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Rolandic epilepsy is mild childhood epilepsy with central temporal spikes (BECTS). It is the most common focal epilepsy syndrome observed in childhood. Up to 23 percent of childhood epilepsy is due to BECTS. Boys suffer from it more often, with the ratio of boys to girls around 3: 2. What are the symptoms of Rolandic epilepsy, how is it treated, and what is the prognosis?

Roland's epilepsyusually occurs between the ages of 7 and 10; simple partial seizures (with preserved awareness) consist of unilateral sensorimotor symptoms affecting the face and the area around the mouth and throat, speechlessness, drooling. The seizures are short-lived and occur after the baby wakes up. The other seizures in this syndrome are seizures during sleep. Family history of epilepsy is positive in about 40%. Currently, it is assumed that inheritance is multi-gene and multi-factorial. A clear dependence of clinical manifestation on age, self-limiting course with symptom relief around puberty, and a family history indicate "hereditary impairment of brain maturation".

Roland's epilepsy: symptoms

  • Seizures occur at night, often shortly after falling asleep or before waking, lasting only seconds or minutes
  • These can be single seizures (16%), rare seizures during the year (66%) up to frequent seizures (21%)
  • Seizures are preceded by a somatosensory aura with paresthesias around the mouth, a feeling of choking and stiffness of the jaw or tongue. There may be abdominal discomfort, somatosensory aura within one limb or systemic dizziness.
  • Due to the onset of the sleep seizure and the young age, the description of the aura may be omitted by patients. At the same time, even in 12% of cases, the aura may be the only manifestation of the disease
  • Motor seizures affect half the face or body. The symptoms affect the face, lips, tongue, throat and larynx. They may be accompanied by speech arrest. The child is usually conscious
  • Additional symptoms include saliva leakage, gurgling noises, loss of consciousness, transition to a generalized tonic-clonic seizure, and sometimes post-paroxysmal vomiting.
  • Generalized tonic-clonic seizures without a focal onset have also been reported

Three highlightedtypes of clinical seizures based on symptoms:

  1. Brief seizures involving half of the face, with speech retention and saliva leakage from the mouth
  2. Seizures plus loss of consciousness, gurgling or grunting noises and vomiting
  3. Generalized Tonic-Clonic Seizures

Roland's epilepsy: neuropsychological symptoms

Neuropsychological symptoms were described in about 53% of patients. Include:

  • behavioral disorders
  • speech development delay
  • memory impairment
  • attention deficit
  • learning disorders

Roland's epilepsy: diagnosis

The diagnosis of the disease is based on a typical clinical picture, and confirmed by electroencephalographic examination (EEG). Diseases with similar symptoms should also be excluded, including Gastaut's syndrome, Panayiotopoulos syndrome, and mild childhood occipital epilepsy. In the EEG examination, a characteristic record of needles in the central-temporal area is observed. In the interictal period, high-voltage needles appear in the leads corresponding to the area of ​​the medial groove (the so-called Roland's groove) of the brain. The number of discharges significantly increases during sleep. It should be remembered that such an image in the EEG examination does not mean that Roland's epilepsy will occur. More than half of children with these types of abnormalities may never experience any symptoms.

Roland's epilepsy: treatment and prognosis

For rare seizures that occur only at night, anti-epileptic treatment may be dispensed with. The indications for the implementation of treatment are: epileptic seizures during the day, recurrent tonic-clonic seizures, prolonged seizures and status epilepticus, as well as the onset of seizures under 4 years of age. The first-line drug is carbamazepine, which is effective in up to 65% of patients. Other effective drugs include clonazepam, levetiracetam, phenytoin, valproate, clobazam, primidone and phenobarbital. Although up to 30% of cases in childhood and adolescence may remain unchecked, almost all patients experience resolution of their seizures by age 18.

In a few cases, the disease may evolve into atypical rolandic epilepsy with linguistic, behavioral, and neuropsychological deficits. Then, the introduction of aggressive steroid treatment may stop the changes and induce remission of neuropsychological symptoms.

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Category:

Neurology