LESIONAL REFLEX EPILEPSY ASSOCIATED WITH THE THOUGHT OF FOOD

A 44-year-old right-handed woman was walking in the Scottish highlands. Upon unwrapping her lunch, she had a focal seizure with witnessed onset on the right side of the face and secondary generalization. Postictally, she was aphasic with a right hemiparesis. She was airlifted to hospital. Sodium valproate was commenced, increasing to 700 mg twice daily, and she was discharged home. Three weeks later, the smell of food triggered another seizure and she was admitted to the neurology unit where carbamazepine was introduced (200 mg twice daily).

The next morning, the patient had a simple partial seizure after eating a spoonful of porridge and 3 more when eating lunch, a snack, and dinner. Thereafter, most meals triggered seizures, as did other food-related stimuli such as being offered a piece of cake, seeing her visitors pass around food at her bedside, and smelling the hospital dinner trolley. Fifty-four seizures occurred over the next 14 days and 50 were related to food. The episodes typically lasted 80 seconds and were characterized by a tingling sensation in the tongue and right-sided facial and tongue movements. Consciousness was unimpaired.

Thirty-four seizures occurred during the act of eating, always early on in the meal while the patient still felt hungry. Fifteen were precipitated by the sight or smell of food alone, 1 while browsing a recipe book, and 3 when she could smell her pet dog's food. …