Benign Rolandic Epilepsy: Symptoms, Causes, And Treatment

A child who experiences two or more seizures at least 24 hours apart without an identifiable cause will be diagnosed with epilepsy. 

Benign rolandic epilepsy (BRE), also called benign childhood epilepsy with centrotemporal spikes, is the most common childhood epilepsy affecting about 10 to 20 per 100,000 children¹ under 15 years. Most BRE cases occur in children under 13, and the seizures often go away at puberty.

In this article, we’ll explore benign rolandic epilepsy and discuss its causes, symptoms, and treatments. 

What is benign rolandic epilepsy?

Benign rolandic epilepsy is a type of childhood epilepsy that causes seizures involving one side of the body, usually the left or right half of the face. The syndrome accounts for approximately 15%² of childhood epilepsies. 

Benign rolandic epilepsy causes bursts of electrical information in the brain (seizures), leading to symptoms like numbness and twitching. 

Moreover, in benign rolandic epilepsy, the seizures often occur at night during sleep but can happen at any time. It is referred to as benign because many children outgrow it around puberty. 

The name "Rolandic" stems from the part of the brain where seizures develop. The centrotemporal or rolandic area is the part of the brain that controls a person's face, throat, and mouth.

The seizures are usually infrequent and brief, lasting just minutes.

Causes of benign rolandic epilepsy

The exact cause of benign rolandic epilepsy in children is somewhat unclear. It is presumed to be a genetic disorder, and there’s evidence some families may be more prone to it than others; however, concordance studies among twins do not support a directly heritable genetic factor.

Researchers³ have identified variations in two genes related to benign rolandic epilepsy — GABRG2 and GRIN2A.  

Symptoms of benign rolandic epilepsy

Benign rolandic epilepsy symptoms start with simple partial seizures that affect one side of the child's face. The episodes usually last for two to three minutes, and the child remains fully awake and aware (if the seizure isn’t happening while they’re sleeping, of course). In most cases, the seizures are mild, and since they occur primarily at night, parents may not notice them unless they investigate nighttime noises in their child's room.

Benign rolandic epilepsy symptoms usually affect one side of the child's body, and it may not affect the same side every time. Symptoms commonly include:

• Increased salivation

• Speaking with gurgling noises

• Facial twitching and stiffness

• Drooling due to the inability to control mouth muscles

• Inability to speak

Occasionally, symptoms are more widespread and may affect both sides of the body in the context of a generalized tonic-clonic seizure. Generalized symptoms may include:

• Stiffening

• Shaking

• Loss of consciousness

• Bowel or bladder incontinence

• Postictal state⁴ (a period of altered consciousness following a seizure characterized by drowsiness, confusion, nausea, and headache)

In some cases, children with benign rolandic epilepsy (and other types) may have learning difficulties and behavioral problems. In their study⁵ of 40 children with the condition and 40 without, one team of researchers found that children with benign rolandic epilepsy were more likely to struggle with visual perception and short-term memory tasks.

Likewise, they were more likely to have social problems and engage in delinquent and compulsive behaviors. 

Risk factors for benign rolandic epilepsy

Generally, benign rolandic epilepsy affects children between the ages of 12 months and 14 years. However, it's most common among children seven to ten years old. 

The condition affects boys more often than girls, with a ratio of 1.5 to 1. 

About one in four children with benign rolandic epilepsy have a family history of febrile seizures or epilepsy. 

Diagnosing benign rolandic epilepsy 

Benign rolandic epilepsy can go undiagnosed, especially when the seizures are mild and happen during sleep. However, doctors diagnose the syndrome based on a description of the episodes. They may also ask about the child's personal and family medical histories. 

If a doctor suspects benign rolandic epilepsy based on symptoms and history, they’ll confirm the diagnosis with imaging tests, including: 

• Electroencephalogram (EEG): This is a painless test where a specialized technician attaches a set of adhesive electrodes to the child's scalp to monitor and record brain activity. An EEG for benign rolandic epilepsy will likely include sleep and wake recordings, as spikes in brain activity may only happen when the child sleeps. The information from the EEG is sent to a neurologist (a doctor specializing in the brain and nervous system) for interpretation. Children with benign rolandic epilepsy have spikes on their EEG in the centrotemporal regions of their brains. Such findings will help confirm the condition.

• Magnetic resonance imaging (MRI): An MRI is a high-resolution scan of the child's brain. It’s not typically necessary for diagnosing benign rolandic epilepsy, but it can help rule out other issues, such as structural lesions in the brain. Like an EEG, an MRI is painless; however, some people feel anxious about the loud noises and small space.

