{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T19:10:44Z","timestamp":1789672244769,"version":"4.0.1"},"reference-count":29,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,11,16]],"date-time":"2022-11-16T00:00:00Z","timestamp":1668556800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"<jats:p>Blinking in children is most frequently a functional and transient symptom. Nonetheless, sometimes it is the first clinical manifestation of a neurological disorder. The differential diagnosis between voluntary actions, tics and other neurological disorders among which seizures may be challenging and misdiagnosis is common. A 6-year-old girl in good health was admitted for a recent history of bilateral eye blinking. Blinking did not interfere with the girl's activities. The patients reported that blinking seemed to be triggered by sunlight exposure and that girl sometimes seemed to be attracted by the sunlight. Ophthalmological diseases had been already excluded. The girl was addressed to our hospital for neurological consultation, as tic disease was considered the most probable hypothesis. Neurological examination was negative. In the field of differential diagnosis of photosensitive abnormal eyelid movements, the hypothesis of seizures was explored and further investigated with a video-EEG recording with light stimulation. This exam demonstrated a photoparoxysmal response (PPR) to intermittent photic stimulation with appearance on EEG of bilateral spike and polyspike waves associated with eyelid jerks. This girl suffers from generalized epilepsy with photosensitivity. Photosensitivity is a common feature of many epilepsy syndromes, mainly occurring in children and adolescents. To control the seizures, it is essential to avoid the triggering stimulus, by wearing specific glasses. Additional antiseizures treatment is often necessary, at first with valproate and levetiracetam, and ethosuximide, lamotrigine, and benzodiazepines as the second choice. Overlapping phenomenology of seizures and movement disorders is well known in paediatric clinical practice. Moreover, epilepsy and movement disorder may coexist, mainly in children. Seizures with semeiology limited to eye motor manifestations may mimic functional blinking, tics, and other motor events frequently observed in childhood. Differentiating seizures from other non-epileptic paroxysmal movements may be challenging and specialist evaluation is needed for proper treatment and prognostic counselling.<\/jats:p>","DOI":"10.3389\/fped.2022.918420","type":"journal-article","created":{"date-parts":[[2022,11,16]],"date-time":"2022-11-16T05:47:40Z","timestamp":1668577660000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Case report: A relevant misdiagnosis: Photosensitive epilepsy mimicking a blinking tic"],"prefix":"10.3389","volume":"10","author":[{"given":"Francesca","family":"Burlo","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Egidio","family":"Barbi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Carrozzi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caterina","family":"Zanus","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2022,11,16]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"27","DOI":"10.1007\/s00702-015-1457-6","article-title":"Blink rate and blink timing in children with ADHD and the influence of stimulant medication","volume":"124","author":"Groen","year":"2017","journal-title":"J Neural Transm"},{"key":"B2","doi-asserted-by":"publisher","first-page":"498","DOI":"10.1002\/mds.26934","article-title":"Blepharospasm 40 years later","volume":"32","author":"Defazio","year":"2017","journal-title":"Mov Disord"},{"key":"B3","doi-asserted-by":"publisher","first-page":"22","DOI":"10.3928\/01913913-20150929-18","article-title":"Episodic excessive blinking in children","volume":"53","author":"Mali","year":"2016","journal-title":"J Pediatr Ophthalmol