Does photoparoxysmal response in children represent provoked seizure? Evidence from simultaneous motor task during EEG

OBJECTIVES: Acute cognitive changes during epileptiform discharges have been studied using computer assisted cognitive tasks. We aimed to demonstrate acute behavioral change (using a simple motor response task MRT) during photoparoxysmal response (PPR) in children below 18 years. METHODS: Children performed a simple repetitive motor task during intermittent photic stimulation (IPS). All episodes of PPR not associated with obvious clinical change (as observed by the technologist or reported by the patient) were analyzed for this study. The average time interval between two successive motor responses across a PPR (test time) was compared to the average time interval between two successive motor responses during IPS not associated with PPR (control time) using Wilcoxon signed ranks test. RESULTS: 21 children who had PPR successfully completed the MRT. The difference between the mean durations was 0.894 s (p=0.002). More than 50% increase compared to the control time was considered a delay in MRT during PPR. 10 children showed slowing of MRT during PPR. CONCLUSION: By definition, acute behavioral change during generalized epileptiform discharges represent provoked seizures. Detecting subclinical seizures can have important safety implications in children (skiing, skating and driving) with PPR on EEG, but no clinical seizures. We recommend MRT during IPS.