Rolandic epilepsy is a benign form of epilepsy occurring during childhood, often without any identifiable prior damage, and which is marked by a typical kind of seizure and characteristic changes in an EEG. The prognosis is favourable.
Rolandic epilepsy is one of the most common types of childhood epilepsy.
Recent findings have shown that Rolandic epilepsy is caused by a genetic disorder in chromosome 11. Only a handful of children that demonstrate a so-called “Rolandic focus” in an EEG actually develop epilepsy.
The disease manifests itself between the ages of 3 and 13, peaking between the ages of 5 and 10. Boys are more commonly affected than girls (ratio of 6 to 4).
The Epileptic Fit
The main symptom of Rolandic epilepsy is sensorimotor seizures. It usually begins with a tingling and numbing sensation (paraesthesia) on the tongue, lips, gums and cheeks on one half of the face. This then turns into twitches and cramps in the same areas (myoclonus). Other ensuing symptoms include speech arrests and difficulties in swallowing combined with increased salivation. The ability to speak while remaining conscious is a key feature of the epileptic fit.
Younger children in particular are afflicted by additional muscle twitching in the arm, leg or the entire half of the body which is being affected. This may then turn into a grand mal seizure, although this is rarely the case.
Fits usually occur during sleep (primarily in phases of light sleep in the morning or evening).
Focal seizures do not usually last very long – between a few seconds and two minutes. Seizures at night may last longer (up to half an hour).
The prognosis for Rolandic epilepsy is good. As a rule, seizures do not happen very often, are not very severe and disappear completely during puberty. EEG changes may be evident for a further period of up to two years.
The long-term development of these children is favourable. Cognitive disorders and behavioural problems also disappear.
Clinical, EEG and Neuropsychological Examination
It is usually very easy to diagnose Rolandic epilepsy due to the typical clinical picture and on the basis of the EEG test results (electroencephalography).
In an EEG, characteristically high spikes with deflections in two directions (biphasic spikes) followed by slow waves can be found above the middle temporal lobe (centrotemporal region).
An EEG of the patients when they are sleeping is able to confirm a preliminary diagnosis.
A physical examination does not usually reveal anything conspicuous.
Neuropsychological tests show the presence of so-called “specific learning disabilities” such as difficulties in concentrating and disruptions to speed, flexibility and perception.
Rolandic epilepsy does not usually have a negative impact on the quality of life of the afflicted children. They can normally attend school without any problems. However, they may suffer from attention, perception and speaking disorders.
It is important that anybody who deals with children suffering from epilepsy (nursery nurses, teachers, etc.) is informed about the disease and knows what to do in the event of a seizure.
The prognosis is very favourable. Both seizures and neuropsychological disorders disappear completely during puberty