Photosensitive Epilepsy: Treatment and Prevention: How?

Photosensitive epilepsy occurs in a variety of epilepsy syndromes, with different degrees of severity. Management of provocative stimuli, as well as pharmacological treatment both play important roles in prevention and treatment. Non-pharmacologic methods for treatment and prevention of photosensitive seizures include stimulus control and specialized lenses, as well as limiting exposure to alcohol and sleep deprivation. Important factors for non-pharmacologic management include viewing television from a safe distance, limiting provocative factors such as extended viewing of television or playing of video games, and recognition of visual symptoms or myoclonic jerks to remove themselves from the provocative stimulus. For pharmacological management, valproic acid is supported by extensive past studies as first line treatment for photosensitive epilepsy. Levetiracetam shows suppression of the photoparoxysmal response (PPR) and is also an effective agent. Lamotrigine, vigabatrin, and carisbamate, all reduce the PPR, and are reasonable choices for treatment of photosensitive epilepsy, depending on other factors such as associated epilepsy syndrome. Other pharmacologic agents which may be useful include ethosuximide, carbamazepine, lacosamide (particularly in JME), and clobazam. In summary, there many useful preventative and pharmacological treatment possibilities for patients with photosensitive epilepsy. Careful management of provocative factors, as well as appropriate use of anti-seizure medications, will provide optimal management.