PURPOSE: Benign childhood epilepsy with centrotemporal spikes (BCECT) or benign rolandic epilepsy (BRE) is not always benign in clinical or neuroimaging features. Recent studies have reported atypical forms of rolandic epilepsy with abnormal neurologic and/or neuroimaging findings, sometimes, also with poor seizure control. We investigated whether there are any differences in linear and nonlinear EEG analysis in typical and atypical rolandic epilepsies of childhood. METHODS: Ten patients with typical BRE group and seven patients with atypical BRE group were included in this study. We selected artifact-free 10-second epochs from 19 electrodes of 10-20 international EEG system from each patient. The power spectrum was calculated in delta, theta, alpha, beta, and gamma frequency ranges. The fractal dimension was analyzed as a nonlinear EEG analysis. We analyzed both EEGs with interictal spikes and without focal slowing or epileptiform activities. RESULTS: The spectral EEG analysis showed a significant increase of absolute and relative power of delta with decrease of alpha bands in atypical BRE group compared to typical group. There was no statistical difference in fractal dimension between the two groups. CONCLUSION: Atypical BRE group showed enhanced delta and decreased alpha power, suggesting a cortical dysfunction in this group with poor clinical outcome.
Electrodes ; Electroencephalography* ; Epilepsy ; Epilepsy, Rolandic* ; Fractals ; Humans ; Neuroimaging ; Seizures

Rolandic epilepsy(or benign epilepsy with centrotemporal spikes) and childhood absence epilepsy are idiopathic epilepsies and are the most common forms of age-related epilepsies, occurring in previously neurologically normal children. Benign epilepsy with centrotemporal spikes is the most common partial childhood epilepsy, beginning between 2 and 13 years of age and characterized by typical EEG focal discharges and a self- limited course with recovery in or before puberty. Childhood absence epilepsy is one of generalized epilepsies with bilateral synchronous and symmetrical spike-wave paroxysms of 3 Hz and it has a good prognosis under a correct antiepilepsy treatment. These two epilepsies share some common features : similar age at onset, overall good prognosis and marked hereditary predisposition. A coincidence of these two epilepsies in a patient is very rare. We experienced a case of a coincidence of rolandic and childhood absence epilepsy in a 6 year-old female. The presence of an absence focus in rolandic epilepy, however, makes the coincidence of these entirely distinct phenomena, even if very rare, not excluded. We present the case with a review of related literature.
Adolescent ; Child ; Electroencephalography ; Epilepsy ; Epilepsy, Absence* ; Epilepsy, Generalized ; Epilepsy, Rolandic ; Female ; Humans ; Prognosis ; Puberty

It has been known that sleep and epilepsy have strong mutual influence and many reports have emphasized the imortance of the EEG recording during sleep in epileptic patients. We analyzed waking and sleep EEGs of 153 consecutive cases of epileptic patients. Waking and sleep recordings were perforrned in succession during 26 minutes. Sleep induction method was 24 to 26 hour sleep deprivation. Most of the sleep recordings consisted of stage 1 and stage 2 sleep. 134 patients had localization-related epilepsy including 23 cases of benign rolandic epilepsy and benign epilepsy with occipital paroxysms, and 19 patients had generalized epilepsy. Ninty-two cases showed definite epileptiform discharges and 37 patients including 30 cases of complex partial seizure disorder had all their epileptiform discharges detected only during sleep state. The epileptiforrn discharges of 43 patients were detected on both waking and sleep recordings and underwent modifications of focalization, synchronization, generalization and the appearance of independent spikes during sleep state.
Electroencephalography* ; Epilepsies, Partial ; Epilepsy ; Epilepsy, Complex Partial ; Epilepsy, Generalized ; Epilepsy, Rolandic ; Generalization (Psychology) ; Humans ; Sleep Deprivation

Child, Preschool ; Electroencephalography ; Epilepsy, Rolandic ; physiopathology ; Female ; Humans ; Male ; Syndrome