• Neurological exam: Children with benign rolandic epilepsy typically perform normally on neurological exams, which may include tests of balance, motor skills, reflexes, and mental awareness. A doctor can use this type of exam to rule out other conditions.

Treatments for benign rolandic epilepsy

Many children with benign rolandic epilepsy seizures do not need treatment. Approximately 95% of children with benign rolandic epilepsy outgrow the seizures by age 15 or 16.

For most children, benign rolandic seizures are mild, harmless, and infrequent. However, a doctor may prescribe anti-seizure medications or other treatments if the child experiences the following problems linked to their condition:

• Daytime seizures

• Frequent seizures

• Generalized seizures

Carbamazepine or levetiracetam is typically the first-line treatment for benign rolandic epilepsy. It’s generally prescribed temporarily, and a child can stop taking the medication (with guidance from a doctor) once they’ve been seizure-free for one or two years. Other medications that may be used for benign rolandic epilepsy include:

• Oxcarbazepine

• Gabapentin

• Sulthiame

• Valproate

• Phenytoin

• Lacosamide

• Zonisamide

Children usually only need one type of anti-epileptic medication, and many doctors favor a nighttime-only dose depending on the medication.

What to do if your child has a seizure

As a parent, watching your child have a seizure can be scary. However, knowing what to do and when to seek help can reduce stress.

While it’s most certainly easier said than done, an essential first step is to stay calm.

Here's what to do if your child has a generalized seizure;

• Move away anything that could hurt the child

• Gently get the child in a safe position on their side to prevent choking

• Do not put anything in the child's mouth

• Do not stop or restrain their movements

• Loosen anything around the child's neck

• Stay with the child, time the episode, and observe the characteristics of the seizure

Other epileptic disorders affecting children

While benign rolandic epilepsy is the most common form of epilepsy affecting children, there are other types, including:

Childhood absence epilepsy

Childhood absence epilepsy is a children's epilepsy disorder characterized by brief, sudden lapses of consciousness (a typical absence seizure). The condition begins in early childhood, between the ages of three to eight.

During an absence seizure, the child stares blankly into space and is unaware and unresponsive. Each episode lasts approximately 10 to 20 seconds and ends abruptly.

The child won't know that the seizure happened and can resume normal activities immediately after the seizure. Seizures may be subtle, so the condition may go undiagnosed for a long time.

Although the cause is still unclear, researchers believe the condition is caused by a combination of genetic and environmental factors. 

The condition usually resolves by late childhood or adolescence. 

Juvenile myoclonic epilepsy (Janz syndrome, previously impulsive petit mal)

Juvenile myoclonic epilepsy is characterized by frequent seizures and starts in childhood. Children with this condition often wake from sleep with quick jerking movements of their legs and arms. They may also experience generalized tonic-clonic seizures, which cause convulsions, muscle rigidity, loss of consciousness, and absence seizures.

Symptoms are typically associated with sleep deprivation.

Juvenile myoclonic epilepsy affects approximately one in 1000 people worldwide and is one of the most common generalized epilepsy syndromes of childhood. The exact cause of juvenile myoclonic epilepsy is unknown. 

Gastaut type late-onset childhood idiopathic occipital epilepsy (childhood occipital visual epilepsy (COVE))

Gastaut-type childhood idiopathic occipital epilepsy typically develops in late childhood (around the ages of eight or nine) and causes frequent seizures presenting as visual hallucinations or blindness. 

In most cases, the seizures remain focal in the occipital lobes but sometimes may spread to both sides of the child's brain, causing a generalized tonic-clonic seizure. 

When to see a doctor

Take your child to the doctor when they first experience seizures. Your child’s seizures may not be caused by a benign condition, such as benign rolandic epilepsy, even if all the symptoms are present. Other conditions, such as diabetes and certain medications, can cause symptoms that align with epilepsy. 

Further, you should seek immediate medical attention if your child:

• Doesn't wake up after a seizure

• Gets hurt during the seizures

• Have repeated seizures

• Has a seizure lasting more than five minutes

The lowdown

Benign rolandic epilepsy is a prominent type of childhood epilepsy, and most children outgrow the syndrome by age 16. Benign rolandic epilepsy causes mild, infrequent seizures that mainly occur at night.

Your doctor will diagnose the syndrome based on symptoms, medical history, family history, and the results of imaging tests. Most children don’t need treatment for benign rolandic epilepsy, but a doctor may recommend anti-seizure medicines if the seizures are disruptive and affect the child’s daily life or performance at school.

If your child has a seizure and hasn’t been diagnosed with epilepsy, take them to the doctor to rule out other possible causes.