Benign Rolandic Epilepsy

Question 1

Semiology of a benign rolandic epilepsy seizure

Answer 1

• Onset:
  
  • Classically occurs when falling asleep or awakening from sleep
• Features:
  
  • Clonic or tonic activity of one side of the lower face
  • Paresthesia of the tongue, lips, gum, and cheek
  • Drooling and arrest of speech or dysarthria
  • May or may not subsequently generalize

Question 2

Epidemiology of onset for benign rolandic epilepsy/benign epilepsy with centrotemporal spikes

Answer 2

• Most common focal epilepsy of childhood
• Age of onset between 3-10 years
• Resolves spontaneously by age 18
• Family history is often present

Question 3

Peri-rolandic region of the brain

Answer 3

• The Rolandic fissure is another name for the central sulcus
• Rolandic epilepsy gets its name because of its focal involvement of the motor and sensory strip

Question 4

EEG in rolandic epilepsy/BECTS

Answer 4

Inter-ictally, it is characterized by the presence of “centrotemporal” or “perirolandic” spikes

These may be unilateral or bilateral

They become more prominent during sleep.

Question 5

Treatment of benign rolandic epilepsy

Answer 5

• Most patients experience only one or less than a handful of seizures, and will grow out of the disease by age 18
• Studies recommend withholding treatment (watchful waiting) unless there were multiple seizures, cognitive changes, quality-of-life changes, and generalized tonic-clonic seizures
• Treatment is with levetiracetam, carbamazepine, or phenytoin

Question 6

The most common focal epilepsy in children is ___.

The most common focal epilepsy in adults is ___.

Answer 6

The most common focal epilepsy in children is benign rolandic epilepsy.

The most common focal epilepsy in adults is temporal lobe epilepsy.

Question 7

“Malignant rolandic epilepsy”

Answer 7

Seizures look similar to typical BECTS, but are frequent, difficult to treat, and do not spontaneously remit by 16 years of age.

It is likely that these patients have a different syndrome rather than a severe form of BECTS.