Self-induction is a mode of seizure precipitation employed by entirely normal or mentally impaired patients to produce seizures for themselves. Maneuvers for self-induction aim to provoke a seizure by producing optimal conditions of stimulation by flickering light (self-induced photosensitive epilepsy), patterns (self-induced pattern-sensitive epilepsy), proprioceptive stimuli or higher brain functions (self-induced noogenic epilepsy).

Prevalence
The exact prevalence of self-induced seizures is difficult to determine and may have been overestimated. In many cases:

1. “self-induced” behaviors do not appear to be wilful or consciously generated,
2. Eyelid blinking or forced eyelid deviation towards the light has been unquestionably taken as evidence of self-induction.

In my experience of 442 patients with onset of nonfebrile seizures from age 0 through 15 years only 5 (1.3%) had self-induced seizures.

Age of onset
Varies from infancy to mainly early childhood.

Sex
Female (70% to 80%) predominate.

Etiology
Unknown. It happens in both symptomatic and idiopathic cases of photosensitive epilepsy.

Clinical manifestations
Absences and myoclonic jerks are the most common seizures in self-induction. Generalized tonic-clonic seizures (GTCS), when they occur, are usually accidental events that were not desired. GTCS usually follow deliberately self-induced absences or jerks.

The objective of self-induced seizures is relief of tension and anxiety, and escape from a disturbing situation.

One particular strategy for self-induction in photosensitive epilepsy is to look at a bright light source, usually the sun, and voluntarily wave the abducted fingers in front of the eyes (sunflower syndrome) in order to produce optimal intermittent photic stimulation. Others do (1) repetitive opening and closing of the eyes or lateral or vertical rhythmic movements of the head in front of a bright light source; (2) make the television picture roll; (3) quickly change television channels while watching from a close distance; or (4) play video games.

Differential diagnosis
Tics but more often genuine ictal phenomena such as eyelid myoclonia or eye closures of occipital seizures.

Early forced eyelid blinking and flutter, eyelid jerks and oculoclonic activity may be ictal manifestations of the occipital lobes as documented with deep stereo- EEG recordings which may not show in surface EEG.

Eyelid blinking and gaze-fixation to light may be a normal ‘attraction movement’ when light is presented and other manifestations of the optic fixation reflexes when volitional movements of the eyes are unattainable or weak.

Blinking functions as a complex indicator of phasic responses to stress such as that produced by listening to emotionally laden words.

Management options*
Avoidance of precipitating factors may be impossible for these patients whose objective is to self-induce seizures in order to achieve relief of tension and anxiety and escape of a disturbing situation. Therefore, self-induced seizures are difficult to control and may need psychiatric or behavioral intervention. On anecdotal evidence, fenfluramine (a serotonin releasing drug) has been recommended for the treatment of self-induced epilepsy mainly combined with valproate or levetiracetam if AEDs are needed (for patients who also have spontaneous seizures or continue with self-induction).

*Expert opinion, please check FDA-approved indications and prescribing information

This page was adapted from:

The educational kit on epilepsies
The epileptic syndromes
By C. P. Panayiotopoulos

Originally published by MEDICINAE
21 Cave Street, Oxford OX4 1BA
First published 2006 and reprinted in 2007