Abstracts

Rationale: Benign epilepsy with centrotemporal spikes (BECTS), also known as rolandic epilepsy, is the most common epilepsy among school age children. The diagnosis is mainly clinical based on parent report of nocturnal focal motor seizures in a developmentally appropriate child with specific interictal electroencephalographic (EEG) pattern of bilateral independent centrotemporal spikes that are typically activated during sleep. The prognosis of BECTS is often favorable for seizures and development. However, there are other types of focal onset epilepsies that may present with a similar EEG interictal pattern of that one of BECTS. We described a series of patients presented with an initial diagnosis of BECTS based mainly on the EEG interictal pattern which due to an atypical course were subsequently referred to the pediatric epilepsy monitoring unit (EMU) where their diagnosis was revised. Methods: We retrospectively described the clinical, EMU (interictal/ictal) and radiological features of six children initially diagnosed with BECTS whose diagnosis was revised during an EMU admission; due to a failure to follow the classic benign course of this syndrome. Results: We described 6 patients with epilepsy, 3/6 were boys age ranged from 8 to 12 years o. Seizure onset was during school age for 4/6 patients (5 to 8 years), very early at age of 2 years for 1/6 patient and late onset at age of 11 years for 1/6 patient.  3/6 were noted to have abnormal development.  Identified seizure risk factors included cognitive impairment (4/6), febrile seizure (1/6) and 3/6 patients had structural brain abnormalities on MRI. The initial EEG finding was bilateral independent centrotemporal spikes, 4/6 patients had atypical features on initial routine EEG including spikes lateralized to one hemisphere, asymmetrical activity, posterior quadrant spike location and/or focal slowing. All patients were diagnosed initially with BECTS.  The diagnosis was modified after prolonged video-EEG through an EMU admission. The reviewed diagnosis included focal structural epilepsy in 3/6 patients, landau kleffner syndrome in 1/6 patient and MRI negative focal onset epilepsy in 2/6 patients. 4/6 children failed at least one anticonvulsant. Conclusions: Benign epilepsy with centrotemporal spikes has a favorable prognosis, however when a child presents with atypical features or fails to follow its benign course, it is advisable to revise the diagnosis via EMU admission given other more severe types of epilepsy may mimic its typical EEG interictal findings. Funding: None