An Overview of Rolandic Epilepsy

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Rolandic epilepsy is a seizure disorder that affects young children and adolescents. It is also called benign rolandic epilepsy (BRE) of childhood, epilepsy with centrotemporal spikes, or benign partial epilepsy of childhood. 

If your child has been diagnosed with BRE, you are probably concerned about how this may affect his or her future. Children with BRE don’t typically develop lifelong epilepsy or have any associated neurological impairment. The condition generally resolves during the teenage years. 

BRE is characterized by brief, intermittent seizures that usually occur during sleep, but they can happen during the day as well. This type of epilepsy is diagnosed based on the symptoms and the EEG pattern. BRE can be managed with anticonvulsants (anti-seizure medication), but some children do not need treatment at all.

Symptoms

The seizures of BRE last for a few seconds at a time. They manifest with face and lip twitching and/or a tingling sensation of the mouth and lips. Some children drool or make involuntary throat noises during the episodes. 

Your child may also experience impairment of consciousness during the seizures—but often, children are completely awake and fully alert throughout the episodes. 

The seizures often occur during sleep. Children do not usually wake up during a seizure, and, sometimes the episodes can go completely unnoticed. While uncommon, the seizures may generalize, which means that they can involve shaking and jerking of the body, as well as impairment of consciousness. 

Children with BRE typically experience a few seizures throughout their whole childhood. The seizures generally stop during the teenage years. However, there are exceptions, and some children may experience other types of seizures, have frequent seizures, or continue to have seizures during adulthood. 

Associated Symptoms 

Generally, kids with BRE are healthy, but some children with the condition have speech or learning difficulties. While it is not common, children can have behavioral or psychological issues as well. 

There is a strong association between BRE and central auditory processing disorders (CAPDs). In fact, one study found that 46% of children with BRE had CAPDs, which causes problems with hearing, understanding, and communicating. CAPDs could be the cause of the learning and speech difficulties, as well as some of the behavioral and psychological issues. 

There is also an association between BRE and childhood migraines, and the cause and frequency of this link is not fully understood. 

Causes

Seizures, including the seizures of BRE, are caused by erratic electrical activity in the brain. Normally, the nerves in the brain function by sending electrical messages to each other in an organized, rhythmic way. When the electrical activity is disorganized and occurs without a purpose, a seizure can occur. 

BRE is described as idiopathic epilepsy, which means that it isn’t known why a person develops it. This condition is not associated with any type of trauma or other identifiable predisposing life factor.

Some experts have proposed that the seizures seen in BRE are related to incomplete maturation of the brain, and suggest that brain maturation is the reason the seizures stop in late adolescence.

Genetics 

There may be a genetic component to BRE and most kids with the condition have at least one relative with epilepsy. 

There has not been one specific gene identified as responsible for BRE. A few genes have been linked to this type of epilepsy, however. One gene that may be associated with BRE is a gene that codes for the voltage-gated sodium channel NaV1.7, encoded by the gene SCN9A. Experts suggest that other genes which may be associated with the disorder are located on chromosome 11 and chromosome 15. 

Diagnosis 

Epilepsy is diagnosed based on the clinical history as well as the EEG. If your child has had seizures, their doctor will do a physical examination to determine if the child has any neurological deficits, such as weakness of one side of the body, hearing loss, or speech problems. 

Your child may also have some diagnostic tests, such as an electroencephalogram (EEG) or brain imaging tests. 

EEG: An EEG is a non-invasive test that detects the electrical activity of the brain.

Your child will have several metal plates (each about the size of a coin) placed on the outside of his or her scalp. The metal plates are each attached to a wire, and the wires are all plugged to a computer, which produces a tracing on a paper or on the computer screen.

The tracing should appear as rhythmic waves that correspond to the location of the metal plates in the scalp. Any change in the typical wave rhythm can give your child’s doctor an idea about whether your child has seizures and how they can be treated. 

With BRE, the EEG typically shows a pattern described as rolandic spikes, which are also called centrotemporal spikes. These are sharp waves that indicate seizure tendency in the area of the brain that controls movement and sensation. The spikes can become more prominent during sleep. 

