Two patients, ages 16 and 28, with left temporal lobe seizures induced by exercise are reported from Austin and Repatriation Medical Centre, Victoria, Australia. Patient 1 had seizures precipitated by physical activity from age 12 years. An aura was followed by blank stare, orobuccal automatisms, and postictal confusion. The seizures occurred within 5 to 20 minutes of commencing running and playing soccer or tennis. Other family members had seizures but none was exercise induced. Interictal EEG showed left temporal slowing, and during video EEG monitoring, two complex partial seizures were induced by stair stepping for 5 minutes. MRIs were normal, but interictal PET scan showed left temporal hypometabolism. Reduced exercise and topiramate were followed by seizure control for 7 months. Patient 2 had seizures from age 21. They began with deja vu and decreased awareness, followed by staring, and oral and bimanual automatisms. They were precipitated by strenuous exercise such as bicycle riding and racing and running. He would continue to ride automatically during seizures. Neurologic exam and MRI were normal. Interictal EEG showed left temporal lobe epileptiform discharges. He continues to have seizures during exercise despite treatment with carbamazepine and gabapentin. Neither patient had seizures induced by hyperventilation, passive and active stationary limb movement or by imagining competitive sports. 
COMMENT. Reflex epilepsies in response to a well-defined precipitating stimulus occur in about 5% of patients with epilepsy. Exercise-induced epilepsies are usually generalized or frontal lobe in origin, and less commonly involve the temporal lobe. Other reflex precipitants for temporal lobe seizures include music, eating, hot water immersion, laughter, and thinking. The stimuli may involve emotional and motivational factors, and require complex processing in limbic structures. Exercise-induced seizures are rare and should not lead to a sedentary life-style. In fact, moderate exercise may offer some protection or improved control of epilepsy.