My first and so far the last encounter with a case of startle epilepsy.
It was during the second year of my Psychiatry residency training during 1978.In our busy Outpatient our Asst. Professor Dr. P. C. Shastri unknown to us had invited a patient and his father to demonstrate as an interesting case.When the patient arrived , the clinic was cleared of some pending cases for a while. The other resident doctors from our outpatient clinics for invited for a demonstration.
The clinic door was closed and the young patient about 11-12 years of age was seated comfortably with his father standing near him.
The initial information elicited was that the child had suffered from cerebral palsy and had weakness in his left side. He was not attending school as he was suffering from uncontrolled epileptic fits.
On a cue from Dr. Shastri the father silently took a position behind his son and without warning he clapped his hands very loudly behind his son’s head. Before we could understand what was happening the boy had slumped down convulsing into the supportive arms of his father.
Then a discussion followed to what we had just witnessed.
That was a startle epileptic fit induced by a loud noise.
Startle epilepsy is a type of reflex epilepsy in which seizures are provoked by loud noises or sudden surprises. Most patients with startle epilepsy are only sensitive to one sensory modality (i.e. temperature, taste, sound, pressure). However, it is the unexpected nature of the stimulus rather than the sensory modality that characterizes startle epilepsy.