복잡한 사고에 의해 유발되는 간질발작 2예 = Two Patients with Epilepsy Induced by Complex Thinking

다국어 초록 (Multilingual Abstract)

Reflex epilepsies are distinct but not clealy understood clinical entity. Various cerebral activities induced by simple stimulation including visual, auditory, somatosensory, as well as diverse functional tasks such as reading, calculation, complex thinking are believed to be seizure-inducing factors. We experienced two patients whose seizure were readily precipitated by complex, streunuous thinking. Both patients was teen-aged boy at the onset of seizure(13, and 15 years of age each) with normal physical and mental growth. Although first seizure was precipitated by watching TV and playing puzzels in each patient, initial diganosis was idiopathic generalized epilepsy, possible juvenile myoclonic epilepsy(JME). For the first few years, seizures were infrequent but mostly precipitated by the tasks needs concentration such as playing computer games, decision-making, mathematics, reading, or during the examination. EEG revealed various thinking process including reading hard books, drawing complex figure, complex calculation induced epileptic discharges even if it usually needs certain period of concentration. Phenytoin, valproic acid, clonazepam, vigabatrin, and lamotrigine sometimes abated their seizures but none of these made them seizure-free. Complex reflex epilepsy induced by thinking was proposed to be a separate type of epilepsy or a variant of JME, Age, sex, stereotypic seizure-inducing factors, clinical course, and refractory epilepsies in these patients highly suggested this type of epilepsy as a variant of JME but its refractoriness and unique provocation still needs more speculation.