Three cases of reflex epilepsy evoked by non-linguistic higher cerebral activities.
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We reported the clinical characteristics of 3 patients with peculiar reflex epilepsy in which specific seizures were evoked exclusively by motivating non-linguistic higher cerebral function.<BR>The first case, a woman of 47, had recurrent myoclonic jerks involving the upper extremities as well as generalized tonic-clonic seizures (GTC) since age 14. Through intensive monitoring with the use of CCTV-EEG, it was determined that myoclonic jerks or spike-wave-complexes (sp-w-c) were evoked only when she was subjected to certain neuropsychological tasks comprised of a combination of complex processes of thinking (decision-making) and voluntary motor activities specifically involving the fingers and arm such as calculation, game playing, writing, construction of designs.<BR>The second case, a woman of 29, had experienced since age 11 myoclonic jerks compound or combined with GTCs evoked only when, for example, calculating, writing or playing piano. Her condition was well controlled by valproate and clonazepam. However, when she was placed at calculation tasks, burst of generalized high voltage slow waves took place.<BR>The third case, a man of 25, had recurrent myoclonic jerks and GTCs since age 15. They were characterized by being precipitated by calculating, constructing designs, writing or playing games. Sp-w-c were also activated by posing tasks of calculation or construction of blocks.<BR>By reviewing a total of 22 cases of reflex epilepsy evoked mainly by non-linguistic higher cerebral activities reported hereto in the literature, we were able to identify a unique group of reflex epilepsy of idiopathic nature, of which the clinical characteristics are summarized as follows: 1) seizure onset at around puberty, 2) seizure-inducing factors comprised of higher cerebral activities requiring a combination of complex thinking and voluntary movement, becoming more and more definitive as the clincal course progresses, 3) clinical seizures of generalized nature, especially of myoclonic jerks mainly involving the upper extremities and combined or compound GTCs, 4) generalized epileptic discharges predominating in the central area activated by posing particular neuropsychological tasks to the patient. There is some resemblance between this type of reflex epilepsy we have postulated and juvenile myoclonic epilepsy.<BR>There exist two different types of reflex epilepsy in which clinical seizures are evoked by higher cerebral activities: language-induced epilepsy on the one hand and epilepsy induced by non-linguistic activities on the other. The significance of the latter within the realm of reflex epilepsy was emphasized.
- 一般社団法人 日本てんかん学会の論文
一般社団法人 日本てんかん学会 | 論文
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