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A Neuroanatomic, Neurophysiologic, and Neuropsychological Study

Anthony L. Ritaccio, MD; Edward J. Hickling, PsyD; Venkat Ramani, MD

Arch Neurol. 1992;49(9):933-939.

Abstract
• We studied a 24-year-old man who had reading epilepsy after removal of a left frontal arteriovenous malformation. Lesion analysis by means of a neuroanatomic template placed a 2-cm region of encephalomalacia anterior to the left central sulcus in premotor cortex (Brodmann's area 6). Lexical and nonlexical reading activation tests demonstrated seizures during reading and increased discharge rates when the patient was reading aloud or silently articulating. Seizures (perceived or actual jaw clicking) were electrographically characterized by brief left frontocentral epileptiform transients. Grapheme to phoneme transformation, not linguistic complexity, appears to be the critical stimulus in some reading epilepsies. The case adds anatomic relevance to the phonologic component of reading and supports the putative role of dominant premotor cortex in activation of precise sequences of motor linguistic output in reading and writing. Reading epilepsy may be a reflex or action myoclonus syndrome localized to Brodmann's area 6 (Exner's area).

Author Affiliations
From the Departments of Neurology (Drs Ritaccio and Ramani) and Psychiatry (Dr Hickling), Albany (NY) Medical College).

Footnotes
Accepted for publication April 23, 1992.

Presented in abstract form at the American Epilepsy Society meeting, Philadelphia, Pa, December 1991.

Reprint requests to Epilepsy Section, Department of Neurology, Albany Medical College, 47 New Scotland Ave, Albany, NY 12208 (Dr Ritaccio).

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