Antiepileptic Drug Treatment of Benign Childhood Epilepsy with Rolandic Spikes: Is It Necessary?

Abstract

Ten untreated and 20 treated patients with benign childhood epilepsy with rolandic (centrotemporal) spikes (BERS) were studied retrospectively after recovery. Seizure frequency, seizure recurrence, and duration of active epilepsy were similar in both groups. No differences were found in social adjustment. Antiepileptic treatment may be unnecessary in most cases of BERS.

Idiopathic focal epilepsies

“…Unfortunately, data available on the natural course of BCECTS are scarce. Seizures are difficult to control with drugs in 40-50% of cases (Ambrosetto and Tassinari, 1990), and they appeared to be frequent in only 6% of patients (Loiseau et al, 1988). Seizures are difficult to control with drugs in 40-50% of cases (Ambrosetto and Tassinari, 1990), and they appeared to be frequent in only 6% of patients (Loiseau et al, 1988).…”

“…Less frequently ictal manifestations include: (1) clonic jerks involving the arm and the leg of one side, with postictal paresis; and (2) generalized seizures which are not infrequently observed in younger children and probably related to rapid generalization of focal seizures. No differences in seizure frequency, seizure relapsing, duration of active period of epilepsy, and social adjustments have been found between BCECTS patients receiving an antiepileptic drug (AED) and those left "untreated" (Ambrosetto and Tassinari, 1990). Several longterm follow-up studies confirmed the good prognosis (Loiseau et al, 1988), and over 90% of the cases are in remission by 12 years of age.…”

Predictors of multiple seizures in a cohort of children prospectively followed from the time of their first unprovoked seizure

“…17 In children, in addition to the recurrence risks, treatment decisions should take account of whether the seizures are part of a benign self-limited syndrome such as benign Rolandic epilepsy as well as seizure frequency and duration. [45][46][47] The authors often do not treat otherwise normal children with infrequent brief seizures even after two or three seizures have occurred. 45,46 Data from randomized clinical trials of children and adults who present with a first unprovoked seizure have shown that AED therapy reduces the risk of seizure recurrence by approximately half.…”

Population study of benign rolandic epilepsy:

“…5 Problems with ascribing a causative relationship include imprecise definitions of narcolepsy 6 and difficulty ruling out a coincidental occurrence of two unrelated disorders. Eighteen patients were identified, nine with narcolepsy commencing within 1 year before or after the other disorder.…”

“…1,2 Partialonset seizures, typically nocturnal, begin between 3 and 13 years of age with remission by 16 years. [5][6][7][8][9] We studied a populationbased cohort with BECT comparing daily treatment with AED versus no medication. 4 Not all children with BECT require antiepileptic drug (AED) treatment.…”