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Reflex reading epilepsy — SCE Neurology MCQ

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EasyEpilepsyReflex reading epilepsySCE Neurology

A 55-year-old man presented with jaw jerks and a generalised seizure triggered by prolonged reading aloud. On examination, neurological examination and standard MRI were normal. Initial investigations showed: EEG while reading showed left temporal and generalised epileptiform discharges. What is the most likely underlying mechanism?

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Correct answer: B — task-specific cortical hyperexcitability during language processing

task-specific cortical hyperexcitability during language processing is the best answer because the vignette describes Reflex reading epilepsy: seizures consistently provoked by reading are a recognised reflex epilepsy. Cortical spreading depolarisation is plausible in a neighbouring presentation, but the chronology, examination or investigation pattern does not match the key discriminator here. Dopamine receptor blockade and Alpha-synuclein neurodegeneration are less appropriate because they would require different localisation, timing or test findings; Paradoxical embolism through a right-to-left shunt would fit a different syndrome. Clinical pearl: primary progressive aphasia would not cause paroxysmal jaw myoclonus.

Reference: NICE NG217; BNF; DVLA Assessing fitness to drive