Clinical history: A 5-year-old girl patient was brought to our attention after a single focal motor seizure that had appeared on awakening, involving the orbicularis oris muscles on the right accompanied by drooling and vomiting. General history: The child’s mother had experienced a single febrile seizure at age 7 years. Examination Neurological examination and cognitive testing were normal. EEG showed normal background activity with frequent spikes over the right central region, greatly activated during sleep. Image findings Brain MRI was normal. Follow-up: Rare, brief focal motor seizures alternately involving the muscles of either side of the face were subsequently reported, always appearing within the first 30 minutes after falling asleep. EEG recordings showed bilateral synchronous and asynchronous spikes over centro-temporal regions (Figs. 1 and 2). Diagnosis: Benign Childhood epilepsy with Centro-Temporal Spikes (BCECTS), or benign rolandic epilepsy. General remarks: Benign rolandic epilepsy is one of the most common childhood epilepsy syndromes, occurring in 15%-20% of pediatric epilepsy patients. Seizures begin in middle childhood and resolve by puberty. The total number of seizures experienced by every patient is highly variable, with some only having a few and others presenting dozens of attacks at times concentrated within short periods of time intercalated with long remissions, Interictal EEG is highly distinctive, showing centrotemporal spikes that are typically activated during sleep. The benign evolution of the syndrome can be predicted from the time of diagnosis, Therapy can be withheld in most patients, since seizures are relatively rare and harmless. There is no evidence that drug treatment is actually beneficial, but it may be considered in children exhibiting secondarily generalized seizures.
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