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As Cabrera-Valdivia et al 1 suggest, ecstatic experiences during spontaneous epileptic seizures are exceedingly rare. Intensely pleasurable experiences are, however, common in self induced seizures, as in the patient whom they describe. Of those 5% of people with epilepsy who are photosensitive some 30% can be shown by prolonged EEG telemetry with video recording in a well lit environment to induce epileptiform discharges by various means, either waving the outstretched fingers of one hand in front of the eyes or carrying out a manoeuvre involving upward deviation of the eyes with the fluttering of the eyelids.2 3 Patients are usually reluctant to discuss their habit but some 50% can be persuaded to do so and commonly describe pleasurable sensations ranging from release of stress to ecstacy. Some may induce orgasm.4 Patients who described similar experiences self induced by approaching closely to a television set have been reported previously.5 6
Cabrera-Valdivia et al reply:
We appreciate the interest of Binnie and Wilkins and Kasteleijn-Nolst Trenité regarding our report on Dostoevsky’s epilepsy.1-1 We agree in part with their comments. However, the cases that they quote as having similar experiences self induced are not described under the term “ecstatic” or “Dostoevsky’s” epilepsy. The patient reported by Andermann1-2 had typical absence attacks with a pattern of generalised spike and wave at 3–3.5 Hz during hyperventilation, and elicited by intermittent photic stimulation; the patient described this as a “trance-like” or “hypnotic” feeling without any reference to the affective state.