Epilepsia, 47(Suppl. 2):115–118, 2006 Blackwell Publishing, Inc. C  International League Against Epilepsy Case Reports Eye-Closure–Triggered Paroxysmal Activity and Cognitive Impairment: A Case Report ∗ Cristiano Termine, †Guido Rubboli, and †Pierangelo Veggiotti ∗ Child Neuropsychiatry Unit, Department of Clinical and Biological Sciences, University of Insubria, Varese, Italy; †Department of Neurology, Bellaria Hospital, Bologna, Italy; and ‡Department of Child Neurology and Psychiatry, IRCCS “C. Mondino” Foundation, University of Pavia, Italy Summary: Purpose: To study the neuropsychological status of an epileptic patient presenting with epileptic activity triggered by eye closure in a 14-year follow-up period. Methods: The patient was studied at 12 and 26 years of age; during this period he underwent periodical clinical evalua- tions and EEG investigations; brain magnetic resonance imaging (MRI) was performed at 12 years of age. A neuropsychological assessment was carried out both at 12 years of age (T0) and at 26 years of age. At T0 and T1, neuropsychological tests (digits and words span, graphoestesia, reactions time to auditory stimuli, sentences repetition, words repetition, digital gnosis, backward counting [i.e.,100–0]) were performed during video-EEG mon- itoring either with eyes closed or with eyes open, to evaluate possible transitory effects related to ongoing epileptic activity. Moreover, at T0 the patient underwent Wechsler Intelligence Scale for Children-Revised, and at T1 to Wechsler Adult Intel- ligence Scale-Revised. Results: EEG recordings showed continuous epileptic activity triggered by eye closure, disappearing only with eyes opening, both at T0 and T1 (in this latter case, anteriorly predominant). The results of neuropsychological assessment during eyes closed as compared to performances with eyes open did not show sig- nificant differences, at T0 as well as at T1. Wechsler Intelligence scales showed a deterioration of performances at T1 with respect to T0; in addition, at T1, attention and short-term memory abnor- malities, impairment in facial recognition and block design, and defective results in Continuous Performance Test and Wisconsin Card Sorting Test were observed. Conclusions: Lack of differences between the results of neu- ropsychological tests performed with eyes closed as compared to the eyes open condition suggests that in our patient epileptic activity did not cause transitory cognitive abnormalities. Deteri- oration of Wechsler Intelligence Scales in the follow-up period might be interpreted as the result of a disruption of cognitive processes possibly related to the persistence of a continuous epileptic activity during eye closure over the years. We spec- ulate whether a dysfunction in posterior cortical areas involved in visual processing might be related to the impairment in face recognition and block design tests as well to eye closure sensitiv- ity. Key Words: Reflex epilepsy—Eye closure sensitivity— Transient cognitive impairment—Neuropsychology. Photosensitive epilepsy, i.e., with seizures triggered by intermittent photic stimulation or by visual stimuli in daily life, is by far the most common form of reflex epilepsy. Visual sensitivity (VS) or intermittent photic stimulation (IPS) sensitivity “per se” is not recognized as a characteris- tic of a specific epileptic syndrome, i.e., these features are not sufficient to delineate a “photogenic epilepsy” as an in- dividual entity (1). Indeed, “photosensitivity” (including VS or IPS sensitivity) can be observed in a variety of hu- man epilepsies, either focal or generalized, or idiopathic, Address correspondence and reprint requests to Dr. Cristiano Termine, Child Neuropsychiatry Unit, Department of Clinical and Biological Sci- ences, University of Insubria, Piazza Biroldi 19—21100 Varese, Italy. E-mail: cristiano.termine@uninsubria.it doi:10.1111/j.1528-1167.2006.00708.x cryptogenic, symptomatic (2–4). The heterogeneity of the epileptic conditions displaying photosensitivity has ren- dered difficult the evaluation of possible neuropsycholog- ical aspects related to photosensitivity itself and its long- term evolution. Epileptic discharges can impair cognitive functions transitorily (i.e., transient cognitive impairment (TCI)), or, when persisting for months in an almost continuous fashion (such as in electrical status epilepsicus during slow sleep) they can be associated with permanent neu- ropsychological deficits (5). Indeed, it has been postulated that many developmental or acquired defects of language (such as acquired epileptic aphasia or Landau-Kleffner syndrome) or behavior (such as autism) in children are a consequence of apparently subclinical spikes interfering with specific cerebral processes (6). 115