Reading epilepsy, a form of reflex epilepsy or sensory precipitated epilesy, is known as the most frequent type of language induced epilepsy. Since Bickford presented 6 cases of reading epilepsy for the first time, about 50 cases of primary reading epilepsy have been reported. We present a case of primary reading epilepsy which is confirmed by clinical features and EEG, with a brief review of literature.
Electroencephalography ; Epilepsy ; Epilepsy, Reflex*

In reflex epilepsy, seizures triggered by eye closure are uncommon but interesting. The clinical significance and the mechanisms of triggering epileptiform discharges on closing on closing the eyes are not clearly defined yet. Here, five cases are described in which the epileptiform discharges provoked by voluntary closing the eyes. The clinical manifestations are variable in these cases and this electroencephalographic abnormality is not specific for any kind of seizures.
Epilepsy, Reflex ; Seizures

In Patients subject to convulsions the attacks occur sporadically, and the factors reponsible for precipitation of a seizure at any given time are usually unknown. In a small number of patients certain sensory stimuli may consistently initiate an attack. The sensory modality involved varies in different patients: however, the entire group has been referred to by the term 'reflex epilepsy.' In certain rare instances, listening to music produces seizures and this subdivision of reflex epilepsy has been called "musicogenic epilepsy". By the Critchley, in 1937, several particular types of musical stimuli were reported, but frequency of such stmuli was much rare and there has been no report yet in Korea. This 40 years old fernale patient revealed a ternporal lobe seizure, which appeared whenever listened to old korean popular songs. The etiology was not known and the response to anti-epileptic drugs was good.
Adult ; Epilepsy, Reflex* ; Humans ; Korea ; Music ; Seizures

Reflex epilepsy describes seizures which are precipitated by clearly recognized stimuli. Reflex epileptic seizures triggered by tooth brushing are rare. We report a case with reflex epilepsy occurring exclusively during tooth brushing. He began having seizures at age 28. Neurological examinations and brain magnetic resonance images were found normal. On long term video-EEG monitoring, he presented two episodes of simple partial seizure induced by brushing molar and premolar teeth, which was right facial clonic movement persisting 3-5 seconds. He was unresponsive during the event, but had no postictal confusion. Ictal EEG showed 6 Hz rhythmic theta activity in the left frontocentral area. Interictal EEG was normal. The findings of EEG suggest that this reflex epilepsy might have epileptic focus in the left frontocentral area. Reasonable precaution such as gargling or less vigorous brushing of his teeth with fingers effectively prevented seizure recurrence.
Bicuspid ; Brain ; Electroencephalography ; Epilepsy ; Epilepsy, Reflex* ; Fingers ; Molar ; Neurologic Examination ; Recurrence ; Reflex* ; Seizures ; Tooth*

Micturition is a complex process involving the bladder, spinal cord, and the brain. Highly sophisticated central neural program controls bladder function by utilizing multiple brain regions, including pons and suprapontine structures. Periaqueductal grey, insula, anterior cingulate cortex, and medial prefrontal cortex are components of suprapontine micturition centers. Under pathologic conditions such as epilepsy, urinary dysfunction is a frequent symptom and it seems to be associated with increased suprapontine cortical activity. Interestingly, micturition can also trigger seizures known as reflex epilepsy. During voiding behavior, frontotemporal cortical activation has been reported and it may induce reflex seizures. As current researches are only limited to present clinical cases, more rigorous investigations are needed to elucidate biological mechanisms of micturition to advance our knowledge on the process of micturition in physiology and pathology.
Brain ; Epilepsy* ; Epilepsy, Reflex ; Gyrus Cinguli ; Pathology ; Physiology ; Pons ; Prefrontal Cortex ; Reflex ; Seizures ; Spinal Cord ; Urinary Bladder ; Urination*

BACKGROUND AND PURPOSE: There are currently few studies on clinical profiles of reflex epilepsy induced by thinking and spatial tasks. We studied the clinical characteristics of reflex epilepsy induced by playing oriental card and board games. METHODS: This study included 17 patients who presented with seizures that occur predominantly while playing games. We collected clinical data via protocol-based interviews. EEGs and brain MRI were performed. RESULTS: All of the subjects were men, and all of them were older than 30 years at the onset of seizure. Thirteen patients (76%) experienced their seizures while playing the oriental card game "Go-stop" and the remaining four patients (24%) experienced them while playing the oriental board game "Baduk". Generalized tonic-clonic seizures were frequently preceded by prodromal symptoms, but myoclonus was not evident. Most patients had no spontaneous seizures and generalized epileptiform discharges on EEGs, and infrequent seizures that were well controlled. CONCLUSIONS: Our patients exhibited some features that differ from those described previously in the literature, suggesting that the clinical spectrum of reflex epilepsy induced by thinking and spatial tasks is wide.
Brain ; Electroencephalography ; Epilepsy, Reflex* ; Humans ; Magnetic Resonance Imaging ; Male ; Myoclonus ; Prodromal Symptoms ; Reflex* ; Seizures ; Thinking

Defecation induced epilepsy is a very rare form of reflex epilepsy, which has not been reported yet in Korea. We experienced a case of defecation-induced epilepsy in a 10 month old boy who has been showing seizure with every defecation since 5 months of his age. Diagnosis was made by clinical history and appearance of clinical seizure with epileptiform activities in electroencephalography after glycerine enema during recording.
Defecation ; Diagnosis ; Electroencephalography ; Enema ; Epilepsy* ; Epilepsy, Reflex ; Glycerol ; Humans ; Infant ; Korea ; Male ; Seizures

