Seizures from Art Exhibit, Latest Example of Photosensitive Epilepsy

gallery-zee_420

Outside Gallery ZEE in Pittsburgh

A Pittsburgh art exhibit that closed this week after three people were treated for reported seizures.

Shaunda Miles, spokeswoman for the Pittsburgh Cultural Trust, said the exhibit titled “Zee” by Austrian artist Kurt Hentschlager is closed indefinitely.

ZEE-7-OSKH-300dpi

The installation, part of the Cultural Trust’s Pittsburgh International Festival of Firsts, was scheduled to run through Oct. 27.

It includes heavy fog and intense strobe effects, and attendees must sign a waiver before entering.

Click here to find out more about this story.

Photosensitive Epilepsy


Epileptic seizure types can be  induced in certain susceptible patents by photic (or visual) stimuli,  usually flashing lights or rapidly changing/alternating images . Some famous examples have included:

Pokeman

An animated segment of a film promoting the 2012 London Olympics:

Flickering fluorescent lighting:

Video Games:

Strobe lights in clubs:

Photosensitive seizure only occur in a small proportion of patients with generalized epilepsy, and those patients will usually know they are susceptible based on their routine diagnostic EEG, which will usually include intermittent photic stimulation as part of routine testing.
Click here to find out more about seizures and epilepsy

Advertisements

Blackout – was it a fit or a faint?

People generally experience a blackout (temporary loss of consciousness) from one of two common problems: (1) Insufficient blood flow to the brain (syncope)  or (2) Abnormal electrical activity within the brain (seizure).

xx

Syncope (or a faint) is caused by insufficient blood flow to the brain because of low blood pressure.  There may be a prodrome of dizziness loss of vision and hearing weakness, flushing, nausea (sometimes referred to pre-syncope).  Then there will be overt loss of consciousness that leads to the faint.  The affected patient will typically fall by dropping forwards from loss of muscle tone. The affected patient might look pale and clammy, and will usually come around quickly of they are allowed to lay down on floor allowing blood flow to return to the brain.  Syncope can be caused by dehydration, irregular heart beat, or emotion (vasovagal or “neurocardiogenic” syncope).

http://www.youtube.com/watch?v=rrjQW7UIvMU&start=35&rel=0

xx

A seizure (or a “fit”) is caused by abnormal electrical activity in the brain, usually accompanied by a clinical event that can vary from a brief loss of awareness (an absence seizure or “petit mal”) to loss of awareness with thrashing limb movements (a tonic-clonic or grand mal seizure).  A generalized tonic-clonic seizure will usually be associated with increased muscle tone, so the patient will stiffen up and fall backwards not forward and may bite their tongue.  The eyes will be open, and their may be loss of bladder and bowel control.  There may be flailing limb movements that lead to injury.  After the seizure stops, the patient will usually be confused or dazed, and not come around immediately like the syncope patient.

http://www.youtube.com/watch?v=wHTPfPcOHyo&start=285&rel=0

xx

Here is a table that emphasizes the differences between fits (seizures) and faints (syncope):

sz2

xx

If you have experienced a blackout, what should you do? A simple faint in an otherwise young healthy person may not need emergent medical care.  However, syncope in an older person with a cardiac history, or syncope associated with chest pain and breathlessness could indicate a heart problem and usually justify an emergency room visit.  Similarly a new onset seizure in somebody not previously know to have epilepsy should justify an emergency room visit.

Epilepsy surgery and functional MRI

fmri

BrainMRI3planes

Epilepsy surgery is an option for patients with intractable partial onset seizures that are not controlled by oral medications.  Epilepsy monitoring is used to localize the seizure focus, often a lesion or abnormal area of brain located in the temporal lobe.  That part of the brain is then carefully removed to prevent future seizures:

seizure surgery2

A patient with a brain abnormality in the R temporal lobe (top) undergoes brain surgery to remove that area of brain and prevent future seizures.

Epilepsy surgery is very effective and yet still underutilized for treating seizures.

Left temporal lobe resections are more risky that right-sided cases, because the left hemisphere controls language functions in most (even left handed) patients.  Surgeons have to be very careful planning seizure surgery on the left side to be sure that they do not damage brain critical for speech and language and leave the patient with aphasia.

