Benign Rolandic Epilepsy

 

Presentation

Childhood epilepsy with centro-temporal spikes (CECTS) is common, seen more in boys starting between 4 to 10 years age and generally stops by puberty (15-18y). Minor learning difficulties may be seen, otherwise development is normal.

There may be a genetic link, as cases cluster in families.

 

Brief focal seizures often wake the child from sleep, with tingling on one side of cheek or tongue; unusual sensation in mouth or throat; making gurgling or clicking sounds but unable to speak clearly.

Sometimes there is excessive salivation, chewing or swallowing movements.

There may be twitching on side of face or cheek and sometimes tonic/ clonic movements in limbs on same side. Consciousness is generally not impaired. Occassionally, there may be incontinence or spread to GTC with postictal drowsiness and sometimes Todd’s paresis.

 

Investigation

EEG shows abnormality in centrotemporal (rolandic) area of brain.

Initial EEG can be normal; if so consider a sleep-deprived EEG recording.

Neuroimaging nor required.

 

Management

The seizures are considered ‘benign’ and spontaneously go in to remission when puberty attained. Seizure frequency is low, so treatment is generally not recommended.

If seizures unacceptable, treat with Carbamazepine, Leveteracetam or Lamotrigine which are generally effective.