Abstracts

Rationale: Reading epilepsy is a rare disorder that manifests with jaw jerking, twitching or clicking while reading, and progression to generalized tonic-clonic seizures if reading continues. Reading epilepsy is thought to be a non-progressive but persistent disorder that requires continuous antiepileptic therapy. Successful treatment with valproic acid or clonazepam has been reported. However, there have been no reports on the use of newer antiepileptic drugs (AEDs) in treatment of reading epilepsy. In addition, little is known regarding the natural long-term course of this condition. We report successful treatment with levetiracetam of primary and secondary reading epilepsy and spontaneous remission of primary reading epilepsy. Methods: We report three patients that were evaluated at the Vanderbilt Epilepsy Center between 2001 and 2011. Two male patients (#1 and #2) developed primary reading epilepsy at 14 and 22 years of age and one woman (#3) developed secondary reading epilepsy at age 27, three years after a left selective amygdalohippocampectomy. All patients underwent video-EEG studies in our Epilepsy Monitoring Unit (EMU). Results: Seizures in all patients were characterized by twitching of the lips and jaw. All three reported secondarily generalized tonic-clonic seizures after prolonged reading. Reading-induced seizures were recorded during video-EEG studies in all patients. Associated EEG patterns were bifrontal synchronous spike-and-wave discharges that were occasionally generalized with left predominance (patient #1), single generalized spike-and-wave complexes with left fronto-central predominance (patient #2), and spikes with a wide left hemispheric field (patient #3). Patients became seizure free after divalproex monotherapy (#1), levetiracetam monotherapy (#2) or levetiracetam add-on therapy (#3). In patient #3 carbamazepine had failed to stop reading seizures despite titration to the maximum tolerated dose of 1400 mg per day. Patient #1 ran out of divalproex less than three years after the onset of his seizures. He remained seizure-free off the medication at most recent follow-up, three years after discontinuation of valproic acid and six years after seizure onset. Conclusions: We have demonstrated successful treatment of primary and secondary reading epilepsy with levetiracetam. While we also confirmed efficacy of valproate in one patient, we propose that levetiracetam should be considered as an initial treatment in patients with reading epilepsy. We report spontaneous medication-free remission of primary reading epilepsy three years after seizure onset. While there are rare reports of medication-free remission in reading epilepsy 10-23 years after onset (Radhakrishnan et al, 1995), our report indicates that much earlier remission is possible.