Abstract

We report a case of primary reading epilepsy, a rare reflex epilepsy syndrome where reading triggers seizures. A 19-year-old man presented with two witnessed generalised seizures. The first occurred while working at his computer and the second while reading a magazine. Both episodes were preceded by his jaw locking open for some seconds. Enquiry revealed a previous episode of loss of consciousness while sitting for an exam. There was no history of myoclonic jerks or family history of seizures. He denied excess alcohol or illicit drug use. The patient's developmental history, neurological and cardiac examinations, blood investigations and MRI scan of the brain were normal. The EEG recording at rest was unremarkable but reading induced intermittent localised sharp and slow wave discharges over the left mid-central and centrotemporal regions after about 90 s. A diagnosis of focal-onset reading epilepsy was made and he was started on Lamotrigine, with resolution of his generalised seizures. He continues to experience occasional episodes of jaw locking and left arm twitching on reading, which worsen with duration of reading, fatigue or when reading black script on a white background. There are few published cases of focal or generalised epilepsy triggered by reading, for which cortical language processing is the postulated physiological basis. Our case, supported by video-EEG, highlights the typical clinical and encephalographic findings in this intriguing condition.