Journal
EPILEPSIA
Volume 63, Issue 4, Pages 739-768Publisher
WILEY
DOI: 10.1111/epi.17175
Keywords
EEG; epilepsy; photosensitivity; seizures
Categories
Funding
- Maslah Saul MD Chair
- James and Carrie Anderson Epilepsy Fund
- Steve Chen Epilepsy Research Fund
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Light stimulation can trigger seizures in certain individuals, especially in young people and those with specific forms of epilepsy. Photosensitive seizures can coexist with spontaneous seizures and have a genetic component. The exact mechanisms of photosensitive seizures are still unclear, but specific triggers such as flashes or color changes can provoke seizures. Prevention strategies include avoiding triggers, covering one eye, keeping a safe distance from screens, reducing contrast, and taking certain antiseizure medications. Visually-induced seizures pose significant public health risks, requiring ongoing scientific research, regulation, and public education.
Light flashes, patterns, or color changes can provoke seizures in up to 1 in 4000 persons. Prevalence may be higher because of selection bias. The Epilepsy Foundation reviewed light-induced seizures in 2005. Since then, images on social media, virtual reality, three-dimensional (3D) movies, and the Internet have proliferated. Hundreds of studies have explored the mechanisms and presentations of photosensitive seizures, justifying an updated review. This literature summary derives from a nonsystematic literature review via PubMed using the terms photosensitive and epilepsy. The photoparoxysmal response (PPR) is an electroencephalography (EEG) phenomenon, and photosensitive seizures (PS) are seizures provoked by visual stimulation. Photosensitivity is more common in the young and in specific forms of generalized epilepsy. PS can coexist with spontaneous seizures. PS are hereditable and linked to recently identified genes. Brain imaging usually is normal, but special studies imaging white matter tracts demonstrate abnormal connectivity. Occipital cortex and connected regions are hyperexcitable in subjects with light-provoked seizures. Mechanisms remain unclear. Video games, social media clips, occasional movies, and natural stimuli can provoke PS. Virtual reality and 3D images so far appear benign unless they contain specific provocative content, for example, flashes. Images with flashes brighter than 20 candelas/m(2) at 3-60 (particularly 15-20) Hz occupying at least 10 to 25% of the visual field are a risk, as are red color flashes or oscillating stripes. Equipment to assay for these characteristics is probably underutilized. Prevention of seizures includes avoiding provocative stimuli, covering one eye, wearing dark glasses, sitting at least two meters from screens, reducing contrast, and taking certain antiseizure drugs. Measurement of PPR suppression in a photosensitivity model can screen putative antiseizure drugs. Some countries regulate media to reduce risk. Visually-induced seizures remain significant public health hazards so they warrant ongoing scientific and regulatory efforts and public education.
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