Investigators at the Department of Neurology, Vanderbilt University Medical Center, Nashville, TN report 3 patients with reading epilepsy, a boy aged 14 years, a 26- year-old male, and a 27-year-old woman, 2 having an excellent response to levetiracetam. The boy had tremors in the jaw and tongue when reading silently, and these progressed into loss of consciousness and generalized jerking if reading was continued. These episodes did not occur when reading aloud, skimming material, or doing mathematics. Video-EEG showed bifrontal synchronous sharp waves or spike-and-wave complexes, occasionally becoming generalized with left predominance. MRI was normal. He was treated effectively with divalproex sodium. Tremors did not recur when divalproex was inadvertently discontinued at 3 years after seizure onset, and at 6-year follow-up he was still seizure-free and on no medication. The 2 adults had twitching of the right lips or “mouth jumping” while reading. One had a video-EEG-monitored, generalized tonic-clonic seizure with left fronto-cental predominance, resistant to lamotrigine and controlled with levetiracetam; the other had a complex partial seizure with left mesial temporal sclerosis. Following left amygdalohippocampectomy, the reading epilepsy was partially controlled with carbamazepine and fully controlled with levetiracetam. Levetiracetam is proposed as first-line treatment for primary and secondary reading epilepsy. Spontaneous medication-free remission of primary reading epilepsy may occur within 3 years of seizure onset. [1]

COMMENT. Reading epilepsy, a form of reflex epilepsy, first described by Bickford R at the Mayo Clinic in 1956, occurs in 2 forms, primary or idiopathic and secondary and attributed to a structural brain lesion. Levetiracetam may prove superior to valproate and clonazepam in treatment, and spontaneous remission of primary reading epilepsy may occur in idiopathic cases. Generalized tonic-clonic seizures may be avoided by stopping reading at onset of mouth jerking, but anticonvulsant medications are usually required. The left predominance of the EEG seizure discharge in cases of reading epilepsy is in keeping with reports of reduced white matter integrity in the left arcuate fasciculus of dyslexics. (see Ped Neur Briefs 2012 April;26(4):32). [2]

Neurocognitive endophenotype with rolandic epilepsy. Children with rolandic epilepsy (RE) have reading, language, and attention disorders. In 13 probands with RE and 11 epilepsy-free siblings who completed a neurocognitive evaluation, 9% of siblings and 31% of probands were reading impaired, 36% of siblings and 54% of probands were language impaired, and 70% of siblings and 67% of probands had attention impairments. Probands and siblings showed a similar profile of deficits in language and attention. Early psychological evaluation and academic intervention may benefit children with RE. [3]