Abstracts

RATIONALE: Reflex epilepsy induced by thinking and spatial tasks has been reported to have the clinical characteristics similar to those of idiopathic generalized epilepsy. However, we recognized that the clinical and electrophysiological findings in Korean patients with thinking-induced epilepsy were different from the previous literatures.
METHODS: Clinical features of the 14 patients were collected via detailed interview with each patient by one of the authors. Brain imaging findings and Routine EEG data including sleep activation, hyperventilation, and photic stimulation were obtained from the patient[ssquote]s charts. In 12 out of the 14 patients, EEG activations were carried out by means of the actual task simulation and the neuropsychological tests for various mental activity.
RESULTS: All patients were male. The mean age at onset of seizures was 38.1 years (13 -55 years). The median age at onset was 47 years. Two patients had family history of epileptic seizures. All patients except one had no spontaneous seizures. The reported stimuli which evoked seizures were playing Korean cards(so called, flower cards) in 9, playing the game of [ssquote]go[ssquote] in 4, making complex decisions in 2, and playing cards in 1. Only 2 patients had more than 1 effective trigger. Reflex seizures usually occurred after a period of 5-24 hours of mental activity with sleep deprivation. All patients had generalized tonic-clonic seizures, which were often preceded by prodromal symptoms including recurrent absence, visual illusion, mental cloudiness, fragmentation of thinking, febrile sensation, dizziness, nausea, and headache. There were no patients reporting myoclonus. On routine EEG, all patients except one showed no epileptiform discharges. Neither neuropsychological testing nor the actual task simulation activated epileptiform discharges in all patients. Brain imaging was normal in eight, abnormal in five, and no images was performed in one patient.
CONCLUSIONS: Comparing to the previous literatures, thinking-induced epilepsy in Korean patients had some different clinical characteristics including adulthood onset of seizure, few spontaneous seizures, reflex precipitation of generalized tonic-clonic seizures preceded by absence but not myoclonus, and few epileptiform discharges on routine and activation EEGs.