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Benign rolandic epilepsy

Benign rolandic epilepsy is called 'benign' because it usually has a good outcome. Nearly all children with it will outgrow it during puberty. It is called ‘rolandic' because the seizures begin in the part of the brain called the rolandic area. The ‘rolandic’ is also the ‘centro-temporal’ part on the brain’s surface. Mostly, the seizures are focal (partial), because only this part of the brain is involved.

Benign rolandic epilepsy is one of the most common types of epilepsy in children. It affects boys slightly more frequently than girls. Almost one in 5 of all children who have epilepsy will have benign rolandic epilepsy. It usually starts between the ages of 3 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 major learning difficulties. However, a significant minority (possibly 10-15%) of children will have difficulties with reading and language, or with drawing and visuo-spatial skills.

The cause for benign rolandic epilepsy is not known. It is probably caused by a genetic abnormality but none have been found as yet.

Other family members, such as a parent or grandparent may also have had this type of epilepsy when they were children. Occasionally, other family members may have a different type of epilepsy.

Other names for benign rolandic epilepsy

• benign rolandic epilepsy of childhood (BREC)
• benign epilepsy with centro-temporal spikes (BECTS)

Symptoms

Seizures often start as the child is asleep or just about to wake up in the morning. They have a feeling of tingling (like pins and needles) on one side of their mouth, involving the tongue, lips, gum and inner side of their cheek. Children sometimes describe their tongue or lips as being “fizzy” or “buzzing”. The seizure may also involve the throat, which may cause the child’s 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 mouth or 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 their arms and legs. This is called a tonic-clonic seizure. A tonic-clonic seizure is a generalised seizure (affecting both sides of the brain). The child may also be incontinent. After this seizure, the child will be sleepy and some children may sleep for a few hours.

Diagnosis

The diagnosis of this epilepsy involves a full and accurate history of the seizure(s) and an EEG (electroencephalogram) test. The EEG records the electrical activity in the brain. In benign rolandic epilepsy, the EEG will pick up epileptic activity in the rolandic – the centro-temporal – area of the brain. Sometimes the EEG may be normal. This doesn’t mean that the child doesn’t have this epilepsy syndrome. Occasionally, if the first EEG is normal, the hospital doctor will arrange a sleep-deprived EEG recording. This is because abnormal brain activity on the EEG is more easily seen when someone is tired or falling asleep.

Brain scans, including magnetic resonance imaging (MRI) scans are usually normal. The majority of children with a very clear history and EEG of benign rolandic epilepsy do not need to have an MRI brain scan.

Treatment

Treatment with an epilepsy medicine is not always considered necessary, because seizures usually remit (‘go away’) when the child gets to puberty. Also, many children will only have one or 2 seizures in a year, and therefore will not need any treatment. However, many parents, and some doctors, feel reassured by giving the child treatment. This is particularly true if the seizures happen frequently, every month or so, or if the seizures are generalised tonic-clonic seizures. The epilepsy medicines, carbamazepine (Tegretol), lamotrigine (Lamictal), levetiracetam (Keppra) or sodium valproate (Epilim) are very effective in controlling seizures.

There may be research studies that your child could take part in if they have this epilepsy syndrome. Your child’s hospital doctor will be able to discuss this with you.

Information about treatments for children can be found on the Medicines for Children website.

Outlook

The fact that this type of epilepsy is called benign means that it has a very good outcome. Nearly all children with benign rolandic epilepsy will outgrow the tendency to have seizures when they reach puberty, and nearly always before their 16th birthday.

Children who have benign rolandic epilepsy do not usually have learning difficulties. However, some children will have difficulties with reading and language, and might need some support. Most children cope well with school work.

Support 

Contact
Freephone helpline (UK only): 0808 808 3555
Website: cafamily.org.uk
Email: info@cafamily.org.uk

What is a syndrome?

A syndrome is a group of signs and symptoms that, added together, suggest a particular medical condition. In epilepsy, examples of these signs and symptoms would be things like the age at which seizures begin, the type of seizures, whether the child is male or female and whether they have physical or learning disabilities, or both. The results of an electroencephalogram (EEG) are also used to help identify epilepsy syndromes.

If you would like to know more about an epilepsy syndrome, please speak to your doctor. If you would like to know more about epilepsy in general, please contact Epilepsy Action.

Code: 
S003.03

Epilepsy Action would like to thank Dr Richard Appleton, consultant paediatric neurologist at Alder Hey Children’s Hospital, Liverpool, UK for preparing this information.

This information is exempt under the terms of The Information Standard.

  • Updated November 2016
    To be reviewed November 2019

Comments: read the 10 comments or add yours

Comments

My son experienced facial seizures in Aug 2015 for about 10-days and we ended up at the hospital for MRI and EEG. He was diagnosed with Benign Rolandic Epilepsy but we did not start medication at this stage. He was then seizure free for almost a year, but experienced 3 partial-facial seizures in 3-weeks in October. The Consultant wasn't overly concerned and again we did not start medication. On 15 December, he awoke in the early hours and had a facial seizure followed by a full clonic-tonic seizure. Without any medication we called 999 and he was given diazapam by the paramedic. He spent the day in hospital and we left with a prescription for Sodium Valproate (as well as Buccolam Midazolam in case of a seizure lasting more than 5-minutes).
My son, who is nearly 8, seems ok on the medication and we have had no further seizures so far; however, he is really struggling to sleep at night - I cannot find this amongst the likely side effects - however, it is not that he is tired and fighting sleep, he often seems wide awake, quite late at night or falls asleep then wakes again. Could this be the medication and if so are there any tips for how we can help him? He is very tired in the morning and I am concerned that the accumulation of lack of sleep could lead to further seizures.

