Benign Rolandic Epilepsy (BECTS, or CECTS)

Latest name “Childhood Epilepsy with centrotemporal spikes”. Not always benign…

Common form of childhood epilepsy, with some characteristic features:

  • Seizures usually in sleep
  • If awake, then start with symptoms in one side of the mouth/tongue eg tingling
  • Speech may be impaired, with gurgling noises, as throat muscles affected – child may be trying to indicate something weird is happening to them!
  • Then twitching of face, spreading to face and arm
  • Can have tonic-clonic seizures
  • Characteristic centro temporal EEG abnormalities.  May need to be done sleep-deprived to provoke.
  • Although focal, MRI not indicated if typical features.

Treatment not always required, many children only ever have one or two seizures! Benign, because almost always goes away in puberty viz before age 16.

NICE recommends treatment with carbamazepine or lamotrigine as first-line treatment.

Be aware that carbamazepine and oxcarbazepine may exacerbate or unmask continuous spike and wave during slow sleep, which may occur in some children with benign epilepsy with centrotemporal spikes.

If these are ineffective, alternatives would be levetiracetam, oxcarbazepine or sodium valproate.