Sunflower Syndrome describes reflex seizures - typically eyelid myoclonia with or without absence seizures - triggered when patients wave their hands in front of the sun. While valproate has been recognized as the best treatment for photosensitive epilepsy, many clinicians now initially treat with newer medications; the efficacy of these medications in Sunflower Syndrome has not been investigated. We reviewed all cases of Sunflower Syndrome seen at our institution over 15 years to describe the clinical course, electroencephalogram (EEG), and treatment response in these patients. METHODS: Search of the electronic medical record and EEG database, as well as survey of epilepsy providers at our institution, yielded 13 cases of Sunflower Syndrome between 2002 and 2017. We reviewed the records and EEG tracings. RESULTS: Patients were mostly young females, with an average age of onset of 5.5 years. Seven had intellectual, attentional or academic problems. Self-induced seizures were predominantly eyelid myoclonia ± absences and 6 subjects also had spontaneous seizures. EEG demonstrated a normal background with 3-4 Hz spike waves ± polyspike waves as well as a photoparoxysmal response. Based on both clinical and EEG response, valproate was the most effective treatment for reducing or eliminating seizures and improving the EEG; 9 patients tried valproate and 66% had significant improvement or resolution of seizures. None of the nine patients on levetiracetam or seven patients on lamotrigine monotherapy achieved seizure control, though three patients had improvement with polypharmacy. CONCLUSIONS: Valproate monotherapy continues to be the most effective treatment for Sunflower Syndrome and should be considered early. For patients who cannot tolerate valproate, higher doses of lamotrigine or polypharmacy should be considered. Levetiracetam monotherapy, even at high doses, is unlikely to be effective.
BACKGROUND:Sunflower Syndrome describes reflex seizures - typically eyelid myoclonia with or without absence seizures - triggered when patients wave their hands in front of the sun. While valproate has been recognized as the best treatment for photosensitive epilepsy, many clinicians now initially treat with newer medications; the efficacy of these medications in Sunflower Syndrome has not been investigated. We reviewed all cases of Sunflower Syndrome seen at our institution over 15 years to describe the clinical course, electroencephalogram (EEG), and treatment response in these patients. METHODS: Search of the electronic medical record and EEG database, as well as survey of epilepsy providers at our institution, yielded 13 cases of Sunflower Syndrome between 2002 and 2017. We reviewed the records and EEG tracings. RESULTS:Patients were mostly young females, with an average age of onset of 5.5 years. Seven had intellectual, attentional or academic problems. Self-induced seizures were predominantly eyelid myoclonia ± absences and 6 subjects also had spontaneous seizures. EEG demonstrated a normal background with 3-4 Hz spike waves ± polyspike waves as well as a photoparoxysmal response. Based on both clinical and EEG response, valproate was the most effective treatment for reducing or eliminating seizures and improving the EEG; 9 patients tried valproate and 66% had significant improvement or resolution of seizures. None of the nine patients on levetiracetam or seven patients on lamotrigine monotherapy achieved seizure control, though three patients had improvement with polypharmacy. CONCLUSIONS:Valproate monotherapy continues to be the most effective treatment for Sunflower Syndrome and should be considered early. For patients who cannot tolerate valproate, higher doses of lamotrigine or polypharmacy should be considered. Levetiracetam monotherapy, even at high doses, is unlikely to be effective.
Authors: Roberto H Caraballo; Elena Fontana; Francesca Darra; Santiago Chacon; Nicolas Ross; Elena Fiorini; Natalio Fejerman; Bernardo Dalla Bernardina Journal: Seizure Date: 2009-05-05 Impact factor: 3.184
Authors: Elizabeth C Galizia; Candace T Myers; Costin Leu; Carolien G F de Kovel; Tatiana Afrikanova; Maria Lorena Cordero-Maldonado; Teresa G Martins; Maxime Jacmin; Suzanne Drury; V Krishna Chinthapalli; Hiltrud Muhle; Manuela Pendziwiat; Thomas Sander; Ann-Kathrin Ruppert; Rikke S Møller; Holger Thiele; Roland Krause; Julian Schubert; Anna-Elina Lehesjoki; Peter Nürnberg; Holger Lerche; Aarno Palotie; Antonietta Coppola; Salvatore Striano; Luigi Del Gaudio; Christopher Boustred; Amy L Schneider; Nicholas Lench; Bosanka Jocic-Jakubi; Athanasios Covanis; Giuseppe Capovilla; Pierangelo Veggiotti; Marta Piccioli; Pasquale Parisi; Laura Cantonetti; Lynette G Sadleir; Saul A Mullen; Samuel F Berkovic; Ulrich Stephani; Ingo Helbig; Alexander D Crawford; Camila V Esguerra; Dorothee G A Kasteleijn-Nolst Trenité; Bobby P C Koeleman; Heather C Mefford; Ingrid E Scheffer; Sanjay M Sisodiya Journal: Brain Date: 2015-03-17 Impact factor: 13.501