There have been very few reports on reflex seizures induced by writing. Complex precipitating behaviors such as calculation, writing, copying of complicated figure, and spatial construction have been recognized as triggering factor of epileptic seizures. We report a case of a patient with a very unusual form of complex reflex epilepsy in which seizures are usually induced by writing or spatial construction. Neurological examination was normal and brain magnetic resonance imaging showed mild brain atrophy without focal lesion. During long-term video-EEG monitoring, she was instructed to write a letter with the right hand. About 20 minutes after writing, she experienced similar aura and motion arrest and then showed an elevation of bilateral upper extremities like myoclonic jerk followed by generalized tonic clonic seizure. On ictal EEG, spike and wave complexes appeared from both centroparietal region followed by 10 Hz rhythmic activities for 20 seconds. Interictal EEG was normal. Ictal-interictal subtraction image of brain SPECT (99mTc-HMPAO) showed hyperperfusion in the middle frontal gyrus and precentral gyrus of left frontal lobe and superior and inferior frontal gyrus of right frontal lobe. We suggest that this reflex epilepsy might be originated from both central areas with maximum on the left side. Oxcarbazepine was effective in controlling this reflex epileptic seizure.
Atrophy ; Brain ; Electroencephalography ; Epilepsy ; Epilepsy, Reflex* ; Frontal Lobe ; Hand* ; Humans ; Magnetic Resonance Imaging ; Myoclonus ; Neurologic Examination ; Reflex* ; Seizures ; Tomography, Emission-Computed, Single-Photon ; Upper Extremity ; Writing

OBJECTIVETo investigate the effect of eyes closure and closed on the epileptiform discharges, and the relationship between eyes closure or closed sensitivity and photosensitivity.

METHODSDuring video-EEG monitoring, open-close eyes tests and intermittent photic stimulation (IPS) under different eyes conditions were carried out in epilepsy patients. The eyes conditions were divided into eyes opened, eyes closure (the period immediately after closing of the eyes and only lasts for less than 3 s), and eyes closed (the period lasting for more than 3 s and persisting as long as the eyes remain closed). From 135 patients, 13 cases whose EEG showed eyes closure or closed sensitivity had been selected out for our study. The clinical, eyes closure or closed sensitivity and the relationship between eyes closure or closed sensitivity and photosensitivity were analyzed.

RESULTSOf the 13 patients, 8 were female, and 5 were male. The age ranged from 6 years to 17 years (median 11 years). The age at onset of epilepsy ranged from 1.5 years to 14.5 years (median 9 years). Epileptiform discharges could be provoked by eyes closure in 10 of 13 patients, associated with photosensitivity in 8 patients. Of the 8 patients, 6 cases showed photosensitivity under eyes closure and only 4 cases showed photosensitivity under eyes closed. Eyes closed sensitivity had been seen in 3 patients, with photosensitivity in 2 patients. Evoked EEG patterns and discharges regions by eyes closure and eyes closed conditions had not obvious differential and might be strongly related to the types of epilepsies. The intensity and frequencies of photosensitivity under different eyes conditions were different. After valproate acid treatment, the eyes closure or closed sensitivity and photosensitivity improved in 4 cases, with improvement of photosensitivity prior to eyes conditions sensitivity.

CONCLUSIONSEyes closure and eyes closed could induce EEG paroxysms, which involved in some types of epileptic syndromes and appeared common in female patients. Eyes closure or closed sensitivity might coexist or be disassociated with photosensitivity. Testing eyes closure, eyes closed and IPS during EEG monitoring would contribute to finding the EEG discharges, further help to diagnose epilepsies and epileptic syndromes and guide treatment.

Adolescent ; Blinking ; Child ; Electroencephalography ; Epilepsy, Reflex ; diagnosis ; physiopathology ; Female ; Humans ; Male ; Photic Stimulation

To analyze clinical features of mah-jong reflex epilepsy, and to explore the underlying mechanisms.
 Methods: The clinical data of 15 patient (a study group), who visited in the outpatient department in the Third Xiangya Hospital, Central South University from 2016 to 2018, were collected and analyzed. The clinical data included disease history, 24 h- electroencephalography (EEG) and magnetic resonance imaging (MRI) scan. Next, previous 84 case (a literature group) reports published in the past 20 years were searched and compared.
 Results: Both groups of mah-jong reflex epilepsy were predominant in middle-aged men, with onset ages of (44.53±10.58) and (41.48±17.85) years old, respectively. In the study group, time interval usually lasted (4.00±2.45) h from starting play mah-jong to seizure attack, 73.3% patients complained mental fatigue before seizure attack, and 93.3% of the patients were described to have general tonic-clonic seizure. Few positive result was discovered in auxiliary examination, and the percentage was 9.3% in EEG, while no positive outcome was seen in head MRI. There were no significant differences in gender, age of onset, duration of playing mah-jong before attack, type of attack, and changes of head MRI between the 2 groups (all P>0.05).
 Conclusion: Mental fatigue after long-time mah-jong playing and cognitive dysfunction might be the potential triggers in mah-jong reflex epilepsy.
Adult ; Electroencephalography ; Epilepsy, Reflex ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Seizures