EPILEPSY WITH READING-INDUCED SEIZURES (EwRIS)

	Mandatory	Alerts	Exclusionary
Seizures	Myoclonus of orofacial muscles, triggered by reading/language tasks	Myoclonic seizures predominantly affect upper limbs	All other seizure types, except generalized tonic–clonic seizures
EEG			Slow background (outside the postictal period)
Age at onset		>20 years
Development at onset	Normal
Neurological exam	Normal
Imaging	Normal
Are MRI or ictal EEG required for diagnosis? An MRI is required for diagnosis to exclude a structural cause An ictal EEG is not required, observation of orofacial myoclonus during reading/language task (either directly, or on video) is highly recommended
Syndrome without laboratory confirmation: in resource-limited regions, this syndrome can be diagnosed in a patient who meets all mandatory criteria and have no exclusionary seizure types

NOTE Alert criteria are absent in the vast majority of patients with the syndrome, but rarely can be seen. Their presence should result in caution in diagnosing the syndrome and consideration of other conditions