Do patients with seizures maintain their wink reflex?

From the Guidelines

During seizures, the wink reflex is typically absent or diminished due to the overwhelming abnormal electrical activity in the brain, as supported by the most recent study 1. This reflex, which causes eye blinking when the cornea is touched, is controlled by cranial nerves V and VII and is suppressed during generalized seizure activity. The absence of this protective reflex during seizures is clinically significant as it indicates the depth of neurological impairment and helps distinguish true seizures from pseudoseizures, where reflexes often remain intact. Some key points to consider include:

• The International League Against Epilepsy (ILAE) defines epilepsy as having at least two unprovoked seizures occurring more than 24 hours apart, or one unprovoked seizure and a probability of further seizures similar to the general recurrence risk after two unprovoked seizures, occurring over the next 10 years, or diagnosis of an epilepsy syndrome 1.
• Seizures are classified as focal onset, generalized onset, or unknown onset, and can be further characterized by having motor onset or nonmotor onset symptoms, and can also be characterized by being aware or having impaired awareness 1. After a seizure ends, during the postictal period, the wink reflex gradually returns as normal brain function resumes. Healthcare providers often test this reflex as part of neurological assessment during and after seizure episodes to evaluate brain stem function and monitor recovery. The temporary loss of this reflex during seizures is one reason why protecting the patient from injury, including eye injury, is an important aspect of seizure management. It is essential to note that the classification of seizures and epilepsy is operational and not based on fundamental mechanisms, and as such, the correct identification of seizures and epilepsy is crucial for etiologic diagnosis, appropriate treatment, and accurate prognostication 1.

From the Research

Seizures and Wink Reflex

• There is no direct evidence in the provided studies to suggest that seizures maintain the wink reflex 2, 3, 4, 5, 6.
• The studies primarily focus on the treatment and management of epilepsy, including the comparison of antiepileptic drugs and their efficacy in controlling seizures 3, 4, 5, 6.
• The wink reflex is not mentioned in any of the studies, and therefore, it is not possible to determine its relationship with seizures based on the provided evidence.
• Further research would be needed to investigate the effect of seizures on the wink reflex, as the current studies do not provide any relevant information on this topic 2, 3, 4, 5, 6.

Antiepileptic Drugs and Seizure Control

• The studies suggest that certain antiepileptic drugs, such as lamotrigine, levetiracetam, and sodium valproate, are effective in controlling seizures in patients with epilepsy 3, 4, 5, 6.
• The efficacy of these drugs varies depending on the type of seizure and the individual patient, and the choice of drug should be based on the specific needs of the patient 3, 4, 5, 6.
• The studies also highlight the importance of considering the potential side effects and interactions of antiepileptic drugs when selecting a treatment regimen 4, 5.

Treatment Outcomes and Seizure Freedom

• The studies report varying rates of seizure freedom among patients with epilepsy, depending on the treatment regimen and individual patient characteristics 3, 4, 5, 6.
• Some patients may achieve complete seizure freedom, while others may experience a reduction in seizure frequency or severity 3, 4, 5, 6.
• The studies emphasize the need for ongoing monitoring and adjustment of treatment regimens to optimize seizure control and minimize side effects 4, 5.