Teaching video neuroimages: reading epilepsy: a seizure in a thousand words (or less)

A 14-year-old right-handed boy developed spells of lip twitching only while reading. With prolonged reading, he occasionally experienced loss of awareness and limb jerking (figure and video on the Neurology® Web site at www.neurology.org). Reading epilepsy is a rare form of reflex seizure in which reading (silently or aloud) may trigger orofacial myoclonus, stammering, aphasia, or generalized convulsions. Onset is typically in early adulthood, with 2:1 male predominance. It occurs in isolation or autosomal dominant fashion.(1) Previous reports suggest efficacy of clonazepam, valproate, or levetiracetam.(2) Our patient did not tolerate levetiracetam but remains seizure-free on oxcarbazepine. Reading epilepsy should be recognized and promptly treated to avoid unnecessary academic struggles.