Reading Epilepsy

For a long time it has been known that seizures could
be evoked in certain epileptic individuals by a discrete
physiologic or psychologic stimulus. The term reflex
epilepsy is reserved for this small subgroup. Forster(1)
has classified these seizures in accordance with their
evocative stimuli into five types: - (1) Visual-flickering
light, visual patterns & specific colors especially red,
leading to rapid blinking or eye closure; (2) Auditorysudden
unexpected noice (startle), specific sounds,
musical themes & voices; (3) Somatosensory-either a
brisk unexpected tap or sudden movement after sitting
or lying still or a prolonged tactile or thermal stimulus to a
certain part of the body (Hot Water Epilepsy); (4) Writing
or reading words or numbers and (5) Eating.
Reading epilepsy is a rare benign, non progressive
syndrome characterized by reading-provoked
sensorimotor symptoms affecting the oral-buccal-lingualfacial
muscles that are involved in reading aloud(2).
However, reading aloud usually not required to trigger
the seizures. As a result, some authorities have
recommended renaming the condition language-induced
Epilepsy(3). Our case was 9 years old male with no
family history, presented as reading epilepsy which was
misdiagnosed for six months as non-organic seizures.
A 9 year old male child used to visit the pediatricians at
different occasions. Always parents complained that most
of the times child starts with abnormal movements of jaw,
face and sometimes myoclonic jerks while reading. He has
3-4 such attacks during school also. Parents and teachers
corelated it as child disintrest toward study. Each attack
used to last for 1-3 minutes. These attacks were more when
he used to read aloud and specifically English language. He
had about twenty attacks in six months time and this has
disturbed the child including his studies. Onexamination child
was well built and neurologically there was no deficit fundus
examination was normal. His BP- 110/70 mm/Hg. & pulse
rate-80/minute, ECG WNL. His biochemical parameters,
sugar, calcium, magnesium, LFT, RFT, haemogram,
blood counts all were normal. His CT scan head was
normal. His EEG was done on 16 channel digital E.E.G.
machine which showed spike wave and polyspike
discharges (Fig. 1).

The child was diagnosed as reading epilepsy and was
put on sodium valproate 300 mg. twice a day. His seizure
completely subsided and now he is doing well in his studies
and he is no more afraid of reading.
Reading epilepsy is a rare, benign non-progressive
syndrome, characterized by reading-provoked
sensorimotor symptoms affecting the oral-buccal-lingualfacial
muscles that are involved in reading aloud (2). This
condition is accompanied by a positive family history of a
similar disorder in as many as one fourth of cases our
patient has no family history and was a sporadic case.
These patients as described b Krishnan et al (4), presents
as myoclonic, jerking or tonic movements of jaw. Some
patients also report with abnormal sensations such as
stiffness, numbness or tightness during the seizures.
Usually disease starts at puberty, the average age of onset
is 17 years with symptoms starting as young as 10 years
of age(4). Cases have been described that overlap
clinically with benign partial epilepsy of childhood
(BPEC), with Juvenile myoclonic epilepsy (JME) and
with absence epilepsy (5, 6,7).
Our case was 9 year old male child who used to get
abnormal movements of jaw, face and myoclonic jerking
while reading English language. All investigations were
normal but detailed history & EEG gave the final diagnosis
and child was treated with sodium valproate and is doing
well and free of seizures.
This rare case has been presented so that clinicians
should be aware and take history properly to reach a
final diagnosis and to treat this benign reflex epilepsy
syndrome effectively.
References
1. Forster FM: Reflex Epilepsy, Behavioral Therapy,
and Conditional Reflexes, Springfield, IL, Charles C
Thomas, 1977.
2. Wolf P., Reading epilepsy. In : Roger J, Bureau M, Dravet
C, Dreifuss F, Perret A, Wolf P, eds. Epileptic Syndromes
in Infancy, Childhood & Adolescence, 2nd edn. London :
John Libbey and Company, 1992 .pp. 281-98.
3. Koutroumanidis M, Koepp MJ, Richardson MP et al. The
variants of Reading Epilepsy. A clinical & video-EEG study
of 17 patients with reading-induced seizures. Brain 1998;
121 : 1409-27.
4. Radhakrishnan K, Silbert PL, Klass DW. Reading epilepsy.
An appraisal of 20 patients diagnosed at the Mayo clinic,
Rochester, Minnesota, between 1949 & 1989, and
delineation of the epileptic syndrome. Brain 1995; 118 :
75-89.
5. Valenti MP, Tinuper P, Cerullo A, Carcangiu R, Marini C :
Reading epilepsy in a patient with previous idiopathic &
focal epilepsy with Centrotemporal spikes. Epileptic
Discord 1999; 1 : 167-171.
6. Wolf P, Mayer T, Reker M. Reading epilepsy. Report of
five new cases and further considerations on the
pathophysiology. Seizure 1998, 7: 271-9.
7. Singh B, Anderson L, al Gashlan M, al Shahwan SA, Riela
AR. Reading-induced absence seizures. Neurology 1995;
45 : 1623-4.