Introduction Reflex epilepsy is a condition in which seizures can be provoked by an external stimulus. We present a very rare case of Lego-induced reflex epilepsy.

Case A previously well 12 year old boy attended emergency services having been found unconscious by his parents among a pile of Lego. He had no tongue biting, incontinence or preceding aura. He subsequently had three further witnessed generalised seizures, all while playing with Lego. Multiple investigations including ECG, brain MRI and standard EEG were normal. However, a sleep-deprived EEG showed epileptiform activity while playing with Lego. Sodium valproate was commenced and he continued to play with Lego without seizures. On stopping Valproate at the age of 17, he had a further Lego-induced seizure. As he was keen to continue playing with Lego, he recommenced his medication. Just prior to recommencement, he interestingly had a seizure while solving a complex question during his AS level Mathematics Exam. He has remained seizure free since.

Discussion The ILAE defines reflex epilepsy as seizures consistently resulting from a specific trigger, without spontaneous seizures otherwise. Triggers may be sensory (commonly photostimulatory) or related to higher cerebral functioning (in our case, related to praxis). To our knowledge, there is only one previous case report of Lego-induced epilepsy in literature. Complex patterns affecting higher cerebral function could explain both seizure types in our patient. Primary management involves removing the trigger. However, when this is not achievable, medical management should be considered.

Conclusion The largest potential clues to diagnosis in reflex epilepsies are in history and examination, especially identifying a consistent trigger. Standard stimulation used during EEG recordings such as light and sound may not capture rarer reflex epilepsies. It is therefore vital to organise a concurrent EEG alongside the specific trigger wherever possible to clinch this rare diagnosis.