BENIGN ROLANDIC EPILEPSY - ATYPICAL FEATURES ARE VERY COMMON

The objective of this study was to determine the frequency of atypical clinical and electrographic features in children with benign rolandic epilepsy. A retrospective case series design was employed in the sett ing of a tertiary care pediatric hospital. Forty-two children with ben ign rolandic epilepsy were seen through our neurology department betwe en January 1, 1991, and December 31, 1993. Their charts were reviewed for atypical clinical features, imaging studies and results, total num ber of seizures at initial presentation and last follow-up, and use of anticonvulsants. Atypical clinical features included status epileptic us, developmental delay, daytime-only seizures, screaming as a seizure component, and postictal Todd's paresis. All children had at least on e electroencephalogram, and these records were reviewed for atypical e lectrographic features such as unusual location, atypical spike morpho logy, and abnormal background. Atypical clinical features were seen in 50% of patients and atypical electrographic features in 31%. Computed tomographic scans were performed in 15 patients and were consistently normal. Treatment with anticonvulsant medication was initiated in 40% . Although patients with atypical features did not have an increased s eizure frequency, they were more likely to undergo imaging studies (P < .01) and to be commenced on anticonvulsant medication (P < .02). Our experience suggests that atypical clinical and electrographic feature s are the rule rather than the exception in benign rolandic epilepsy. Further work must be done to develop a reliable definition of this com mon entity.