PSEUDO-BECRS - INTRACRANIAL FOCAL LESIONS SUGGESTIVE OF A PRIMARY PARTIAL EPILEPSY SYNDROME

Benign epilepsy of childhood with rolandic spikes (BECRS) is an electr oclinical entity that is the most common primary partial epilepsy synd rome of childhood. Typically presenting between the ages of 3 and 13 y ears, it is characterized by a well-recognized seizure pattern arising in a normal child with EEG findings restricted to rolandic/centrotemp oral regions. Seizure control is usually easily achieved and prognosis is believed to be uniformly good. Some authors have suggested that in dividuals fitting the electroclinical parameters of this entity need n ot undergo neuroimaging due to the benign evolution of this disorder. Five patients presenting over a 13-year period with peribuccal seizure s, normal neurologic examinations, and EEG data initially suggestive o f BECRS found to have focal lesions on neuroimaging are summarized, In dependent bilateral centrotemporal epileptiform abnormalities were see n in 3 patients. Imaging studies (CT, MRI, or both) documented a mass lesion in all in variable locations, Histologic examination documented a low-grade astrocytoma in 3 patients and a cavernous angioma in anot her. The fifth patient refused treatment or biopsy. Careful retrospect ive review of the clinical features of these patients reveals variable atypical features in each. Therefore, despite an electroclinical phen otype initially suggestive of the BECRS presentation, the presence of atypical clinical features raises the possibility of an underlying str uctural lesion and thus a negative neuroimaging study may in some pati ents be essential to the definitive accurate diagnosis of BECRS.