According to a recent study, children with Rolandic epilepsy should receive treatment in order to reduce their risk of cognitive and behavioural problems.BackgroundRolandic epilepsy is the most common form of childhood focal epilepsy syndrome, accounting for 15-20% of epilepsies in people aged between 5 and 14 years. It is characterised by a pattern of brain activity in between seizures (i.e. interictally) known as ‘centrotemporal spikes’, and the seizures themselves usually begin in an area of the brain called the Rolandic region, which is involved in sensation and movement. For information about Rolandic seizures, please click here.Rolandic epilepsy has historically been referred to as ‘benign’, because most affected children ‘outgrow’ it by the time they are 14 or 18 years old. For this reason, and because seizures usually occur during sleep, neurologists have tended not to prescribe treatment (the potential side-effects of which are thought to outweigh the benefits). However, there is now evidence that Rolandic epilepsy can have a negative impact on upon learning, behaviour and language development, which has led some specialists to reconsider treatment.MethodsScientists at Sichuan University in China have recently examined the role of interictal centrotemporal spikes (ICTS) in causing these neuropsychological and behavioural difficulties. Earlier research had already suggested a connection, but the precise part played by ICTS wasn’t clear.During the study, which is published in the scientific journal Neurology, 22 children between the ages of 8 and 14 years, who had a diagnosis of Rolandic epilepsy, were enrolled. All had had between 1 and 17 seizures in the past, and none of them had previously taken any anti-epileptic medication. This was very important, as medication can alter ICTS. The researchers used a mixture of EEG and functional MRI (fMRI) imaging to record ‘real time’ activity in the children’s brain in three time periods: before ICTS, during ICTS and after ICTS.FindingsThe team discovered that ICTS directly disrupted key functional circuits that are responsible for language, behaviour and cognition. Interestingly, they also noticed that ICTS were linked to lower activity than normal in the so called ‘default mode network’, a group of interacting brain regions that are most active when the brain is at wakeful rest (e.g. during daydreaming/mind-wandering).It is known that disruption of these ‘rest regions” can contribute to several neuropsychiatric disorders, and this second finding may help to explain the aggressive and antisocial behaviour often reported by parents and teachers of children with Rolandic epilepsy.SignificanceThis study adds to important evidence that children with Rolandic epilepsy should be given appropriate anti-epileptic treatment, in order to prevent the disruption caused by ICTS and reduce the risk of longer-term neuropsychological and behavioural difficulties.Click here for more articles about epilepsy in children.