Self-limited epilepsy with centrotemporal spikes: An old acquaintance in a new guise

Abstract

Summary: The International League Against Epilepsy (ILAE) in 2017, in its latest classification, lists Selflimited epilepsy with centrotemporal spikes (SeLECTS) among childhood focal epilepsies. The cardinal feature of rolandic epilepsy is focal epileptic seizures. Seizures can manifest in various ways, usually classified into groups of symptoms: 1) unilateral facial sensory-motor symptoms (30% of patients); 2) oro-pharyngo-laryngeal symptoms (53% of patients); 3) speech impairment (40%); 4) hypersalivation (30%). There is a clear influence of sleep, drowsiness, and sleep deprivation on seizure frequency. Threequarters of seizures occur during nonREM sleep, mostly at the beginning of sleep or just before waking up. Febrile convulsions are often encountered in personal history (5-15%). A positive family history is often found in SeLECTS, indicating a genetic etiology. EEG findings: High-voltage spike-wave complexes activated during drowsiness and sleep are a striking feature of this entity (essential for diagnosis). The initial part of the graph element is usually described as a spike, although precise measurements often show it to be a sharp wave. The site of occurrence is typical, and most earlier names for this syndrome referred to that site. Furthermore, it has been shown that the frequency of spike-wave complexes depends on the state of wakefulness, i.e., they occur more often during sleep. Moreover, in repeated EEG registrations, the site of occurrence can change, so the epileptic focus often appeared in a different location compared to previous registrations ("spike migration"). This also involved a change of hemisphere, which was strong evidence against a structural lesion, i.e., indirect evidence that this is the entity in question. With the expansion of knowledge about benign childhood epilepsy with centrotemporal spikes, it is generally accepted that there are small but statistically significant abnormalities in the cognitive, behavioral, and emotional fields of children with this type of epilepsy.