Benign Rolandic Epilepsy, also known as benign childhood epilepsy with centrotemporal spikes (BECTS), is the most frequently diagnosed epilepsy syndrome in children. This condition is characterized by specific types of seizures. An electroencephalogram (EEG) serves as a primary diagnostic instrument, confirming this form of childhood epilepsy by identifying characteristic electrical patterns within the brain.
Understanding Benign Rolandic Epilepsy
Benign Rolandic Epilepsy manifests in children between 3 and 13 years, with symptoms often peaking around 7 to 8 years. Seizures are focal, meaning they originate in the rolandic or centrotemporal region of the brain, which controls movements of the face, mouth, and throat. Children may experience twitching, numbness, or tingling sensations in these areas, along with drooling or difficulty speaking. These episodes are brief, lasting less than two minutes, and occur during sleep, either when falling asleep or waking up.
The term “benign” highlights the condition’s favorable outlook, as it is not associated with underlying brain damage or developmental delays. Most children diagnosed with Benign Rolandic Epilepsy are otherwise healthy and experience normal cognitive development. The seizures decrease in frequency over time and ultimately resolve spontaneously as the child approaches adolescence.
The Role of EEG in Diagnosis
An electroencephalogram (EEG) records the brain’s electrical activity using electrodes placed on the scalp. These electrodes detect electrical signals produced by brain cells, which are amplified and displayed. This procedure helps observe how different areas of the brain are functioning.
For epilepsy, an EEG identifies abnormal brain activity and classifies the type of epilepsy. During the test, a technician measures and marks specific points on the scalp to ensure accurate electrode placement. The child relaxes in a comfortable position, and the recording may include periods of wakefulness and sleep to capture various brain states.
Characteristic EEG Patterns in Benign Rolandic Epilepsy
The diagnosis of Benign Rolandic Epilepsy is supported by distinct EEG findings, specifically the presence of “centrotemporal spikes,” also referred to as rolandic spikes. These unique electrical discharges are high-amplitude, sharp waves often followed by a slower wave. They are observed in the centrotemporal regions of the brain.
These centrotemporal spikes become more frequent and prominent during sleep, particularly during non-rapid eye movement (NREM) sleep. This activation during sleep is a significant diagnostic indicator and helps differentiate Benign Rolandic Epilepsy from other seizure types. These EEG patterns are important for confirming the diagnosis and guiding management decisions.
Prognosis and Management
Children with Benign Rolandic Epilepsy have an excellent long-term prognosis, with the condition nearly always resolving on its own. The majority of children outgrow their seizures by adolescence, often by age 15 or 16, without lasting neurological or cognitive difficulties. Most individuals experience a low total number of seizures throughout childhood, with some having only a single episode.
Management for Benign Rolandic Epilepsy involves a conservative approach if seizures are infrequent, mild, and primarily occur during sleep. In such cases, medication may not be necessary. If seizures are more frequent, severe, or impact daily activities, a healthcare provider may recommend a low dose of anti-epileptic drugs such as levetiracetam, valproic acid, or oxcarbazepine. The decision to initiate or discontinue medication is made in consultation with a physician, considering the child’s specific seizure pattern and overall well-being.