Population study of benign rolandic epilepsy:: Is treatment needed?
AlbertoVerrotti, University G. D"Annunzio Chieti Italychiarelli@unich.it
Guiseppe Latini, Daniela Trotta, Raffaella Giannuzzi, Carmela Salladini, and Francesco Chiarelli
Submitted April 26, 2002
We read with great interest the article by Peters et al [1] about
benign rolandic epilepsy (BECT); the authors reported their experience on
79 children suffering with this type of epilepsy; forty-three of 79
children were treated with different antiepileptic drugs while 36 were not
treated. The authors conclude that anticonvulsant therapy is not necessary
because all patients achieved the expected remission. Despite the fact
that, by definition, this type of epilepsy is considered a benign
situation, recently atypical evolution have been repeatedly recognised. In
some large studies, the percentage of atypical features (including diurnal
seizures, screaming as a seizure component, aura and Todd’s paralysis)
ranged from 10 to 50%. [2, 3, 4]. Our experience [5], in agreement with
these authors, suggests that among patients with atypical BECT a small
proportion might have learning disabilities and/or behavioral
disturbances. In fact, it seems a little strange to us that Peters et al.
did not observe any atypical case.
It is important to remember that, at the present time, there are no
established clinical signs or EEG pattern useful to identify, at the onset
of seizures, the patients who will show an atypical course of disease.
Moreover, the real frequency of these atypical features is still unknown.
Nevertheless, although children with BECT have a normal cognitive function
and behavior, it is increasingly suggested that transient cognitive
impairment may accompany interictal spike discharges, especially when they
are frequent; for example, a small series of children with BECT showed a
trend toward higher error rate in short-term memory tests for trials that
had accompanying EEG discharges [6]. It is possible that also in typical
form of BECT, a high number of seizures might play an important role in
the development of mild cognitive impairment and/or behavior disturbances.
Probably, BECT is a heterogeneous condition, which includes a large
spectrum of clinical features, and there are no clear criteria for the
definition of benignity of this type of epilepsy. Therefore, we suggest
that the decision to treat these children must take into consideration
these aspects.
References:
1.Peters JM, Camfield CS, Camfield PR. Population study of benign
rolandic epilepsy: is treatment needed? Neurology 2001; 57: 537-539.
2.Bouma PAD, Bovenkerk AC, Westendorp RGJ, Brouwer OF. The course of
benign partial epilepsy of childhood with centrotemporal spikes: a meta-
analysis. Neurology 1997; 48: 430-437.
3.Fejerman N, Caraballo R, Tenembaum S. Atypical evolutions of benign
-localization-related epilepsies in children: are they predictable?
Epilepsia 2000; 4: 380-390.
4.Wirrel EC, Camfield PR, Gordon KE, Dooley JM, Camfield CS. Benign
rolandic epilepsy: atypical features are very common. J Child Neurol 1995;
10: 455-458.
5.Verrotti A, Latini G, Trotta D, Giannuzzi R, Cutarella R, Morgese
G, Chiarelli F. Typical and atypical rolandic epilepsy in childhood: a
long term follow-up study. Pediatr Neurol 2002; 26: 26-29.
6.Binnie CD, Marston D. Cognitive correlates of interictal
discharges. Epilepsia 1992; 33: s11-s17.
We read with great interest the article by Peters et al [1] about benign rolandic epilepsy (BECT); the authors reported their experience on 79 children suffering with this type of epilepsy; forty-three of 79 children were treated with different antiepileptic drugs while 36 were not treated. The authors conclude that anticonvulsant therapy is not necessary because all patients achieved the expected remission. Despite the fact that, by definition, this type of epilepsy is considered a benign situation, recently atypical evolution have been repeatedly recognised. In some large studies, the percentage of atypical features (including diurnal seizures, screaming as a seizure component, aura and Todd’s paralysis) ranged from 10 to 50%. [2, 3, 4]. Our experience [5], in agreement with these authors, suggests that among patients with atypical BECT a small proportion might have learning disabilities and/or behavioral disturbances. In fact, it seems a little strange to us that Peters et al. did not observe any atypical case.
It is important to remember that, at the present time, there are no established clinical signs or EEG pattern useful to identify, at the onset of seizures, the patients who will show an atypical course of disease. Moreover, the real frequency of these atypical features is still unknown. Nevertheless, although children with BECT have a normal cognitive function and behavior, it is increasingly suggested that transient cognitive impairment may accompany interictal spike discharges, especially when they are frequent; for example, a small series of children with BECT showed a trend toward higher error rate in short-term memory tests for trials that had accompanying EEG discharges [6]. It is possible that also in typical form of BECT, a high number of seizures might play an important role in the development of mild cognitive impairment and/or behavior disturbances.
Probably, BECT is a heterogeneous condition, which includes a large spectrum of clinical features, and there are no clear criteria for the definition of benignity of this type of epilepsy. Therefore, we suggest that the decision to treat these children must take into consideration these aspects.
References:
1.Peters JM, Camfield CS, Camfield PR. Population study of benign rolandic epilepsy: is treatment needed? Neurology 2001; 57: 537-539.
2.Bouma PAD, Bovenkerk AC, Westendorp RGJ, Brouwer OF. The course of benign partial epilepsy of childhood with centrotemporal spikes: a meta- analysis. Neurology 1997; 48: 430-437.
3.Fejerman N, Caraballo R, Tenembaum S. Atypical evolutions of benign -localization-related epilepsies in children: are they predictable? Epilepsia 2000; 4: 380-390.
4.Wirrel EC, Camfield PR, Gordon KE, Dooley JM, Camfield CS. Benign rolandic epilepsy: atypical features are very common. J Child Neurol 1995; 10: 455-458.
5.Verrotti A, Latini G, Trotta D, Giannuzzi R, Cutarella R, Morgese G, Chiarelli F. Typical and atypical rolandic epilepsy in childhood: a long term follow-up study. Pediatr Neurol 2002; 26: 26-29.
6.Binnie CD, Marston D. Cognitive correlates of interictal discharges. Epilepsia 1992; 33: s11-s17.