Submitted by Sarah B on

Hi, 

Not being able to sleep is a terrible thing to experience. 

Sodium valproate can cause restlessness/hyperactivity as a side-effect. This may affect your son’s ability to sleep. But it would be likely he would also have these side-effects during the day. 

With Benign Rolandic epilepsy, seizures often start when the child is asleep or just about to wake up in the morning. Could it be your son is scared/anxious of going to sleep as he might have another seizure? 

As some people can have seizures in their sleep, we do have some sleep tips on our website 

If his sleeping pattern doesn’t improve it would be best to get a medical opinion.

If we can be of any more help, please feel free to contact us again, either by email or the Epilepsy Action Helpline freephone 0808 800 5050.  

Regards 

Diane

Epilepsy Action Helpline Team

Submitted by rich on

Hi,

My son is 3 and has had his 2nd tonic clonic seziure yesterday! It was status epilepticus both times and yesterday was 1hr 15mins before they could get him out of it 3 medications later. Is this normal?
He was diagnosed with focal epilepsy and they recently done another eeg 2 weeks ago and now saying he has benign rolandic epilepsy.
Any advice or help would be great x

Submitted by Laura on

Hi Laura 

That sounds like a really upsetting situation. And so hard to watch your boy have such a long seizure.

Status epilepticus is not a usual thing to happen with benign rolandic epilepsy. But it can be quite difficult to diagnose a young child with the right kind of epilepsy. This is because their brain is still developing. 

Hopefully they can get to the bottom of what’s happening for him very soon.

If we can be of any more help, please feel free to contact us again, either by email or the Epilepsy Helpline freephone 0808 800 5050.

Regards

Cherry  

Epilepsy Action Helpline Team

Submitted by rich on

Hi, My daughter, who is now 10 as diagnosed with focal epilepsy when she was about 18 months and has been on medication ever since which mostly controls the seizures. In school she seems ot have problems processing instructions when in the classrooom ( I ma guessing with other noise around). This appears to be something associated with rolandic epilepsy. Could they have got the diagnosis wrong? Other sysmtoms seem to fit rolandic epilepsy too. Thanks,

Submitted by Sarah James on

Hi Sarah

Thanks for your message. Rolandic epilepsy is a type of focal epilepsy. Focal epilepsy is not a very specific diagnosis, but simply means that the seizures start in one part of the brain. In rolandic epilepsy, children have focal seizures that start in the rolandic part of the brain.

If your daughter had an EEG when she was younger, this might have shown if her seizures happen in the rolandic area of her brain or somewhere else. However sometimes the EEG is normal, in which case the doctor would make the diagnosis based on her symptoms.

If you think your daughter’s symptoms fit rolandic epilepsy you could speak to her doctor about this. They should explain what type of focal epilepsy they think she has and why.

Problems with learning can sometimes be associated with rolandic epilepsy, but they can also happen in other types of epilepsy. They can also sometimes be a side-effect of epilepsy medicine. It’s worth talking to your daughter’s doctor about any problems she has with learning. They may be able to look into whether the problems are related to her epilepsy, her medicine or something else.

I hope this helps.

Grace

Epilepsy Action Helpline Team

Submitted by rich on

My daughter has benign rolandic epilepsy and her teachers are telling me that she will freeze and just stare for a minute. Is she having focal seizures?

Submitted by Angel Raborn on

Hi Angel

That could be a sign of focal seizures or possibly absence seizures. You could ask her teachers to keep a note of what happens and how often. You could then show this to your daughter’s doctor. Capturing the episodes on video and showing this to the doctor can also be really helpful. They might want to re-assess what type of epilepsy your daughter has to make sure she’s on the right treatment.

Best wishes

Grace

Epilepsy Action Helpline Team

Submitted by rich on

Hi, my 12 year old son was diagnosed with benign rolandic epilepsy last year. He has had 5 seizures in the past year, 3 late at night and 2 early in the morning. They usually last around 5 minutes or so and is only the one seizure at a time. I have noticed that it usually follows a stressful or busy day or more lately too much time with screens (XBox, phones etc) which I am now limiting.
The consultant at the hospital has not suggested any medication to control them as he has only had the 5 in total, which I have agreed with, however, my son is due to go skiing in the USA in April with the school. Is there any specific advise that you can give me to pass onto the school for his trip? I don't want to stop him going but of course am concerned about him suffering one whilst he is away. Thanks.

Submitted by Anna on

Hi Anna

It’s quite usual for a specialist not to prescribe epilepsy medicine when someone is diagnosed with benign rolandic epilepsy.

The most useful information for the school will be what your son’s possible seizure triggers are and what, if anything to do about the seizures if he has any.

But it might also help to discuss this with the consultant to be sure.

I hope it’s possible for him to go ahead with the trip.

Regards

Cherry  

Epilepsy Action Helpline Team

Submitted by Cherry-Epilepsy... on

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