We describe a young adult with a history of remote head injury, who had focal seizures induced by thinking in the context of acute bacterial meningitis.
Three clinical characteristics of the seizures in this patient are unusual. Similar to the patient described by Martinez et al, our patient was clearly able to start a seizure by thinking. He did not report the ability to abort seizures, which is used in behavioral therapy and was reported to decrease seizure frequency particularly in reflex epilepsies.
Our patient had complex partial seizures, although reflex thinking epilepsies are typically idiopathic and generalized, and occur particularly in patients with juvenile myoclonic epilepsy.[11,12] In a literature review, partial seizures were described in only 5 cases. Navarro et al reported a man with intractable partial epilepsy, who had both spontaneous and reflex seizures. The latter were induced either by tooth-brushing or by seeing or thinking of a toothbrush or toothpaste, and originated in the left temporal lobe. Martinez et al reported a man with intractable symptomatic complex partial seizures, who had spontaneous seizures for several years. Later, seizures were precipitated by the thought of his family home, and the onset was localized to the left temporal lobe. The patient became seizure-free after a left temporal resection. Bouzidi et al reported a patient with symptomatic eating epilepsy. The seizures were triggered by food-related stimuli, including the thought of food. In a study of neuropsychological EEG activation in patients with epilepsy reported by Matsuoka et al, the provocative effect of the tasks was observed in only 2 patients with localization-related epilepsy. One of them had a complex partial seizure triggered by nonspecific psychic tension, and asymptomatic focal spike-wave discharges were triggered by reading in the other.
Finally, unlike previous reports of thinking-induced seizures, our patient had no spontaneous seizures before or following his acute illness. According to the accepted definition, acute provoked seizures occur in the context of an acute brain insult. Despite a severe head injury several years earlier, our patient's seizures were provoked by acute bacterial meningitis and none of them was triggered by other stimuli. To our knowledge, this is the first report of provoked seizures that were exclusively triggered by thinking.
The authors thank Mrs Yana Skif, EEG technician, for her help during this patient's recordings.
Neurologist. 2012;18(6):415-417. © 2012 Lippincott Williams & Wilkins