Rolandic Epilepsy

Rolandic Epilepsy or Benign partial epilepsy of childhood with centrotemporal spikes (BECTS) is one of the most common forms of epilepsy in children. Most seizures occur from sleep. The child has partial seizures with a characteristic EEG pattern in the centrotemporal region of the brain. 

The outlook for a child with BECTS is very good. It is usually easy to control with anti-epileptic drugs, and in most cases it goes away by the time the child is 16 years old. 

What are other terms for BECTS?

Benign childhood epilepsy with centrotemporal spikes 
Benign epilepsy of children with rolandic (centrotemporal) paroxysmal foci 
Benign rolandic epilepsy 
Benign rolandic epilepsy of childhood 
Centrotemporal epilepsy 
Sylvian epilepsy 

What causes BECTS?

About 21% to 32% of children with BECTS have a family history of the condition.

There is usually no structural brain abnormality associated with BECTS, but about 10% of children with BECTS have a history of birth difficulties, CNS infections, head trauma, or other such problems. There are various possible explanations for this: it could be simply a coincidence, since BECTS is very common; BECTS could have resulted from the brain lesion; or the addition of the lesion could cause seizures in a child who would otherwise have had only an abnormal EEG. 

What are the features of BECTS?

BECTS is a type of idiopathic epilepsy with seizures that begin in a specific area of the brain. It usually begins between the ages of two and 13; most children start having seizures between five and 10 years of age. Children with BECTS are otherwise healthy, with normal mental and neurological development. 

Most seizures happen while the child is asleep. They are usually partial motor seizures, often beginning in the face. However, generalized seizures are seen fairly often, especially in younger children. 

A typical seizure with BECTS may include:

  • Gurgling or guttural sounds; often, these sounds are what let parents know their child is having a seizure at night 
  • Movements or jerking of the tongue or jaw 
  • Myoclonic twitches on one side of the face 
  • Drooling and trouble swallowing 
  • Numbness or weakness on one side of the tongue, lips, gums, or cheek 
  • Trouble speaking 
  • Sensory symptoms in one leg or one side of the body 

A seizure that begins on one side of the face may spread to an arm or leg or may become secondarily generalized. Different seizures may begin on different sides of the child’s body. 
Most children with BECTS usually have the same type of seizure each time, but 20% to 25% of children have more than one type of seizure. 

Some children with BECTS have atypical symptoms, including seizures in the daytime only, Todd paralysis (weakness affecting one side of the body following a seizure), long seizures, or unusual EEG features. Rarely, children with BECTS may have other complications, including atonic seizures or status epilepticus. 

About 10% to 20% of children with BECTS only ever have one seizure, and most children do not have very many seizures. However, about 20% of children with BECTS have frequent seizures. 

Some children may have behaviour or learning problems associated with BECTS. This has not been well studied.
The seizures associated with BECTS usually go away by age 16.

How many other children have BECTS?

BECTS is common. It is estimated that out of all children under 15 years old, one child in 4,800 to 14,000 has BECTS. Because parents and children do not always realize that the child is having seizures at night, BECTS may be even more common than this. 

One study found that BECTS accounted for 8% of children with epilepsy, not including neonatal seizures.

Because BECTS has a strong genetic component, close relatives of children with BECTS are also likely to have either BECTS or the classic EEG pattern related to it. 

How do you know that a child has BECTS?

If a child’s symptoms are typical of BECTS, meaning that she has seizures at night and has the classic EEG pattern between seizures, it is easy to make a diagnosis of BECTS. If her symptoms are not typical, her doctor may want to do more tests to see if she has another cause of seizures, such as a structural brain problem. 

How is BECTS treated?

The treatment for BECTS depends on how severe the syndrome is. The treatment should be considered individually for each child. If the child is having frequent seizures, it may be necessary to give the child an anti-epileptic drug. For some children, treatment is not necessary. 

Various anti-epileptic drugs are effective for BECTS. Rarely, BECTS is very resistant to anti-epileptic drugs; if this is the case with your child, it is important to talk to your child’s doctor and discuss how best to optimize treatment. 

The seizures nearly always go away by the time the child is 16 years old, so anti-epileptic drugs can usually be tapered off when the child has been seizure-free for a year or more. However, if the child stops taking medication too soon, the seizures may reappear.  

It is usually not necessary to restrict a child’s activities or over-protect her.

What is the outlook for a child with BECTS?

As with other epilepsy syndromes, it is not possible to predict the outlook for a child who has just been diagnosed with BECTS for certain. However, BECTS has an excellent prognosis. The seizures associated with BECTS are usually easy to control with anti-epileptic drugs, and they usually go away by the time the child is 16 years old. Even if the seizures are resistant to drug therapy, they usually go away in late adolescence. 

Once the child has been seizure-free for a year or more, her doctor will usually try to gradually discontinue her anti-epileptic drugs. 
People with BECTS have a higher risk of generalized seizures as adults than people without epilepsy. However, one study that followed 168 people with BECTS for seven to 30 years found that only three people had continuing seizures once they reached adulthood. 

Recent studies suggest that children with BECTS can have subtle language and learning difficulties. We are still learning about the causes of these problems, and it is unclear whether they get better over time.

Behavioural problems are less common with BECTS than with other forms of childhood epilepsy. In fact, if the child’s family and teachers know that the syndrome is benign and behave accordingly; most of the behaviour problems that are associated with epilepsy do not appear.

BECTS may affect a child’s sense of self-worth if it interferes with her normal social activities. For instance, if a child with BECTS wants to stay overnight at a friend’s house, her friend’s parents may not want the responsibility of looking after her in case she has a seizure at night. It is important to communicate with the parents of her friends to address their concerns and reassure them that the risks are low. The uncertainty of not knowing when a seizure might happen may decrease the child’s self-confidence because of worry about when the next seizure might occur, or may increase parental monitoring because of safety concerns. In either case, these factors may prevent the child from participating in age-appropriate activities, even during the day. 

Children who had BECTS do not seem to have problems in adult life. The seizure frequency and the length of time that the child had seizures do not seem to affect her development over the long term.