PURPOSE: Recently have there been a few reports that raised the question that Benign Rolandic Epilepsy (BRE) could be a spectrum. This study was conducted to identify whether or not the clinical and electrophysiological characteristics of typical Rolandic Spikes (RS) are different from those of concomitantly additional frontal or occipital spikes with RS. METHODS: The consecutive 39 patients who showed centro-temporal spikes were divided into typical RS and RS+ groups. We defined RS+ groups as having concomitantly additional frontal or occipital spikes with RS. The independent variables included clinical data 0(age of onset, a significant antecedent event as part of their etiology of epilepsy, nocturnal seizure, abnormal development, abnormal neurologic examination, pattern of seizure, response to medication for at least 1 year and epilepsy syndrome) and electrophysiological data (dipoles, spikes accentuated during sleep). RESULTS: Eighty two percents (32/39) of patients were RS, whereas 18% (7/39) were RS+. The median age of onset was 7 years old and only 10% showed significant antecedent events. Eighty six percents (34/39) of patients had BRE as epilepsy syndrome. Neither clinical factors nor electrophysiological characteristics were different between both groups. CONCLUSION: Although RS+ showed additional spikes more than centro-temporal area, the clinical and electrophysiological characteristics of RS+ were not different from those of RS. Centro-temporal with or without additional spikes could be a homogeneous condition rather than a spectrum.
Age of Onset ; Child ; Electroencephalography ; Epilepsy* ; Epilepsy, Rolandic ; Humans ; Neurologic Examination ; Seizures

PURPOSE: The aim of this study was to investigate the speech problems in benign rolandic epilepsy (BRE) according to the seizure focus in EEG and semiology. METHODS: Twenty three patients [right origin (13 patients) or left side (10 patients)] who met the BRE criteria by International League Against Epilepsy (ILAE) were prospectively enrolled. We excluded the patients who had abnormal MRI or showed both side spikes in EEG. Computerized Speech Lab was used to assess the speech characteristics of the patients. RESULTS: The error pattern of laryngeal articulation in BRE was exclusively substitution of stop consonants, these errors showed more frequent in the left group (16.0% vs 25.5%). Voice onset time (VOT) of stop consonants and Total duration (TD) of word in both groups were prolonged than normal control group, especially in left group (P<0.05). The first formant of vowel /o/ and second formant of /e/ were significantly decreased in left group (P<0.05). The right group scored wider on pitch range (192.9+/-54.0 Hz) and energy range in spontaneous speech (14.2+/-6.4 dB) than the left group (233.3+/-12.5 Hz, 19.4+/-9.3 dB, respectively, P>0.05). Duration of counting (5 to 9) in left group slower than right group (8.6+/-1.7 vs 7.9+/-1.8 sec). CONCLUSION: Our data suggested that interictal spikes and seizures in either centrotemporal sides, especially left side group, may induce speech problems. We recommend the logopedic and phoniatric evaluations of speech in BRE patients.
Acoustics* ; Electroencephalography ; Epilepsies, Partial* ; Epilepsy ; Epilepsy, Rolandic ; Humans ; Magnetic Resonance Imaging ; Prospective Studies ; Seizures ; Voice

PURPOSE: This study was performed to analyse urine gamma-hydroxybutyric acid(GHB) in children with seizures, and to investigate the pattern of seizures and neurologic abnormalities in children related with gamma-hydroxybutyric aciduria. METHODS: We reviewed retrospectively medical records of children who admitted to our hospital with seizures between August 1. 2001 and February 28. 2003. We compared urine GHB levels with controls, and also analyzed the clinical features of patients who showed increased urine GHB. RESULTS: The mean urine GHB was 1.7+/-1.6 mmol/mol cr in febrile seizures, 1.8+/-2.5 mmol/mol cr in non-febrile seizures, and 1.8+/-2.0 mmol/mol cr in controls. Compared with control group, there was no significant difference in urine GHB levels(P>0.05). In 8 of 64 children with seizures, GHB levels increased above 2 standard deviation of normal controls. The types of seizure in children who showed increased urine GHB were generalized tonic clonic seizure in 3 patients, complex partial seizure in 2 patients, febrile seizure in 2 patients, and benign Rolandic epilepsy in 1 patient. 3 patients showed neurologic abnormalities, 4 patients showed electroencephalographic abnormalities, and 2 patients of 6 patients who performed brain imaging study showed brain imaging abnormalities. CONCLUSION: Children with gamma-hydroxybutyric aciduria should be suspected succinic semialdehyde dehydrogenase deficiency as a cause of underlying disease.
Child* ; Epilepsy* ; Epilepsy, Rolandic ; Humans ; Medical Records ; Neuroimaging ; Retrospective Studies ; Seizures* ; Seizures, Febrile ; Succinate-Semialdehyde Dehydrogenase

