Startle can precipitate seizures in susceptible persons, and occasionally is the only precipitant. Startle-induced seizures usually occur in patients with a frontal or central focus and usually in lesional epilepsy. The seizures usually take a form similar to a tonic seizure, and the EEG is commonly normal
Table 1.33 Tactics that can reduce the risk of television-induced seizures in susceptible individuals.
Use a small screen, or view screen from a distance, use a remote control for changing channels (thereby reducing the area of screen in the visual field) View the screen from an angle
Use a 100 Hz television screen, a non-interlaced computer screen with a high refresh rate or a liquid crystal display Close or cover one eye Keep the screen contrast and brightness low Avoid exposure when sleep deprived Avoid looking at a fixed flickering pattern Use polarizing glasses or shows rather non-specific changes. A susceptibility to startle is more common in late childhood and adolescence and may resolve as the patient get older. The most common stimulus is a loud noise, but touch, sudden movement or fright can also precipitate attacks. Startle-induced epilepsy must be differentiated from hyperekplexia, which has a very similar clinical form, but which is not a form of epilepsy. Treatment can be difficult although carbamazepine and the benzodiazepine drugs have been said at an anecdotal level to be most likely to control the attacks.
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