Video-EEG monitoring and reflex epilepsy

A 21-year-old right-handed male college student was evaluated for a 2-year history of spells that occurred primarily while reading text books. He grew up with an abusive father who was an alcoholic. Risk factors for seizures included multiple concussions while playing high school football. The attacks were frequent and severe enough to cause him to leave school when they would occur. His professors and school officials thought he was making the events up to avoid school. During the events he was described as abruptly staring off into space with unresponsiveness that would last for several minutes. His family stated he may have had a rare event even when he was not reading. The events were so disruptive that he contemplated leaving school permanently. There was no history of injury from the events, nor was there an aura or history of a convulsion. He is mildly anxious and depressed. He smoked marijuana, which he thought helped these events. His neurological examination was normal. Two routine sleep deprived EEG's (with photic stimulation and hyperventilation) and a high-resolution brain MRI with attention to the temporal lobes were normal. Video-EEG monitoring was performed. Two events were captured (Fig. 27.1). Both occurred while reading an anthropology text book. EEG demonstrated an abrupt run of independent bi-temporal rhythmic ictal theta activity provoked by reading. SISCOM imaging correlated with EEG during his right temporal seizure. PET scan and neuropsychological testing were non-localizing. Subsequently, the patient failed to respond to four AEDs. Invasive EEG recording was performed in the course of pursuing resective epilepsy surgery.