Self induced noogenic (thought provoked) absence seizures are reported in a photosensitive epileptic patient, a 20 year old man, treated at St Thomas’ Hospital, London, UK. A febrile seizure at age 4 was followed by generalized tonic-clonic seizures precipitated by television at age 11 years and the onset of absence seizures at 12 years, coinciding with the time of his father’s death. Photosensitivity to frequencies from 10 to 50 Hz were accompanied by 3-4 Hz polyspike and wave EEG discharges. Seizures were refractory to sodium valproate at age 15, but were controlled by the addition of lamotrigine at age 18 and his introduction to university life. When seen at 20 years, he retrospectively admitted to having self induced seizures by thinking about his deceased father and the time he spent with him in the hospital. [1]

COMMENT. Reflex epilepsies can be precipitated by external stimuli, eg flickering lights or patterns, or by internal complex stimuli, eg thought processes. The latter are more difficult to diagnose, and are uncovered only by detailed history and patient admission. Emotional factors were obviously involved in the above patient’s seizure disorder, and a change in life style was important in seizure control. Macdonald Critchley (1942) in his report of cases of musicogenic epilepsy considered emotion an important precipitant [2]. In his hagiographic obituary of Macdonald Critchley, who died Oct 15, 1997, aged 97, Robert J Joynt described him as “a reminder of the great heritage of our specialty and a vibrant contributor to it.”. [3]