Bitemporal form of partial reading epilepsy: Further evidence for an idiopathic localization‐related syndrome

The temporal lobe is a common focus for epilepsy. Temporal lobe epilepsy in infants and children differs from the relatively homogeneous syndrome seen in adults in several important clinical and pathological ways. Seizure semiology varies by age, and the ictal EEG pattern may be less clear cut than what is seen in adults. Additionally, the occurrence of intractable seizures in the developing brain may impact neurocognitive function remote from the temporal area. While many children will respond favorably to medical therapy, those with focal imaging abnormalities including cortical dysplasia, hippocampal sclerosis, or low-grade tumors are likely to be intractable. Expedient workup and surgical intervention in these medically intractable cases are needed to maximize long-term developmental outcome.

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“…The seizure is accompanied by left temporal ictal discharge although independent bilateral temporal seizure onset has been reported [50]. …”

Section: Differential Diagnosismentioning

confidence: 99%

Temporal Lobe Epilepsy in Children

Nickels

Wong‐Kisiel

Moseley

et al. 2012

Epilepsy Research and Treatment

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“…This MSI investigation suggests that RE-PMJs are associated with reading-induced activation of hyperexcitable neurons in the left SMC, followed by secondary propagation to the left PSMFA producing the myoclonus. KEY WORDS: Reading epilepsy, Reflex epilepsy, Magnetoencephalography, Magnetic source imaging, Supplementary motor cortex.Reading epilepsy (RE) is a rare idiopathic partial reflex epileptic syndrome characterized by two types of readinginduced seizures (Koutroumanidis et al, 1998;Gavaret et al, 2010;Koepp 2010;Maillard et al, 2010;Miller et al, 2010). The most common seizure type associates perioral myoclonic jerks (PMJs) with left-dominant frontotemporal spike-wave discharges (SWDs).…”

mentioning

confidence: 99%

Supplementary motor cortex involvement in reading epilepsy revealed by magnetic source imaging

Beeck¹,

Legros

Gaspard

et al. 2011

Epilepsia

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SUMMARYReading epilepsy (RE) is an idiopathic reflex epilepsy syndrome characterized by perioral myoclonic jerks (PMJs) during reading associated with left-dominant frontotemporal spike-wave discharges (SWDs). To better understand the pathophysiology of this syndrome, we studied a 45-year-old patient using magnetic source imaging (MSI). The patient underwent two whole-head magnetoencephalography (MEG) recordings (Elekta Neuromag Oy) within 2 months while reading aloud. Forty-two SWDs associated with PMJs were recorded and averaged with respect to SWDs peak power. Epileptic discharges were then reconstructed using conventional equivalent current dipoles (ECDs) modeling, distributed sources sLORETA modeling, and beamformer approach. These methods identified two brain sources located in the left supplementary motor cortex (SMC) and the left primary sensorimotor face area (PSMFA). The spatiotemporal pattern of the sources was characterized by a cross-talk between these two brain regions, with an initial source in the left SMC. This MSI investigation suggests that RE-PMJs are associated with reading-induced activation of hyperexcitable neurons in the left SMC, followed by secondary propagation to the left PSMFA producing the myoclonus. KEY WORDS: Reading epilepsy, Reflex epilepsy, Magnetoencephalography, Magnetic source imaging, Supplementary motor cortex.Reading epilepsy (RE) is a rare idiopathic partial reflex epileptic syndrome characterized by two types of readinginduced seizures (Koutroumanidis et al., 1998;Gavaret et al., 2010;Koepp 2010;Maillard et al., 2010;Miller et al., 2010). The most common seizure type associates perioral myoclonic jerks (PMJs) with left-dominant frontotemporal spike-wave discharges (SWDs). The second seizure type associates visual symptoms and alexia or dyslexia with leftdominant temporooccipital SWDs.The pathophysiology of RE characterized by PMJs remains unclear. Combined electroencephalgraphy (EEG) and functional magnetic resonance imaging (EEG-fMRI) studies have found left-dominant activations of motor and premotor cortical areas, together with some subcortical structures, during reading-induced PMJs (Archer et al., 2003;Salek-Haddadi et al., 2009). Due to the relatively low temporal resolution of EEG-fMRI, these studies did not inform on the neuronal recruitment chronology within the identified network.To tackle this temporal dimension, we report a case of RE with PMJ studied with magnetic source imaging (MSI). MSI localizes noninvasively neuronal sources contributing to signals detected by magnetoencephalography (MEG), with a temporal resolution in the millisecond range and a spatial resolution of a few millimeters (Hämäläinen et al., 1993) Material and Methods Clinical dataA right-handed and Dutch-speaking 45-year-old woman, diagnosed with catatonic schizophrenia, was treated with quetiapine, an oral antipsychotic drug. A few months after quetiapine was started, right PMJs appeared while she was reading and led to two episodes of secondary tonic-clonic generalized seizures. Vide...

