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What is benign rolandic epilepsy?

Benign rolandic epilepsy is a common form of epilepsy among children, and a condition most will grow out of it during puberty.

On average children are between three and ten years old when they first develop seizures from benign rolandic epilepsy.

Seizures from benign rolandic epilepsy usually begin while a child is asleep or waking up in the morning, and start with tingling in the mouth.
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 the 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 benign rolandic epilepsy.

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 lips, inside of the cheek, on the tongue or on the face
  • Difficulty speaking
  • Drooling due to inability to control the mouth muscles

In some 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 secondary generalised seizure. They are also called tonic-clonic seizures. Their symptoms are more alarming to witness:

  • Unresponsiveness
  • Contracting 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 or as the child starts to wake up in the morning. For this reason they may not be noticed at all. At other times parents witness a seizure after investigating noises in their child's room.

Some children with benign rolandic epilepsy may also have specific learning difficulties – such as with reading or drawing - or behavioural problems. These are not usually severe, although these children may need additional attention at school and further 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. However in some cases the EEG is normal, but this does not rule out the diagnosis of benign rolandic epilepsy.
  • Neurological examination. Children with benign rolandic epilepsy generally have a normal neurological examination.
  • Magnetic resonance imaging (MRI). This high-resolution scan of the brain is normal in children with benign rolandic epilepsy. It is not usually considered necessary if the diagnosis is clear from the history and EEG. Getting an MRI is noisy and can cause anxiety, but it's painless.

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