‘Visual epilepsy’

During a talk I was invited to give last weekend, I was happy to see again Dr. Alberto Daysog, one of our professors at the University of Santo Tomas College of Medicine.

Dr. Daysog graduated from UST in 1956 and trained in kidney diseases at the Baylor University College of Medicine and Jefferson Davis Hospital in Houston, Texas. He was one of the pioneers of the subspecialty of nephrology in the Philippines, together with other foreign-trained specialists who came back in the 1960s like Doctors Eduardo Gotamco Tan, Antonio Talusan, Marieta de Luna, Aurora Padolina-Perez and Claver Ramos.

Pioneering efforts

Nephrology is now one of the major subspecialties of internal medicine in this country and the younger kidney specialists owe much of this to the pioneering efforts of this first batch of nephrologists who went through the difficult learning curve to establish the subspecialty in the country.

Dr. Daysog is well-known for asking a lot of tough questions during scientific symposiums which have proven to be a good baptismal ground for many young lecturers. Dr. Christopher de los Reyes, one of our very promising young cardiologists, was also present during last Saturday’s symposium. He told us that some lecturers really prepare hard if they know that Dr. Daysog would be in the audience.

Dr. Daysog didn’t ask any question that night, but while having dinner before the lecture, and shortly after, we had a very interesting discussion on another topic—visual epilepsy—which was something new to me. In fact it was the first time I heard about it. So I requested him to tell me more about it.

Enjoying the visual treat

Visual epilepsy seems to be quite different from the usual type of epilepsy we know, which is characterized by seizures or convulsions. Dr. Daysog said he was diagnosed with visual epilepsy   a few years ago, but he seems to be enjoying the visual treat he gets from it.

Instead of epileptic seizures, he gets flashes of rainbow colors surrounding sources of light. The magnificent interplay of colors is beyond description. He also sees auras surrounding persons, which come in different layers, colors and densities. He described the aura he saw surrounding me as I lectured and described it as beautiful and pleasant.

“No wonder you didn’t ask any question,” I told him, “you were having an epileptic seizure during my talk.”

I searched the medical literatures about visual epilepsy when I got home, and I learned that it is a relatively rare form of focal epilepsy, with a variety of underlying causes. It’s also called occipital lobe epilepsy since the epileptic seizures, coming in the form of paroxysmal visual manifestations arise from the occipital lobe of the brain, which sits at the back of the brain. It is the main center of the visual system, hence occipital lobe epilepsy presents as flashes of light, flickering or colored lights, multilayered and multicolored auras, as Dr. Daysog had described.

Visual triggers

These visual seizures may occur spontaneously but they may also be caused by visual triggers, such as car lights. Flickering lights like disco lights would be strong triggers. Sometimes, visual epilepsy may be mistaken for migraine headache because it may present with similar symptoms—visual illusions and disturbances, nausea and vomiting, and headache.

Although visual epilepsy may be idiopathic (no known cause), one should always have oneself examined by a brain specialist (neurologist) for any possible identifiable problem in the brain. If the brain studies like electroencephalogram (EEG) and CT scans turn out to be normal, and the visual illusions are not really scary and bothersome, one does not have to take any medicine and can just enjoy every episode one has.

I could sense as Dr. Daysog described what he saw every time he had an “attack” that it’s more of a “visual treat” rather than an actual “epileptic seizure.”