Teaching Video NeuroImages: Reading epilepsy

A 14-year-old right-handed boy developed spells of lip twitching only while reading. With prolonged reading, he occasionally experienced loss of awareness and limb jerking (figure and video on the Neurology® Web site at www.neurology.org). Reading epilepsy is a rare form of reflex seizure in which reading (silently or aloud) may trigger orofacial myoclonus, stammering, aphasia, or generalized convulsions. Onset is typically in early adulthood, with 2:1 male predominance. It occurs in isolation or autosomal dominant fashion.¹ Previous reports suggest efficacy of clonazepam, valproate, or levetiracetam.² Our patient did not tolerate levetiracetam but remains seizure-free on oxcarbazepine. Reading epilepsy should be recognized and promptly treated to avoid unnecessary academic struggles.

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Figure Reading epilepsy captured on video EEG

Interictal EEG was normal during wakefulness and showed frequent midline central spikes during sleep. Reading precipitated frequent clonic jerks of the lower jaw, during which EEG showed generalized discharges maximal over the midline/left central head region. Jaw jerking appeared after 15 seconds of reading and was followed by a secondary generalized tonic-clonic seizure.

• © 2013 American Academy of Neurology