Reflex seizures induced by calculation, card or board games, and spatial tasks: a review of 25 patients and delineation of the epileptic syndrome.

Nine patients had reflex activation of seizures by calculation, card and board games, or spatial tasks. The common denominator for these and the 16 others reported in the literature appears to be activity related to function of the parietal lobe. The clinical and EEG findings in all 25 patients support the diagnosis of primary generalized epilepsy. Seizures usually start during adolescence and consist of myoclonus, absences, and generalized convulsions. Specific inquiry about reflex activation should be carried out in patients with generalized epilepsy since this is rarely provided spontaneously. Attacks could be controlled satisfactorily in 89% of our patients. The genetic features are those of a primary generalized epileptic disorder without evidence for a specific inheritance of reflex sensitivity. Neuropsychological analysis of the stimuli points to parietal cortical dysfunction. These stimuli lead to activation of a generalized epileptic process analogous to the occipital cortical participation in the activation of generalized epileptic abnormality occurring in patients with photosensitive epilepsy.