Clinical, electroencephalographic and psychometric evaluation of rolandic epilepsy cases

Introduction: The diagnosis of the epilepsy is established after excluding cases that mimic it, if at least two seizures that were not clinically provoked are seen at intervals of at least 24 hours, if there are at least two unprovoked seizures within 10 years after an unprovoked seizure (probability of recurrence is over 60%), if one has been diagnosed with a syndrome associated with epilepsy. Rolandic epilepsy or benign centrotemporal spikes (BECTS) is the most common epilepsy syndrome in childhood (86). It often starts at the ages of 3-13, is most common at the ages of 8-9, and the seizures stop at the age of 14-18. Therefore, it is considered benign. The seizures start around the central sulcus of the brain. This area is named as the centrotemporal area, located around the rolandic fissure. The presence of centrotemporal spike wave in EEG is characteristic. Antiepileptic drugs often easily control seizures. Carbamazepine, valproate, levetiracetam and sultiam have been found to be effective in treatment. However, the cases that do not have a benign process, resistant to treatment and proceed with regression in cognitive and motor functions can also be seen. The aim of this study is to contribute to our understanding about unknown aspects of the electroclinic syndrome by evaluating the characteristics of patients with rolandic epilepsy who applied to our hospital. Materials and Methods: Ethical approval was obtained from the Non-Interventional Studies (NIS) Ethics Committee of Dokuz Eylül University Faculty of Medicine on 06.07.2020 with the decision number 2020 / 15-38. Also, an approval was obtained from the Chief Physician of the Faculty of Medicine Hospital in order to conduct a research in the database of our hospital. The cases diagnosed with "Rolandic Epilepsy", who applied to the Pediatric Neurology Polyclinic of Dokuz Eylül University Faculty of Medicine, Department of Child Health and Diseases between July 1, 2016 and July 1, 2020 were evaluated clinically, electroencephalographically and psychometrically in a retrospective manner. The cases were diagnosed according to the clinical and electroencephalographic findings published by the ILAE. The files with missing data in the medical records were excluded from the study. Firstly, after recording the gender of the subjects, the province of residence, the age of onset of the seizure, the onset type of the seizure, the duration of the seizure, the clinical findings after the seizure, the existence of any additional disease, the presence of an individual diagnosed with epilepsy in the family, a history of consanguinity between parents, EEG results, cranial MR findings, treatment scheme and accompanying medical and psychiatric comorbidities into the registration form, they were evaluated by using the SPSS 26.0 Statistics Program. Informed parental consent was not required for the study. Results: 92 patients with a diagnosis of Rolandic epilepsy were included in the study. 47 (51.1%) of the cases were boys and 45 (48.9%) of them were girls. The boy / girl ratio was found to be 1.04. The age of diagnosis of the cases ranged from 3 to 17 years. The age of seizure onset was observed mostly between the ages of 5-10 with a frequency of 51.1%. This is followed by the onset frequency over 10 years old with a 32.6% rate. The frequency of seizures below the age of 5 was 16.3%. There was a family history of epilepsy in 26.1% of the cases. The presence of consanguinity between parents was in 17.4% of the cases. The various additional medical conditions were identified in 38 (41.3%) of the cases. 29 (31.5%) of these cases were followed up by the Child and Adolescent Psychiatry department due to psychiatric comorbidities such as anxiety, anxiety disorder, depression and attention deficit. The medical conditions other than psychiatric comorbidities were nonspecific and they had no effect on the diagnosis and prognosis of rolandic epilepsy. 10 of the cases had a WISC-R evaluation and only one of them had a poor performance with a 70 score. However, this case had a treatment response and a good prognosis. When the first seizure type of the patients was evaluated, it was found that the seizures of the "generalized tonic-clonic" type were the most common with 43.5%. The second most common type of seizure was "focal orofacial motor seizures" with 14.1%. It was identified that focal clonic seizures took third place with an 8.7% frequency. 51.1% of the cases had their first seizure during night sleep. The duration of the first seizure was less than 5 minutes in 66.3% of the cases. It was between 5-30 minutes in 29.4% of the cases and more than 30 minutes in 4.3%. Neurological examination findings of all cases were normal. Transient nonspecific neurological findings were detected in 11 (12%) cases during the neurological examinations performed after seizures. One case was intubated due to status epilepticus. When the first EEG findings of the cases were evaluated, normal findings were detected in 18.5% of cases, focal findings in 35.9% of cases, multifocal findings in 26.1% of cases, and generalized findings in 19.6% of cases. When the 2nd and 3rd EEG findings of the patients were evaluated, they return to normal levels with 44.4% and 48.2%, respectively. When the brain imaging findings performed by MR or CT were evaluated, it was found that nonspecific findings were reported in 9.8% of the cases. Drug treatment was initiated in 92.4% (85 cases) of the cases. As the first treatment, levetiracetam treatment was used mostly with a 46.8% frequency. Valproic acid treatment was the second choice as the first drug with a 30.4% frequency. Carbamazepine was the first drug chosen in 9.8% of patients and oxcarbazepine in 5.4% of the patients. In 74 (87.1%) of the cases in whom treatment was initiated, the seizures either stopped completely or decreased more than 50%. When the success rates of the first drugs were examined, it was found that levetiracetam was 86% effective, valproic acid 79.3%, carbamazepine 100% and oxcarbazepine 100%. 22.8% of the second drug users benefited from the treatment. In 8.7% of cases who did not benefit from the second drug, the third antiepileptic treatment was initiated and all cases benefited from the treatment except one (1.1%) case whose EEG findings were converted to ESES. Conclusion: In this study, the clinical and laboratory data evaluated in our cases with rolandic epilepsy were found to be quite compatible with the literature. However, the fact that the first seizure type is of the generalized tonic-clonic type in most cases may be related to an overlooked initial symptoms of these seizures and it should be emphasized that patients presenting with generalized tonic-clonic seizures may also have rolandic epilepsy. In addition, the high rate of psychiatric comorbidity that we identified in our patients who had a good prognosis with regards to seizures and EEG in our study reveals the necessity and importance of evaluating these cases especially in terms of anxiety, anxiety disorder, depression and attention problems. Keywords: Rolandic epilepsy (BECTS), EEG, centrotemporal spike wave discharge, antiepileptic therapy