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To the Editor:
El Bouzidi et al.1 report a patient with symptomatic epilepsy featuring reflex focal seizures triggered by food-related stimuli and, in particular, triggered by the thought of food.
The authors claim that reflex seizures triggered by the thought of a specific stimulus are extremely rare.1 Reflex activation of seizures by thinking has been well-established in idiopathic generalized epilepsies in response to nonverbal higher mental activities such as calculation, card and board games, or spatial tasks.2,3
Functional neuroimaging studies have recently shown that seizures arise from regions of cortical hyperexcitability overlapping with areas physiologically activated during specific sensory, cognitive, or motor stimulations. This stimulation may subsequently involve the cortico-reticular or cortico-cortical pathways, thus resulting in a generalized epileptic event.4
However, thinking as an effective trigger in focal reflex seizures is exceptional.1 Eating-induced epilepsy is very rare, accounting for possibly 0.5–1 per 1,000 patients with epilepsy. However, an unusually high incidence has been reported in specific geographic areas of India.5 Previous attempts to find a specific stimulus during all aspects of eating have been unsuccessful. …
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