Objective:

Not applicable

Background:

Reflex epilepsies are a group of uncommon epileptic syndromes in which seizures are triggered by specific sensory, motor, or cognitive stimuli. Among these, calculation-induced epilepsy or Epilepsia arithmetices is an exceptionally rare form of reflex epilepsy triggered by mathematical calculation or complex arithmetic reasoning. Only a limited number of cases have been described in the literature, and the underlying mechanism remains poorly understood. The proposed mechanism involves cortical hyperexcitability within frontoparietal networks engaged in numerical processing, particularly in the dominant hemisphere.  

Design/Methods:

Not applicable

Results:

A 21-year-old male college student with a history of seizures since age 12 presented to establish care.   His mother described a semiology resembling bilateral tonic-clonic seizures. The patient reported an aura of lightheadedness and “brain fog” prior to his events, followed by loss of awareness.  He reported that his seizures were stereotypically reproducible by performing complex mathematics while performing his college coursework.  To confirm the diagnosis, a 2-hour video EEG study was obtained during which patient performed calculations involving discrete mathematics.  As he began performing calculations, 2-4 Hz interictal generalized spike-wave discharges were noted.  Subsequently, one electroclinical seizure was induced characterized by behavioral arrest and whole-body myoclonic jerking with rapid return to baseline.  Electrographically, 3-3.5 Hz spike and wave discharges were seen at onset, evolving to diffuse semirhythmic delta activity with superimposed spike wave discharges and abrupt termination followed by diffuse attenuation. 

Conclusions:

We describe a rare case of calculation-induced reflex epilepsy or Epilepsia arithmetices. This case contributes to the limited literature on calculation-induced epilepsy and highlights the relationship between cognitive processing and cortical excitability.