Two Patients with Epilepsy Induced by Complex Thinking

복잡한 사고에 의해 유발되는 간질발작 2예

  • Kim, Jae-Moon (Department of Neurology, College of Medicine, Chungnam National University) ;
  • Lee, Keong-Mok (Department of Neurology, College of Medicine, Chungnam National University) ;
  • Shon, Eun-Hee (Department of Neurology, College of Medicine, Chungnam National University) ;
  • Jung, Ki-Young (Department of Neurology, College of Medicine, Chungnam National University)
  • 김재문 (충남대학교 의과대학 신경과학교실) ;
  • 이경목 (충남대학교 의과대학 신경과학교실) ;
  • 손은희 (충남대학교 의과대학 신경과학교실) ;
  • 정기영 (충남대학교 의과대학 신경과학교실)
  • Published : 2000.05.30

Abstract

Reflex epilepsies are distinct but not clearly understood clinical entity. Various cerebral activities induced by simple stimulation including visual, auditory, somatosensory stimulation, as well as diverse functional tasks such as reading, calculation, complex thinking are believed to be seizure-inducing factors. We experienced two patients whose seizures were readily precipitated by complex, strenuous thinking. Both patients was teen-aged boy at the onset of seizure(13, and 15 years of age each) with normal physical and mental growth. Although first seizure was precipitated by watching TV and playing puzzles in each patient, initial diagnosis was idiopathic generalized epilepsy, possibly juvenile myoclonic epilepsy( JME). For the first few years, seizures were infrequent but mostly precipitated by the tasks needs concentration such as playing computer games, decision-making, mathematics, reading, or during the examination. EEG revealed various thinking process including reading hard books, drawing complex figure, complex calculation induced epileptic discharges even if it usually needs certain period of concentration. Phenytoin, valproic acid, clonazepam, vigabatrin, and lamotrigine sometimes abated their seizures but none of these made them seizure-free. Complex reflex epilepsy induced by thinking was proposed to be a separate type of epilepsy or a variant of JME. Age, sex, stereotypic seizure-inducing factors, clinical course, and refractory epilepsies in these patients highly suggested this type of epilepsy as a variant of JME but its refractoriness and unique provocation still needs more speculation.

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