Rolandic epilepsy, also known as self-limited epilepsy with centrotemporal spikes (SeLECTS), is a prevalent form of childhood epilepsy. This condition is considered benign, meaning it resolves on its own as a child grows. Electroencephalography, an EEG, serves as a diagnostic tool in confirming this condition.
Understanding Rolandic Epilepsy
Rolandic epilepsy is the most common epilepsy syndrome found in children, accounting for approximately 6% to 15% of all childhood epilepsies. It manifests between the ages of 3 and 14 years, with a peak onset around 6 to 11 years, and is slightly more common in boys. This type of epilepsy is self-limited because most children outgrow the condition by adolescence.
Seizures characteristic of Rolandic epilepsy occur during sleep or upon waking. These seizures are focal, originating specifically in the centrotemporal region around the central sulcus. Clinical manifestations include unilateral facial sensory-motor symptoms, such as twitching, numbness, or tingling of one side of the face or tongue. Children may also experience oropharyngolaryngeal symptoms like drooling, difficulty speaking, or making strange noises, while remaining aware during the episode.
The Role of EEG in Diagnosis
An electroencephalogram (EEG) is a non-invasive medical test that records the electrical activity of the brain. It involves placing electrodes on the scalp, which detect electrical signals produced by brain cells and display them as wave patterns on a monitor or paper. While the clinical symptoms of Rolandic epilepsy can suggest the diagnosis, an EEG provides confirmation.
The distinctive feature on an EEG for Rolandic epilepsy is the presence of “centrotemporal spikes,” also referred to as “rolandic spikes.” These are specific patterns of brain electrical activity that are considered pathognomonic for the condition. These spikes are high-amplitude, biphasic or triphasic sharp waves, often followed by a slow wave. Their maximum negativity is observed in the central and temporal regions of the brain.
These characteristic spikes are activated or more pronounced during sleep, particularly during non-REM sleep, which makes sleep recordings an important part of the EEG procedure for diagnosis. An EEG performed for suspected Rolandic epilepsy includes both awake and sleep states to ensure these patterns are captured. The presence of these EEG patterns, combined with clinical presentation, allows for a diagnosis of Rolandic epilepsy.
Implications of EEG Findings
An EEG-confirmed diagnosis of Rolandic epilepsy offers reassurance to families, as the prognosis for this condition is excellent. Most children with Rolandic epilepsy will stop having seizures within 2 to 4 years after onset, and complete remission occurs before age 16. The condition is considered benign, with seizures usually resolving by adolescence.
Unlike some other forms of epilepsy, Rolandic epilepsy does not lead to significant cognitive impairment. Children maintain normal intelligence. While some children might experience mild, temporary difficulties in areas such as expressive language, verbal learning, or attention during the active phase of the epilepsy, these issues improve once the seizures cease and the EEG patterns normalize.
Treatment with anti-seizure medication is not necessary due to the benign and self-limiting nature of Rolandic epilepsy. Medication is considered only if seizures are frequent, severe, or significantly disruptive, such as occurring during the daytime or causing language or neurocognitive changes. The EEG findings, particularly the frequency of discharges, can help guide these management decisions. Monitoring involves periodic clinical evaluations, with routine follow-up EEGs not required unless there are changes in symptoms.