Benign rolandic epilepsy

Epilepsy Action is indebted to Dr Richard Appleton, a Consultant Paediatric Neurologist who specialises in children’s epilepsy, and to Dr Rachel Kneen, Consultant Paediatric Neurologist and Dr Stewart Macleod, Specialist Registrar in paediatric neurology, at Alder Hey at Alder Hey Children’s Hospital, Liverpool, who have kindly prepared the information on this page.

Benign rolandic epilepsy is an epilepsy syndrome. It is also known as benign rolandic epilepsy of childhood (BREC) or benign epilepsy with centro-temporal spikes (BECTS).

Benign rolandic epilepsy is called 'benign' because it has a good outcome - nearly all children with it will outgrow it during puberty.

'Rolandic' means the seizures begin in the part of the brain called the rolandic area. The seizures are classified as a partial seizure because only this one part of the brain is involved.

Benign rolandic epilepsy is one of the most common types of epilepsy in children. It affects almost one in five of all children who have epilepsy. It affects boys and girls equally. It usually starts between the ages of three and 10 years, and often stops around puberty (aged 14-18 years).

Children who have this type of epilepsy are usually well otherwise and do not have learning difficulties, although some may have specific difficulties with reading and language or with drawing and visuo-spatial skills.

Symptoms

Seizures often start as the child is waking up in the morning. There is a feeling of tingling (like pins and needles) on one side of the mouth involving the tongue, lips, gum and inner side of the cheek.

The seizure may also involve the throat which may cause speech to be unclear and therefore difficult to understand. The child may make strange throaty or gurgling noises and it is often this which alerts parents that something may be wrong. The child often knows what they want to say but cannot speak properly.

The seizure may also cause twitching movements (called clonic movements) or a stiffness (called a tonic movement) of one side of the face. These movements may then spread to the arm and/or the leg, usually on the same side as the movements in the face.

Occasionally, both sides of the body are affected. When this happens, the child loses consciousness, becomes stiff and has regular, jerking movements of the arms and legs. The child may also be incontinent. This is called a tonic-clonic seizure, which is a generalised seizure. After this seizure, the child will be sleepy and some children may sleep for a few hours.

Diagnosis

This will involve a full and accurate history of the seizure(s) and an EEG test (electroencephalogram), which records the electrical activity in the brain. In benign rolandic epilepsy, the EEG will pick up epileptic activity in the rolandic – also called the centro-temporal – area of the brain. However, sometimes the EEG may in fact be normal, but this does not mean that the child does not have this epilepsy syndrome.

Treatment

Treatment with anti-epileptic drugs is not always considered necessary, since it is known that the seizures will tend to disappear when the child gets to puberty. In addition, many children will only have one or two seizures and therefore will not need any treatment.

However, most parents and most doctors feel reassured by treatment. Either carbamazepine (Tegretol), lamotrigine (Lamictal) or sodium valproate (Epilim) are almost certain to be effective in controlling seizures.

The anti-epileptic drugs are taken every day, usually for two years.

Prognosis (outlook)

The fact that this type of epilepsy is called benign means that it has a very good outcome. Nearly all children with this type of epilepsy will outgrow the tendency to have seizures during puberty.

Children who have benign rolandic epilepsy do not usually have learning difficulties. Some may have some problems with reading and language, but most cope well with school work.

Support organisation

Contact a Family, 209-211 City Road, London, EC1V 1JN, telephone 0808 808 3555, www.cafamily.org.uk

If you would like any more information about epilepsy, then please contact Epilepsy Action via the Email Helpline or, if you live in the UK, by phoning the Freephone Helpline on 0808 800 5050.

14 March 2007