PURPOSE: This study was aimed to evaluate cognitive and behavioral problems in benign childhood epilepsy with centrotemporal spikes (BECTS) using objective scales. In addition, we investigated the efficacy and cognitive effects of topiramate by introducing it once a day as a pilot study. METHODS: Seven patients were evaluated. They were diagnosed as BECTS based on clinical features and electroencephalography findings. We assessed cognitive and behavioral functions with several neuropsychological tests and followed up the seizure frequency, side effects, and cognitive dysfunction for six months after introducing topiramate once per day. RESULTS: The mean intelligence quotient, memory quotient, and social quotient of patients show the difference as compared to the general population. However, three patients showed attention deficit/hyperactivity disorder. Further, the seizure reduction rate was 100% after receiving topiramate once a day and there were no newly reported neuropsychological problems on questionnaires. CONCLUSION: This study demonstrated that a significant number of children with BECTS have behavioral problems and that topiramate monotherapy once a day is effective.
Child ; Cognition ; Electroencephalography ; Epilepsy ; Epilepsy, Rolandic ; Fructose ; Humans ; Intelligence ; Memory ; Neuropsychological Tests ; Seizures ; Weights and Measures

PURPOSE: The benign childhood epilepsy with centrotemporal spikes (BECTS), commonly affecting children between 3 and 13 years of age, is focal epilepsy with the presence of centrotemporal spikes on electroencephalography (EEG). The aim of our study was to assess the relationship between EEG findings and clinical prognosis in patients with BECTS. METHODS: From 2005 to 2010, patients with a diagnosis of BECTS with a follow-up period of over one year after the diagnosis were included in our study. We analyzed their first interictal EEG: frequency of interictal discharges and average voltage in each waking and sleep phase. In addition, multiple factors were reviewed from the medical records: the age at the time of seizure onset, frequency of seizures, use of antiepileptic drugs (AEDs), duration of AED therapy, age at the time of EEG normalization and age at the time of last seizure. RESULTS: Seventy-four patients were included in our study. Frequent interictal epileptiform discharges during sleep correlated with younger age of seizure onset (P=0.040), earlier onset of AED therapy (P=0.022), younger age at the time of seizure cessation (P=0.027), greater frequency of interictal epileptiform discharges during wakefulness (P=0.006), higher average voltage (P=0.001) and higher frequency of seizures after AED initiation (P=0.043). CONCLUSION: In BECTS patients, frequent interictal epileptiform discharges during sleep could be correlated with higher seizure frequency, even after cessation of AED. These findings would be helpful in predicting the prognosis of children with BECTS.
Anticonvulsants ; Child ; Electroencephalography ; Epilepsies, Partial ; Epilepsy ; Epilepsy, Rolandic ; Follow-Up Studies ; Humans ; Prognosis ; Seizures ; Wakefulness

BACKGROUND: Centrotemporal spikes (CTS) are the hallmark of the syndrome of benign childhood epilepsy with centrotemporal spikes or Rolandic seizures. However, they also can be encountered in other symptomatic epilepsies or may incidentally be found in non-epileptic children with or without neurological symptoms. We investigated clinical and electroencephalographic characteristics of children with CTS on EEG. METHODS: A 7 year material of children with CTS on EEG were reviewed. Sixty-eight children were found. RESULTS: Among them, 55 patients exhibited recurrent rolandic seizures of benign course (so-called benign rolandic epilepsy ; BRE), 9 children suffered from chronic headache without clinical seizure, three patients showed multiple types of seizures or rolandic seizures with some degree of mental retardation, and one child was asymptomatic. In 55 BRE cases, seven children (13%) had a preceding history of febrile convulsions, and a positive family history of epilepsy was found in 9 patients. Generalized spike and wave discharges were observed in 9 patients (16.7%), but none of them experienced clinical absence seizure. In 25 of 29 BRE patients who showed overt lateralized ictal manifestations on history, symptoms were correlated with the main foci of spike discharges. Of the nine children, found to have CTS during evaluation of chronic intermittent or daily headache, the headache was successfully controlled by antiepileptic drugs in two cases. CONCLUSION: Most children with CTS were compatible to the BRE without any causative lesional factor. However, nonepileptic cases were not uncommon and, though rare, atypical cases were also present in children with CTS on EEG.
Anticonvulsants ; Child* ; Electroencephalography* ; Epilepsy ; Epilepsy, Absence ; Epilepsy, Rolandic ; Headache ; Headache Disorders ; Humans ; Intellectual Disability ; Seizures ; Seizures, Febrile