Objective:

NA

Background:

Design/Methods:

We describe a 10-year-old boy with normal development, and diagnoses of ADHD and tic disorder, who presented for a second opinion after generalized tonic clonic seizures (GTCs). He had a non-focal neurological physical exam. Mother reported repetitive arm waving in front of his face and eye fluttering that preceded GTCs.

Results:

Routine blood work and brain MRI were normal. Video electroencephalogram (EEG) revealed interictal polyspike discharges, and a photoparoxsymal response. Our patient’s hand-waving episodes and seizures responded almost completely to valproic acid and other non-pharmacological measures (sunglasses). 

Conclusions:

Sunflower Syndrome is an under-recognized, typically refractory, photosensitive epilepsy syndrome characterized by compulsive hand-waving in front of the face to mimic a strobe effect. Patients are often drawn to light sources (sunlight, bright lights) that will induce the epileptic seizure, eyelid myoclonia and hand-waving episodes. Although there are several reports of Sunflower syndrome in the medical literature, this epilepsy continues to be poorly understood. There continues to be uncertainty regarding whether the hand-waving episodes themselves are ictal in nature. We describe in this case report electrographic ictal correlation with the hand-waving episodes. This is consistent with other studies that have presented EEG data that supports the hypothesis that the hand-waving episodes are in fact part of the seizure semiology. In this case the patient was able to be treated and had good clinical and electrographic response to mono-therapy with valproic acid.