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

Abstract

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...

Do reflex seizures and spontaneous seizures form a continuum? – Triggering factors and possible common mechanisms

“…However the underlying causal mechanism is not fully understood [11]. The fact that reading seizures can still be language-specific and highly individual suggests that the triggers involved have to act on very distinct hyperexcitable neuronal networks that vary across patient populations [60].…”

“…Triggering factors in reflex seizures are most commonly extrinsic sensory stimuli such as flashing lights or startling noises [49]. Other documented triggers of reflex seizures include visual [50], olfactory [51] proprioceptive [52] or somatosensory stimuli [53] as well as thinking [54], music [55,56], eating [57,58], exercise [59], reading [60,61], hot water [62][63][64][65], startle [66] and even rare triggers such as orgasms [67,68] and answering telephones [69] have recently be added to the list. Extrinsic triggers remain the most common type.…”

Are proprioceptive‐induced reflex seizures epileptically‐enhanced stretch reflex manifestations?

“…Thus, although the stereotyped evoking stimulus and seizures in these epilepsies suggest a specific and fixed epileptic network in each patient, it remains unclear in most cases, e.g. parietal and temporal seizures activated by hot water (Bebek et al , 2001; Ilker et al , 2010), focal seizures or periodic epileptic spasms activated by eating (Nakazawa et al , 2002; Seneviratne et al , 2003), and myoclonic jerks or focal seizures activated by reading (Salek‐Haddadi et al , 2009; Osei‐Lah et al , 2010). Proprioceptive‐induced reflex seizures appear to represent a specific group clearly suggesting the involvement of only a single anatomo‐functional system; the sensory‐motor network.…”

Photosensitivity and Reflex Epilepsies

“…Okuma ile uyarılan sol posterior temporal başlangıçlı olup daha sonra sekonder jeneralize olan ve disleksi ile prezente bir olgu bildirilmiştir. [28] Sekonder okuma epilepsisi olanlarda ise spontan nöbetler ile birlikte okuma ve ışık uyaran ile indüklenen nöbetler görülür. Primer okuma epilepsisi uzun süreçte iyi prognoza sahip bir refleks epilepsidir.…”