Typical vs Atypical Rolandic Epilepsy?

Is atypical Rolandic really "benign"? If a child has atypical features (todd's paralysis), other developmental problems, look again?

Rolandic epilepsy is characterized by an absence of neurological deficits, motor focal seizures, typical electroencephalogram (EEG), and spontaneous recovery.

Recently, some authors have suggested that, depending on the particular syndrome, some children with rolandic epilepsy can demonstrate oromotor deficits, intellectual impairment, and impulsivity.

Do sequential EEG changes predict atypical clinical features in rolandic epilepsy?

Aim  Although the prognosis for rolandic epilepsy is regarded to be favourable, a small proportion of cases that initially present as rolandic epilepsy evolve into atypical benign partial epilepsy (ABPE) of childhood. The purpose of our study was to determine electroencephalogram (EEG) criteria in relation to atypical seizure manifestations, and cognitive and behavioural problems in rolandic epilepsy.

Methods  The rolandic epilepsy group consisted of 10 children (mean age 5y 6mo, SD 1y 1mo, median age 5y 5mo; six males, four females). The ABPE group comprised five children (mean age 5y, SD 1y 2mo, median age 4y 5mo; three males, two females). We recorded the number of spikes, the locations of spikes, and the duration of the spike activity. The Wechsler Intelligence Scale for Children–Third Edition or the Wechsler Preschool and Primary Scale of Intelligence, depending on age, was administered to all children at the onset of seizures and every year thereafter. The diagnosis of attention-deficit–hyperactivity disorder was made according to the DSM-IV.

Results  Significant correlations were found between atypical clinical features and extended periods of high-frequency paroxysmal EEG abnormalities (>24mo after onset; p<0 .01="" and="" eeg="" focus="" frontal="">10mo after onset; p<0 .003="" font="">

Interpretation  A combination of spike rate and extended periods of high-frequency paroxysmal EEG abnormalities may predict the evolution of atypical rolandic epilepsy.