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Benign Rolandic Epilepsy (BRE)

Marissa A. Broadley

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Who has this type of epilepsy?

Benign Rolandic Epilepsy  (BRE) accounts for 15-20% of all childhood epilepsies. This type of epilepsy is typically only seen in children, usually between 3 and 13 years of age. BRE is more common in boys than girls. Children with Benign Rolandic Epilepsy are typically intellectually and otherwise normal. It is considered idiopathic, meaning that there is no known cause of the epilepsy.

There is frequently a genetic component. Approximately 40% of children with this epilepsy have a family history of Benign Rolandic Epilepsy.

 

What types of seizures occur with Benign Rolandic Epilepsy?

The seizures typically occur at night when the child is sleeping, or upon awakening. Therefore, the child is usually in the safety of his/her home when the seizures occur. If it occurs while he is awake, the child is usually conscious during the seizure and can recount it. He/she usually looks scared and will have difficulty talking. The seizure typically affects one side of the child’s body (i.e., it is a focal seizure). In particular, he may start twitching on one side of the mouth, then the face will start twitching and this twitching may spread to the arms and legs. The arms and legs may also stiffen. This could continue into a generalized tonic clonic seizure (“grand mal”), in which the child will lose consciousness.

 

How did this type of epilepsy get its name?

“Benign” is even part of the name because this type of epilepsy:

bulletis almost always outgrown and may not require treatment;
bulletis not due to any underlying structural brain problem;
bulletmay frequently recur; but would only very, very rarely cause any harm; and
bulletis not detrimental to the child’s intelligence.

“Rolandic” refers to the area of the brain where these seizures typically start: the “rolandic” strip, which is also known as the “motor strip.”

“Epilepsy” simply refers to “recurrent seizures.”

 

How is Benign Rolandic Epilepsy diagnosed?

It is usually straight forward for a physician to diagnose this type of epilepsy, which is typically suggested by the patient’s or witnesses' recount of the seizure. An EEG (electroencephalogram) is done to confirm the diagnosis. The EEG of  people with Benign Rolandic Epilepsy shows centrotemporal spikes (increased brain activity in the central and temporal regions of the brain). These spikes are much more prominent during sleep, so the EEG should be done with sleep deprivation or sedation—so that a sample of sleep is captured on the EEG.  However, some children will have a normal EEG.  An MRI would be expected to be normal.

 

What is the treatment?

Many times no treatment is needed. However, if the seizures become recurrent and/or bothersome, medication may be needed. This type of epilepsy responds very well to medications. If a child needs to be put on medication, it is usually wise to wait until the child is seizure-free for about two years before discontinuing it. Some anti-epileptic medications that are used to treat this type of epilepsy are:

  1. carbamazepine (Tegretol)
  2. phenytoin (Dilantin)
  3. oxcarbazepine (Trileptal)
  4. valproic acid (Depakote)

Although very effective, these medications do have potential negative side effects. It is important to consider this when deciding to treat the seizures with the medications. Remember, the overwhelming majority of children with Benign Rolandic Epilepsy outgrow the seizures and are not harmed by them!

 

Readings

Devinsky, O. (1994). A guide to understanding and living with epilepsy. Philadelphia: F.A. Davis Company.

Epilepsy Foundation of America. “Epilepsy Syndromes.” http://www.efa.org/answerplace/children/syndromes.html

Fraser Valley Epilepsy Society. “Benign Rolandic Epilepsy.” http://www.epilepsy.cc/rolandic.html

Freeman, J.M., & Vining, E.P., (1997). Seizures and epilepsy in childhood: a guide for parents (2nd ed.). Baltimore:
                        The Johns Hopkins University Press.

 

 

Disclaimer: This information does not constitute medical advice; nor is it a substitute for discussion between patients and their doctors.  The views of cited references do not necessarily represent  the views of our staff.  There are no commercial sponsors.  This information was last modified 07/11/07.

 

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