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“…It is considered uncommon and is possibly underdiagnosed (Koutroumanidis et al., 1998). The age of onset reported in the literature ranges from 6 (Gastaut & Tassinari, 1966) to 28 years (Gavaret et al., 2010), with seizures starting in most patients during the teenage years (Gastaut & Tassinari, 1966; Koutroumanidis et al., 1998; Gavaret et al., 2010; Maillard et al., 2010). Increased task difficulty and increased complexity (e.g., professional reading rather than recreational) increase the chance of EEG or clinical seizure activation (Gastaut & Tassinari, 1966).…”

Section: Discussionmentioning

confidence: 99%

Focal reading epilepsy—a rare variant of reading epilepsy: A case report

et al. 2010

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SUMMARYReading epilepsy is a distinct form of epilepsy in which all or almost all seizures are precipitated by reading. Seizures typically show orofacial or jaw myoclonus. Nevertheless, reading epilepsy is not homogenous and its classification is unclear. We report a patient with readinginduced prolonged left temporal seizures, presenting clinically as dyslexia. KEY WORDS: Reading epilepsy, Reflex epilepsy, Electroencephalography, Paroxysmal dyslexia.Reading epilepsy is a distinct type of reflex epilepsy in which all or almost all seizures are precipitated by reading (Koutroumanidis et al., 1998). The most common ictal manifestation is jaw or orofacial myoclonus, which may spread to the limbs (Radhakrishnan et al., 1995;Salek-Haddadi et al., 2009). These may be associated with focal, regional, or generalized discharges on electroencephalography (EEG) or may not be associated with EEG changes (Wolf, 1992;Koutroumanidis et al., 1998). Secondary generalized tonic-clonic (SGTC) seizures can occur if reading is not interrupted.Reading epilepsy is, however, not homogenous as various seizure types can be induced by reading (Koutroumanidis et al., 1998). Bilateral myoclonic seizures and readinginduced absence seizures associated with 3Hz spike and wave discharges have been reported (Singh et al., 1995). We present a patient in whom reading was associated with prolonged focal seizures with secondary generalization. Case HistoryThe patient was a 19-year-old right-handed man at the time of presentation to the epilepsy clinic. He was studying journalism at a university. His first seizure had occurred 8 months prior to attending our clinic. He reported that while reading very late at night that his reading suddenly became disturbed; he could not make sense of what he was reading and felt confused. He then lost awareness and recovered in the ambulance en route to a hospital. He subsequently had three further similar attacks, all associated with reading at the onset. He would have a brief period of confusion and difficulty understanding what he was reading followed by a generalized tonic-clonic seizure. He also reported a few occasions when he had felt that he was about to have a seizure while reading, which had not progressed. He had never had jaw or facial myoclonic jerks associated with his seizures. All of his seizures were associated with reading at the onset.He reported that the seizures were more likely to occur when reading difficult material, printed material with small font, reading during late afternoon or evening, or when he was tired. He frequently read at other times without any problems. Writing, talking, solving mathematical problems, or listening to material being read to him did not trigger a seizure. He had not attempted reading texts in foreign languages.He had no other significant medical history. He was born following a normal pregnancy and delivery and had normal early development. He had no history of learning disability and had attended normal schools. He had pneumonia in infancy and may have had a feb...

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Bitemporal form of partial reading epilepsy: Further evidence for an idiopathic localization‐related syndrome

Cited by 14 publications

References 7 publications

Temporal Lobe Epilepsy in Children

Temporal Lobe Epilepsy in Children

Supplementary motor cortex involvement in reading epilepsy revealed by magnetic source imaging

Focal reading epilepsy—a rare variant of reading epilepsy: A case report

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