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