Dados do Trabalho

Título

The sunflower syndrome: an uncommon presentation of a photosensitive epilepsy

Apresentação do caso

An 18-year-old woman with a history of mild global cognitive impairment referred for a 60-hour Video-Encephalographic Monitoring (VEEG) in 2017. Her parents noticed since 2 years of age, stereotyped hand waving movements while interposing her hands between the eyes and the sun on a recurring basis. During these events, she had impaired responsiveness for a few seconds, and then stopped spontaneously the hand waving motion. At 4 years of age, every 15 to 20 days, some seizures evolved to bilateral tonic-clonic associated with ictal groan. She was on lamotrigine and topiramate, previously using several antiepileptic drugs (AED). Interictal VEEG was characterized by occasional generalized spike-wave and polyspikes complex with frequency between 1hz and 4hz lasting 0.5 to 2 seconds, in addition to a symmetrical and organized background activity. MRI didn´t show any abnormalities.

Discussão

First described in 1932, Self-induced Photosensitive Epilepsy also known as Sunflower Syndrome (SFS) is characterized by various stereotypical movements that create a flickering effect (mainly handwaving in front of the eyes or eye fluttering) from a light source, especially sunlight. It usually starts between 3 and 10 years and was more common in females. Myoclonic and absence seizures are the main types of seizures met, rarely presenting with generalized tonic-clonic seizures. Patients with SFS are often refractory to most AED, but there are descriptions of favorable outcome with valproate and lamotrigine. Behavioral and environmental measures such as wearing hats, sunglasses, sometimes with blue lenses; and avoidance of sunlight exposure, may help to reduce episodes

Comentários finais

SFS is a poorly described and known condition, often confused with abnormal behavior. In addition, patients often have embarrassment in admitting or reporting their seizures. The exact diagnosis of this pathology ultimately allows the adoption of AED treatment and behavioral measures.