Benign Epilepsy with Centrotemporal Spikes (Rolandic Epilepsy)

Benign Epilepsy with Centrotemporal Spikes (BECTS) Also known as Rolandic Epilepsy, BECTS is a common and benign childhood epilepsy syndrome that typically resolves by adolescence.

Definition

Benign Epilepsy with Centrotemporal Spikes (BECTS) is a type of epilepsy that primarily affects children aged 3 to 13 years, with a peak onset around 7-8 years. It is characterized by focal seizures involving the face and mouth, often occurring during sleep. These seizures are associated with a specific EEG pattern showing centrotemporal spikes. BECTS is benign, meaning it has an excellent prognosis and does not usually result in long-term neurological or cognitive issues.

Epidemiology

BECTS is one of the most common epilepsy syndromes in children, accounting for approximately 15% of all childhood epilepsy cases. It affects boys slightly more often than girls. There is a strong genetic component, as it is more common in children with a family history of epilepsy.

Clinical Manifestations

Seizures Focal Seizures: The hallmark seizures typically begin in the face and mouth, causing twitching or tingling of one side of the face, speech arrest or difficulty speaking. and drooling or abnormal movements in the tongue. In some cases, seizures may spread to the arm or result in generalized convulsions. 

Nocturnal Seizures: Most seizures occur at night or during sleep. Consciousness Children remain conscious during focal seizures but may experience altered awareness during generalized seizures.

Cognitive and Neurological: Function Children with BECTS have normal cognitive and neurological development.

Rarely, mild language or learning difficulties can occur but are generally transient.

Diagnosis

Diagnosis is dependent on typical clinical symptoms, characteristic high-voltage spikes localized to the centrotemporal regions of the brain, particularly during sleep and usually normal neuroimaging.

Neuroimaging (MRI): MRI is usually normal but may be conducted to rule out other structural abnormalities if the presentation is atypical.

Treatment

No Treatment: Many children do not require treatment due to the benign nature of the condition and the infrequent seizures.

Antiepileptic Drugs (AEDs): If seizures are frequent or distressing, medications like levetiracetam, carbamazepine, or valproate may be prescribed.

Lifestyle Adjustments: Maintaining good sleep hygiene and minimizing triggers can help reduce seizure frequency. 

Prognosis

Resolution: BECTS is self-limiting, with seizures typically resolving by the mid-teen years (usually by age 14-16).

Long-Term Outcomes: Children with BECTS have normal cognitive development and lead healthy lives.

Complications: Rarely, mild language or learning challenges may persist during the active phase of the condition but do not usually have long-term impacts.

Quality of Life

With proper diagnosis and minimal intervention, BECTS has little to no impact on a child's quality of life. Educating caregivers about the condition and seizure first aid is essential for reducing anxiety. Regular follow-ups with a neurologist ensure the child's ongoing health and reassure the family.