Strabismus"},{"key":"B4","doi-asserted-by":"publisher","first-page":"405","DOI":"10.1111\/pai.13035","article-title":"Diagnosing and managing allergic conjunctivitis in childhood: the allergist\u2019s perspective","volume":"30","author":"Fauquert","year":"2019","journal-title":"Pediatr Allergy Immunol"},{"key":"B5","doi-asserted-by":"publisher","first-page":"314","DOI":"10.1111\/pai.12197","article-title":"Vernal keratoconjunctivitis: a severe allergic eye disease with remodeling changes","volume":"25","author":"Vichyanond","year":"2014","journal-title":"Pediatr Allergy Immunol"},{"key":"B6","doi-asserted-by":"publisher","first-page":"31","DOI":"10.1016\/j.jaapos.2013.11.007","article-title":"The long-term outcomes of ocular tics in a pediatric neuro-ophthalmology practice","volume":"18","author":"Bisker","year":"2014","journal-title":"J AAPOS"},{"key":"B7","doi-asserted-by":"publisher","first-page":"145","DOI":"10.1002\/mdc3.12043","article-title":"The semiology of tics, tourette\u2019s, and their associations","volume":"1","author":"Ganos","year":"2014","journal-title":"Mov Disord Clin Pract"},{"key":"B8","doi-asserted-by":"publisher","first-page":"S89","DOI":"10.1002\/mdc3.13053","article-title":"Photosensitive epilepsy syndromes mimicking motor tics","volume":"7","author":"Longardner","year":"2020","journal-title":"Mov Disord Clin Pract"},{"key":"B9","doi-asserted-by":"publisher","first-page":"2137","DOI":"10.1007\/s00415-012-6470-1","article-title":"Prevalence and phenomenology of eye tics in gilles de la tourette syndrome","volume":"259","author":"Martino","year":"2012","journal-title":"J Neurol"},{"key":"B10","doi-asserted-by":"publisher","first-page":"1443","DOI":"10.1111\/epi.17240","article-title":"International league against epilepsy classification and definition of epilepsy syndromes with onset at a variable age: position statement by the ILAE task force on nosology and definitions","volume":"63","author":"Riney","year":"2022","journal-title":"Epilepsia"},{"key":"B11","doi-asserted-by":"publisher","first-page":"40","DOI":"10.1212\/01.WNL.0000131909.74506.5F","article-title":"Paroxysmal eyelid movements: a confusing feature of generalized photosensitive epilepsy","volume":"63","author":"Camfield","year":"2004","journal-title":"Neurology"},{"key":"B12","doi-asserted-by":"publisher","first-page":"372","DOI":"10.1684\/epd.2015.0773","article-title":"Paroxysmal eyelid movements in patients with visual-sensitive reflex seizures","volume":"17","author":"Brinciotti","year":"2015","journal-title":"Epileptic Disord"},{"key":"B13","doi-asserted-by":"publisher","first-page":"347","DOI":"10.1111\/j.1469-8749.2004.tb00496.x","article-title":"Photosensitivity and epilepsy: a follow-up study","volume":"46","author":"Verrotti","year":"2004","journal-title":"Dev Med Child Neurol"},{"key":"B14","doi-asserted-by":"publisher","first-page":"3766","DOI":"10.3390\/jcm11133766","article-title":"Photo-dependent reflex seizures\u2014a scoping review with proposal of classification","volume":"11","author":"Strzelecka","year":"2022","journal-title":"J Clin Med"},{"key":"B15","doi-asserted-by":"publisher","first-page":"11","DOI":"10.1016\/S0074-7742(08)00002-0","article-title":"Epidemiology and classification of epilepsy: gender comparisons","volume":"83","author":"McHugh","year":"2008","journal-title":"Int Rev Neurobiol"},{"key":"B16","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1016\/j.jocn.2019.08.086","article-title":"Photosensitive epilepsy and photosensitivity of patients with possible epilepsy in Chinese han race: a prospective multicenter study","volume":"69","author":"Bai","year":"2019","journal-title":"J Clin Neurosci"},{"key":"B17","doi-asserted-by":"publisher","first-page":"733","DOI":"10.1002\/ana.410370606","article-title":"First seizures associated with playing electronic screen games: a community-based study in Great Britain","volume":"37","author":"Quirk","year":"1995","journal-title":"Ann