Neurological Disorders: Benign Rolandic Epilepsy

Introduction

Benign Rolandic Epilepsy is one of the commonest epilepsy conditions during the childhood. The seizure focus lies in the rolandic area of the brain corresponding to the central sulcus and sylvian fissure.

As the name implies in majority of the cases they are benign in the sense;

• Patients eventually out grow the seizures around late teen or young adult age
• Seizures are easily controllable with anti seizure medicines

Also no underlying brain pathology is identifiable to explain the occurrence of seizures. So it is an idiopathic epilepsy syndrome (idiopathic means there are no identifiable causes).

What causes it?

This epilepsy is thought to have genetic basis. It has shown autosomal dominant inheritance pattern with an involvement of chromosome 15.

Who gets it?

This is typically a childhood-epilepsy. Seizure onset age-range varies from round 3 to 14; the peak is around 8 or 9 years, the epilepsy starts getting diluted as age advances and around late teen or early adulthood majority of the patients are seizure free. Boys are affected more frequently than girls.

How does this epilepsy manifest?

These seizures occur mostly in the night. This is a partial epilepsy syndrome, and patients can experience simple partial, complex partial with or without secondary generalization. Seizures involving the face, oral cavity, speech are characteristic for this childhood epilepsy syndrome.

Mental retardation and developmental problems are not seen or only minimal in the classical cases of this epilepsy disorder.

Diagnosis

Diagnosis is made from the characteristic clinical features and EEG findings. Night time EEG, Ambulatory or Video EEG may be necessary to clinch the diagnosis. High amplitude and well defined spike & slow waves are seen in the centrotemporal areas of the brain.

A CT or MRI of brain is not generally necessary however children with atypical features should get one to rule out any structural pathology in the brain.

Treatment

AEDs (antiepileptic drugs) are not always necessary, especially for minor partial seizures. However if frequent and bigger seizures occur then AEDs are started. AEDs like cabamazepine, Topiramate, oxcarbazepine, levetiracetam are all useful. These seizures generally respond well to AEDs.

If seizures not occurring for about 2 years, then tapering & stopping of AED can be accomplished generally without any hassles as recurrence of seizures is not common.

A pediatric and/or adult neurologist is commonly involved in the management of patients with Benign Rolandic Epilepsy disorder.



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