Researchers at Hopital de la Timone, Marseille, France, report a 28-year-old woman with a history of a febrile seizure at age 4 years and recent onset of partial seizures precipitated by silent reading. Left occipito-temporal localization of the seizures was confirmed by EEG, PET and SPECT. During a seizure, she was unable to understand what she was reading, and after looking up from the page, she saw letters and words, had a feeling of strangeness, right hemi-body jerks, and secondary seizure generalization. Seizures were controlled with carbamazepine. Interictal EEG showed left temporal posterior spikes, and during video-EEG a seizure was recorded 5 min after silent reading of a woman’s magazine, with left occipito-temporal predominance. Interictal PET showed bilateral occipito-temporal hypometabolism with left predominance, and ictal SPECT showed hyperperfusion in left occipitoparietal, left lateral temporal, and left inferior frontal regions. Brain MRI was normal. Two varieties of reading epilepsy are differentiated, jaw jerk variant and posterior variant with visual symptoms. [1]

COMMENT. Bickford RG and colleagues at Mayo Clinic were the first to describe reading epilepsy as a new syndrome [2]. Seizures were precipitated by reading difficult material, and the cortical or lexical aspects of the seizure provocation were stressed by Bickford and others. In a report from University of Ottawa, Canada, a 24-year-old woman experienced jaw jerking while reading aloud material of medium or high linguistic complexity [3]. These authors found several factors might be involved in seizure precipitation while reading. These included saccadic eye movements, articulation, in addition to difficulty of reading content, and no factor acted solely as the critical stimulus. In a further Mayo Clinic report of 20 patients diagnosed between 1949 and 1989, age at onset ranged from 10 to 46 years (median 17 years). Seizures were myoclonic, involving orofacial and jaw muscles, and generalized tonic-clonic. EEG showed generalized spike or spike and wave discharges in 15 patients and left hemisphere discharges in 5. Seizures responded to valproic acid. [4]

In an editorial, Koepp MJ of the UK emphasizes that although jaw jerks are the hall mark of reading epilepsy, many other reading-induced ictal symptoms are described: absence seizure, abrupt loss of consciousness, paroxysmal alexia or dyslexia, and prolonged stuttering. Dr Koepp advocates more case studies, similar to that of Gavaret et al, to determine the localization and mechanism of reading epilepsy, in contrast to the current focus on statistical analysis of large random samples in epilepsy research.