What is Benign Rolandic Epilepsy?

Benign rolandic epilepsy is one form of epilepsy. With this condition, seizures affect the face and sometimes the body. As a result, the disorder causes problems for some children. It almost always disappears, though, by adolescence.

Who Gets Benign Rolandic Epilepsy?

Benign rolandic epilepsy accounts for about 15% of the cases of epilepsy in children. On average, children are between 6 and 8 years old when they first develop seizures from benign rolandic epilepsy. Adults aren't affected by this form of epilepsy, however.

It's called "rolandic" because seizures originate in the rolandic area of the brain. That's the area that controls the face. Because these seizures begin in a specific part of the brain, they are called partial seizures.

Benign rolandic epilepsy is also called "benign childhood epilepsy with centrotemporal spikes." This refers to a pattern of brain waves it often creates on an electroencephalogram (EEG).

What Causes Benign Rolandic Epilepsy?

No one knows what causes benign rolandic epilepsy. Children who have close relatives with epilepsy are slightly more likely to develop the condition.

What Are the Symptoms of Benign Rolandic Epilepsy?

Like all forms of epilepsy, benign rolandic epilepsy results in seizures. The seizures in benign rolandic epilepsy are usually mild. They typically begin in the face and can take a variety of forms:

• face or cheek twitching
• tingling, numbness, or unusual sensations in the tongue or face
• difficulty speaking
• drooling due to inability to control the mouth muscles

In about one out of every two children with benign rolandic epilepsy, seizures spread from the rolandic area to the rest of the brain. When this happens, the seizure is called a secondarily generalized seizure. They are also called tonic- clonic seizures. Their symptoms are more alarming to witness:

• unresponsiveness
• clenching of muscles all over the body for a short period
• rhythmic convulsions of the whole body
• confusion and disorientation upon regaining consciousness

Typically in benign rolandic epilepsy, the seizures occur during sleep. For this reason, they may not be noticed at all. Other times, parents witness a seizure after investigating nighttime noises in their child's room.

Some children with benign rolandic epilepsy may also have:

• learning difficulties
• behavioral problems

These children with benign rolandic epilepsy may need additional attention and treatment.

What Tests Are Used to Diagnose Benign Rolandic Epilepsy?

When seizures are mild and only occur during sleep, benign rolandic epilepsy can easily go undiagnosed. Often, parents bring a child to the doctor after a tonic- clonic seizure during sleep.

Doctors diagnose benign rolandic epilepsy based on the pattern of seizures. They also gather information from multiple tests:

• Electroencephalogram (EEG): By attaching a set of adhesive electrodes to the scalp, a technician records brain waves during this painless test. A neurologist interprets the EEG. Children with benign rolandic epilepsy often have spikes on their EEG tracings that help make the diagnosis.
• Magnetic resonance imaging (MRI): This high-resolution scan of the brain is normal in children with benign rolandic epilepsy. Getting an MRI is noisy and can cause anxiety, but it's painless.
• Neurologic exam: Children with benign rolandic epilepsy generally have a normal neurologic exam.

What Are the Treatments for Benign Rolandic Epilepsy?

Often in benign rolandic epilepsy, no treatment is needed or recommended. Seizures in benign rolandic epilepsy are usually mild, harmless, and infrequent. Virtually all children outgrow the condition.

Children might benefit from treatment if they're having any of these problems related to benign rolandic epilepsy:

• learning difficulties
• problems thinking or concentrating
• behavior problems
• daytime seizures
• frequent seizures

Anti-seizure medications like carbamazepine (Tegretol), gabapentin (Neurontin), levetiracetam (Keppra), lacosamide (Vimpat) oxcarbazepine (Trileptal), or zonisamide (Zonegran) are most often prescribed to treat benign rolandic epilepsy. In some studies, treatment reduced tonic-clonic seizures, but facial seizures continued.

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