J Korean Epilepsy Soc.  2004 Dec;8(2):155-159.

Reflex Epilepsy Provoked by Mental Activities Mainly Associated with Use of the Hands

Affiliations
  • 1Department of Neurology, Dong-A University College of Medicine, Busan, Korea. shkim1@damc.or.kr

Abstract

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.

Keyword

Reflex epilepsy; Writing epilepsy

MeSH Terms

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
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