Neurol"},{"key":"B18","doi-asserted-by":"publisher","first-page":"225","DOI":"10.1016\/j.yebeh.2016.10.040","article-title":"Photosensitivity in generalized epilepsies","volume":"68","author":"Poleon","year":"2017","journal-title":"Epilepsy Behav"},{"key":"B19","doi-asserted-by":"publisher","first-page":"30","DOI":"10.1111\/j.0013-9580.2004.451010.x","article-title":"Photosensitivity: the magnitude of the problem","volume":"45","author":"de Bittencourt","year":"2004","journal-title":"Epilepsia"},{"key":"B20","doi-asserted-by":"publisher","first-page":"93","DOI":"10.1684\/epd.2014.0630","article-title":"Self-induction seizures in sunflower epilepsy: a video-EEG report","volume":"16","author":"Belcastro","year":"2014","journal-title":"Epileptic Disord"},{"key":"B21","doi-asserted-by":"publisher","first-page":"75","DOI":"10.1093\/brain\/118.1.75","article-title":"Reading epilepsy. An appraisal of 20 patients diagnosed at the mayo clinic, Rochester, Minnesota, between 1949 and 1989, and delineation of the epileptic syndrome","volume":"118","author":"Radhakrishnan","year":"1995","journal-title":"Brain"},{"key":"B22","doi-asserted-by":"publisher","first-page":"382","DOI":"10.1111\/j.1399-0004.1979.tb01770.x","article-title":"Progressive myoclonus epilepsy: genetic and nosological aspects with special reference to 107 Finnish patients","volume":"15","author":"Norio","year":"1979","journal-title":"Clin Genet"},{"key":"B23","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1111\/j.1528-1167.2011.03319.x","article-title":"Methodology of photic stimulation revisited: updated European algorithm for visual stimulation in the EEG laboratory","volume":"53","author":"Kasteleijn-Nolst Trenit\u00e9","year":"2012","journal-title":"Epilepsia"},{"key":"B24","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1111\/j.1528-1167.2009.02114.x","article-title":"Eyelid myoclonia with absences (jeavons syndrome): a well-defined idiopathic generalized epilepsy syndrome or a spectrum of photosensitive conditions?","volume":"50","author":"Striano","year":"2009","journal-title":"Epilepsia"},{"key":"B25","doi-asserted-by":"publisher","first-page":"8","DOI":"10.1016\/j.seizure.2021.09.021","article-title":"Epilepsy in \u2018sunflower syndrome\u2019: electroclinical features, therapeutic response, and long-term follow-up","volume":"93","author":"Belcastro","year":"2021","journal-title":"Seizure"},{"key":"B26","doi-asserted-by":"publisher","first-page":"259","DOI":"10.1111\/dmcn.14723","article-title":"Sunflower syndrome: a poorly understood photosensitive epilepsy","volume":"63","author":"Geenen","year":"2021","journal-title":"Dev Med Child Neurol"},{"key":"B27","volume-title":"Epileptic syndromes in infancy, childhood and adolescence","author":"Bureau","year":"2019"},{"key":"B28","doi-asserted-by":"publisher","first-page":"58","DOI":"10.1016\/j.eplepsyres.2018.03.002","article-title":"Clinical and electrographic features of sunflower syndrome","volume":"142","author":"Baumer","year":"2018","journal-title":"Epilepsy Res"},{"key":"B29","doi-asserted-by":"publisher","first-page":"273","DOI":"10.1684\/epd.2020.1161","article-title":"Characterizing sunflower syndrome: a clinical series","volume":"22","author":"Barnett","year":"2020","journal-title":"Epileptic Disord"}],"container-title":["Frontiers in Pediatrics"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2022.918420\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,11,16]],"date-time":"2022-11-16T05:47:42Z","timestamp":1668577662000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2022.918420\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,11,16]]},"references-count":29,"alternative-id":["10.3389\/fped.2022.918420"],"URL":"https:\/\/doi.org\/10.3389\/fped.2022.918420","relation":{},"ISSN":["2296-2360"],"issn-type":[{"value":"2296-2360","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,11,16]]},"article-number":"918420"}}