By: Iris Zhao
What is Benign Rolandic Epilepsy?
Benign Rolandic epilepsy (BRE) can also be referred to as “benign childhood epilepsy with centrotemporal spikes.” This type of epilepsy causes children to experience brief seizures that mainly occur as they fall asleep or wake up, usually affecting only one half of the face, arm, or leg. These seizures may also occur during the day while the child is fully awake or when the child falls asleep doing an activity however, those are not as common (Tenney, 2024). Benign Rolandic epilepsy is the most common type of focal epilepsy found in 6 to 12 year old children, meaning that seizure activity begins in one part of the brain (Tenney, 2024). Generally, the majority of these children manage to overcome this condition by puberty and in their teenage years (Amrutkar et al., 2023; John Hopkins Medicine, 2024).
Causes
The exact cause of BRE is unknown. While many researchers have found that the cause of BRE may be linked to a family history of epilepsy, this is not the case for everyone (Tenney, 2024; Xiong et al., 2017). For instance, in a retrospective study by Vargas et al. (2018) where they analyzed the history and manifestation of this epilepsy in BRE patients, they found that 38% of the children with BRE had a family history of epilepsy or a history of febrile seizures.
Signs and Symptoms
Seizures in BRE typically begin when the child is 6 to 8 years old, but they may also occur in children ages 3 to 12. BRE may affect both boys and girls but are more likely to affect boys (Hernandez et al., 2015).
Symptoms of BRE may include a numb or tingly sensation on the child’s face, mouth or tongue. These might interfere with the child’s ability to produce speech. In addition to that, the child might experience unintentional drooling and uncontrollable twitching of the face, arms, or legs. These seizures can spread from one area of the brain and then may become generalized which is why they generally affect one half of the face, arm, or leg. When these seizures occur, the child may be aware of what is happening if they are awake or if they wake up during the seizure. However, some children may not remember the seizures, or they may sleep through them. These focal seizures may also progress to a full body seizure which in that case, the child’s muscles would stiffen, and their arms and legs jerk uncontrollably (John Hopkins Medicine, 2024; Tenney, 2024).
Children with BRE almost always maintain their normal intelligence. Although a few children may have learning and behavioral difficulties during the period in which they have this condition, these difficulties will most likely disappear once the seizures stop (Hernandez et al., 2015).
Diagnosis
If a child experiences a focal seizure at night, BRE may be the likely cause of it. It is important to confirm whether the child has BRE with the child’s doctor. Typically, a doctor will perform a neurological exam and execute a variety of tests to gather information relevant for the diagnosis.
Doctors most commonly perform an electroencephalography (EEG) test when the child is awake and then asleep to diagnosis BRE. An EEG test will look at and measure the electrical activity or brain waves of the child by placing electrodes on their scalp. Children with BRE would show a specific pattern of spikes on their EEG in the centrotemporal regions of the brain, confirming their diagnosis.
A magnetic resonance imaging (MRI) test may also be performed if the findings from an EEG test need further clarification in order to confirm a diagnosis of BRE. Although in most cases, it is not necessary (Hernandez et al., 2015; Tenney, 2024).
Treatment
BRE does not normally cause major problems for the child and often resolves on its own. For many children with BRE, seizures often stop within 2 to 4 years of onset, and most children experience full recovery by the age of 15. As a result, aggressive treatments are usually unnecessary (Hernandez et al., 2015; Tenney, 2024).
However, treatment is considered if the seizures are frequent, severe, occur during the day, become generalized, or are associated with neurocognitive changes or learning difficulties. Treatment is most strongly recommended when seizures interfere with the child’s ability to perform daily activities. For instance, some children with BRE have difficulty with reading, verbal learning, or attention. In such cases, the child’s family should consult a physician to decide whether treatment with common seizure medications, also known as antiepileptic drugs, is appropriate. These medications are typically used short-term and may be discontinued after 1–2 years of full recovery from the seizures (Amrutkar et al., 2023; Johns Hopkins Medicine, 2024).
It is essential to recognize that children with BRE almost always have favorable outcomes. However, if medication is prescribed, the child and their family should be fully informed about potential side effects and understand when to consult a physician about adjusting or discontinuing the treatment. This is especially important, as some antiepileptic drugs may contribute to cognitive side effects, including cognitive decline, in certain cases (Amrutkar et al., 2023 ; Kessi et al., 2021).
Conclusion
Benign Rolandic Epilepsy (BRE) is a common and generally mild form of childhood epilepsy that typically resolves on its own by adolescence. Although the exact cause is unknown, a family history of epilepsy may contribute to some cases. Seizures associated with BRE are usually brief, focal, and occur most often during sleep, while children typically maintain normal development and intelligence throughout the condition. Diagnosis is commonly confirmed with an EEG, and treatment is not required unless the seizures are frequent, severe, or disrupts a child’s daily functioning. When medication is prescribed, it is important for families to work closely with their healthcare providers and stay informed about possible side effects. Overall, the outlook for children with BRE is mostly positive, which may offer comfort and reassurance to families.
References
Amrutkar, C.V., Romero, R.M. (2023). Rolandic Epilepsy Seizure. National Institutes of Health. https://www.ncbi.nlm.nih.gov/books/NBK534845/
Hernandez, A., Holmes, G.L., Fisher, R. (2015). Childhood Epilepsy Centrotemporal Spikes (Benign Rolandic Epilepsy). Epilepsy Foundation. https://www.epilepsy.com/what-is-epilepsy/syndromes/childhood-epilepsy-centrotemporal-spikes
Johns Hopkins Medicine. (2024). Benign Rolandic Epilepsy. John Hopkins Medicine. Retrieved from: https://www.hopkinsmedicine.org/health/conditions-and-diseases/epilepsy/benign-rolandic-epilepsy
Kessi, M., Yan, F., Pan, L., Chen, B., Olatoutou, E., Li, D., He, F., Rugambwa, T., Yang, L., Peng, J., & Yin, F. (2021). Treatment for the benign childhood epilepsy with Centrotemporal spikes: A monocentric study. Frontiers in Neurology, 12. https://doi.org/10.3389/fneur.2021.670958
Tenney, J. (2024). Benign Rolandic Epilepsy – Symptoms, Diagnosis, & Treatment. Cincinnati Children’s. https://www.cincinnatichildrens.org/health/b/benign-rolandic-epilepsy
Vargas, R., Beltrán, L., Lizama, R., Valenzuela, G. R., & Caraballo, R. (2018). Benign Rolandic epilepsy and generalized paroxysms: A study of 13 patients. Seizure, 57, 27–31. https://doi.org/10.1016/j.seizure.2018.03.004
Xiong, W., & Zhou, D. (2017). Progress in unraveling the genetic etiology of Rolandic Epilepsy. Seizure, 47, 99–104. https://doi.org/10.1016/j.seizure.2017.02.012
