Precipitating stimuli, including eye-movements, reading aloud versus reading silently, linguistic complexity, and concentration, were investigated in a 24 year old young woman with reading epilepsy seen in the Division of Neurology and Clinical Neurophysiology Laboratory, University of Ottawa General Hospital, and Depts of Psychology and Computer Engineering, Carleton University, Ottawa, Ontario, Canada. A viral illness at 19 years of age was followed by episodic jerking of the jaw while reading silently and a single generalized tonic-clonic seizure. After 2 years freedom from symptoms, the jaw jerking returned while reading, and was aggravated by fatigue or stress. Reading material was presented on a microcomputer video display monitor while the patient underwent EEG radiotelemetry video monitoring. Seizures were most readily elicited by reading aloud material of medium or high linguistic complexity. 
COMMENT. Bickford et al., in their original description of reading epilepsy, observed precipitation of seizures by difficult reading matter (Trans Am Neurol Assoc 1956 ; 81:100), and other authors have stressed the cortical or “lexical” aspects of the reading process in seizure provocation. The results of the present study suggest that a combination of factors involved in reading, including saccadic eye movements, articulation, and difficulty of linguistic content, contribute to epileptogenesis. Seizures were more readily provoked when greater demand was placed on each of the subtasks collectively and no factor acted solely as the critical stimulus.
In an article in the same issue of Epilepsia from the National Centre for Children with Epilepsy, Park Hospital for Children, Headington, Oxford, England, Verduyn et al surveyed mothers' impressions of seizure precipitants in children with epilepsy. Reading was not included in the list of precipitants, but stimuli that are somatic, psychological, and sensory were frequently followed by seizures. Mothers reported a relaxed state, emotional state, anxiety, exercise, and drowsiness as precipitants in 60-75% of the sample of 446 children. Sensory-evoked epilepsy in 2.5% was provoked by loud noise, startle, flashing lights, bright light, diet, touch, television, and pattern.