Seizures that occur during sleep can often be identified with an EEG test. If your child has a seizure during an EEG, this suggests that seizures could be occurring at other times as well. 

Brain imaging: There is also a high likelihood that your child will have a brain computerized tomography (CT) or magnetic resonance imaging (MRI), which are noninvasive tests that produce a visual image of the brain. 

A brain MRI is more detailed than a brain CT, but it takes about an hour, while a brain CT only takes a few minutes. A brain MRI must be done in an enclosed space, which feels like a small tunnel. For these reasons, your child may not be able to sit still through an MRI exam or handle the feeling of being enclosed in an MRI machine, making a CT an easier option. 

These imaging tests can identify problems, such as previous head trauma or other anatomical variants that can cause seizures.

Typically, brain imaging tests are normal in BRE.

There are no blood tests that can confirm or eliminate the diagnosis of BRE, so your child will only need blood tests if your doctor is concerned about other medical problems, such as metabolic conditions.

Differential Diagnosis 

There are a few conditions that can produce involuntary muscle moments, and they may seem similar to rolandic epilepsy, especially when your child’s symptoms are just beginning, or if you have not been able to observe them yourself. 

Absence seizures: Another type of childhood seizure, also described as petit mal seizure, is characterized by brief staring spells. 

The difference between absence seizures and rolandic seizures is that absence seizures usually don’t involve motor movements (but they can include lip smacking or eyelid fluttering), while rolandic seizures don’t typically involve altered consciousness. 

However, since there can be some similarities and confusion between the conditions, an EEG can differentiate them. The EEG of absence seizures should show changes in the wave appearance throughout the brain, not just in the centrotemporal region. 

Tics or Tourette Syndrome: Tourette syndrome is characterized by involuntary muscle movements, often described as tics. Some children have tics but do not have Tourette’s. These movements can involve any area of the body, including the face.

Generally, tics can be suppressed for a few minutes, while seizures cannot. Tics are not associated with the EEG brain wave characteristics of seizures.

Congenital metabolic illness: Some hereditary conditions can make it difficult for your child to metabolize common nutrients, and may manifest with twitches or changes in consciousness. For example, lysosomal storage disorders and Wilson’s disease can cause some symptoms that can overlap with those of BRE. 

Usually, metabolic diseases also produce other symptoms, including motor weakness. Often, blood tests or genetic tests can distinguish between rolandic epilepsy and metabolic disorders. 

Treatment 

There are treatments for rolandic epilepsy. However, the symptoms can be so mild that treatment is often unnecessary.

If your child has frequent seizures, it may be beneficial for them to take anticonvulsants. And if the symptoms involve jerking of the arms or legs, falling, loss of bowel or bladder control, or impairment of consciousness, anti-seizure medication is often considered. 

The most common anti-seizure treatments used for rolandic epilepsy are Tegretol (carbamazepine), Trileptal (oxcarbazepine), Depakote (sodium valproate), Keppra (levetiracetam), and sulthiame.

If your child has other types of seizures in addition to rolandic seizures, then their doctor will prescribe anticonvulsants to control other seizure types—and this may also completely control the rolandic epilepsy.

Most of the time, since children outgrow rolandic epilepsy before adulthood, medication can eventually be discontinued. However, be sure not to stop you child’s anticonvulsants yourself, as abrupt discontinuation can trigger a seizure.

Your child’s doctor may re-evaluate the condition and might order another EEG before gradually tapering the medication. 

A Word From Verywell 

If your child has seizures or another neurological condition, you may be concerned about his or her cognitive and physical development. 

While rolandic epilepsy is generally a mild and temporary childhood condition, it is important to avoid situations that can provoke a seizure. These situations include sleep deprivation, food deprivation, high fevers, alcohol, and drugs. Keeping your child informed of the added risk of seizures posed by these triggers is an important part of helping provide a sense of control over his or her health.

This can be empowering for a child who may be somewhat overwhelmed by his or her medical condition. 

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Article Sources

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