That’s where functional magnetic resonance imaging (fMRI) comes in.  fMRI goes beyond the conventional imaging of brain structure, and can actually localize regional brain functions by detecting changes in regional blood flow in response actual or imagined activity.

fMRI is increasingly being used to evaluate candidates for epilepsy surgery by identifying important functional regions within the brain, including unpredictable patterns of functional reorganization, to prevent unexpected post-operative deficits.  Click here for a link to a paper with illustrative cases.

Monmouth’s New Onset Seizure Center Opens in June!

https://i1.wp.com/www.mnepilepsyhudson.org/wp-content/uploads/2011/07/iStock_000017472498Small.jpg

New onset seizures can be isolated events or the harbinger of future epilepsy.

Decisions about starting medications and restricting driving are complicated, and are best made by neurology sub-specialists (“epileptologists“) after a detailed evaluation that usually includes an electroencephalogram (EEG) and brain magnetic imaging study (MRI).

Monmouth Neuroscience Institute is pleased to announce the opening of the region’s first New Onset Seizure Center in June 2013.

Patients who come to the emergency room with their first seizure can be stabilized and then sent home with instructions to follow-up in New Onset Seizure Center, an integral part our Certified Epilepsy Center within one week.

All patients coming to the center they will undergo an EEG, MRI of the brain and a visit with one of our board certified fellowship-trained epilepsy experts during a single visit.

This avoids hospitalization and hasty decisions about medical management.

Click here to find out more about the center.

Monmouth Epilepsy Program Receives NAEC Certification

Monmouth Medical Center’s Epilepsy Program was awarded prestigious level 3 certification today by the National Association of Epilepsy Centers!

Monmouth certificateThe National Association of Epilepsy Centers (NAEC) is a non-profit  association with the primary objective of connecting people with epilepsy to specialized epilepsy care and epilepsy centers.

Founded in 1987 by physician leaders committed to setting a national agenda for quality epilepsy care, the NAEC educates public and private policymakers and regulators about appropriate patient care standards, reimbursement and medical services policies.

NAEC works in conjunction with existing scientific and charitable epilepsy organizations.

A third-level center must provide all the medical, neuropsychological, and psychosocial services needed to treat patients with refractory epilepsy to achieve certification.

Click here to find out more about Monmouth’s Epilepsy Program.

Click here to find out more about seizures and epilepsy.

Alice in Wonderland Syndrome

Caused by a disturbance of perception rather than an actual physiological change
Altered body image (Ex: big buildings look same size as person’s own body)
Distorted perception of size (micropsia, macropsia)
Distorted perception of the shape of objects
Loss of spatial perspective (sense of time and space)
Auditory or tactile hallucinations

AIWS generally affects a younger population and has several associated conditions. Migraine is the classic disease linked to AIWS, the distorted sensations can either begin before a migraine (aura or “warning”) or afterwards, and in younger patients can even occur without headache

Check out these first-hand accounts of people with this interesting phenomenon:
Size Matters: Living in a Lewis Carroll ‘Wonderland’ – ABC News

When the world looks like a real-life Wonderland

Experience: I have Alice In Wonderland syndrome 

A Not So Pleasant Fairy Tale: Investigating Alice in Wonderland Syndrome | Serendip Studio

Other causes of Alice in Wonderland Syndrome are:
psychoactive drugs
infectious mononucleosis
malignancy
temporal lobe epilepsy

Certain tests & imaging studies help rule out secondary causes:
urine toxicology screen
monospot test   
(for mononucleosis)
MRI brain
with and without contrast (to look for malignancy)
EEG   
(to detect seizures or seizure-like activity)

Sounds scary, right? Well, good news is it’s not as bad as it sounds. Most patients who experience AIWS as children will outgrow the condition as adults. Patients should be monitored for worsening of symptom severity and frequency. If all studies are negative and the patient continues to improve clinically, then further evaluation and/or treatment is not needed. Best management for future attacks is focused on migraine prophylaxis and lifestyle modifications (healthy diet, regular exercise, adequate sleep).

Posted By Sidra Ghafoor, Drexel University College of Medicine Class of 2013