New observations in primary and secondary reading epilepsy: Excellent response to levetiracetam and early spontaneous remission

The response of reading epilepsy to new antiepileptic drugs is not known. Due to the rarity of this condition little is known about its natural history. We evaluated and treated three patients with primary and secondary reading epilepsy. Seizures in all patients were characterized by twitching of the jaw or lips with secondarily generalized tonic–clonic seizures if reading continued. One patient with primary reading epilepsy became seizure-free with divalproex monotherapy and another with levetiracetam monotherapy after failure of lamotrigine. One other patient with secondary reading epilepsy became seizure-free with levetiracetam add-on therapy. The divalproex-treated patient stopped therapy less than 3 years after seizure onset and remained seizure-free with 6 years of follow-up. We propose levetiracetam as a first-line treatment for primary and secondary reading epilepsy. Spontaneous medication-free remission of primary reading epilepsy may occur within 3 years of seizure onset, much earlier than previously reported.

► Levetiracetam is very effective in primary and secondary reading epilepsy.
► Levetiracetam should be considered a first-line treatment for reading epilepsy.
► Valproate is also effective.
► Primary reading epilepsy may remit as early as 3 years from onset.
► Medication-free remission may occur earlier than previously reported.