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Reading-induced focal seizure with alexia (ictal video EEG)

Reading-induced focal seizure manifested with alexia in a 23-year-old man. Soon after the patient started reading aloud, rhythmical monomorphic delta activity at 0.8-1 Hz appeared over the left temporal area showing a relative equipotentiality over T3-T5 channel and extending to the ipsilateral parietal-occipital region (first arrow). The patient was still able to read, but 9 s later (20 s after behavioral onset, second arrow) he stuck on a word, hesitated, and repeated it for a couple of times as though he tried to understand it, and pressed the event button. The EEG normalized for the next 20 s and then an irregular low voltage slow activity at 3.5-5 Hz appeared on the left (third arrow), followed by a sharpened rhythmic theta activity at 5 Hz (fourth arrow). The electrical seizure ceased 94 s after the onset of the first behavioral changes, followed by a short period of left postictal suppression. For other behavioral changes, see text. The numbers on the left side of the arrows indicate the time in seconds after the first behavioral changes. The seizure is depicted in a discontinuous manner to include only the periods during which distinct behavioral and electrical changes occurred. (Courtesy of M Koutroumanidis from Koutroumanidis et al 1998.)