Reflex Photosensitive Epilepsy

Abstract Sunflower syndrome is a frequently misdiagnosed and misunderstood reflex epilepsy with childhood onset characterized by distinctive handwaving episodes, sometimes associated with eyelid myoclonia. During a typical seizure associated with Sunflower syndrome, an individual turns toward a bright light source, often tilting their head, and waves one hand in front of their eyes. The individual’s eyes may be closed or fluttering during the handwaving episode. Each episode is typically brief, although some individuals can have prolonged episodes that can result in loss of consciousness or progress to other seizure types. A family history of generalized epilepsy is common, which, in addition to the very stereotyped semiology of the handwaving episodes, suggests a genetic etiology for Sunflower syndrome. The EEG features are consistent with a generalized epilepsy. Associated seizures are often pharmacoresistant, although some patients have attained seizure control with currently available broad-spectrum anti-seizure medications. The nature of the handwaving episodes has been debated in the medical community, but recent studies have supported the hypothesis that the handwaving episodes themselves are seizures, and not a method of inducing seizures. The provoking stimulus is most often the sun, although many patients report handwaving episodes that are triggered by artificial lights as well.