Abstracts

Rationale: Benign focal epilepsy of childhood with centrotemporal spikes (BECTS) or benign rolandic epilepsy (BRE) is a common type of focal epilepsy in childhood; the prevalence is as high as 23-24% of school children with epilepsy. The mean age of onset of about 7 years, and 75% of seizures occur after children fall asleep, or just before they wake up. Other seizure types occur in 20-54%, with only 16% having secondarily generalized seizures. Many children will have spontaneous resolution of seizures during the second decade of life, and the overall long-term seizure outcome is considered as benign; however secondary generalized seizures can be seen, and still could impose risks for safety. For such reasons, many clinicians will weigh risks and benefits of treatments with antiepileptic drugs (AEDs). There is no guideline or consensus in when to consider prophylactic AEDs in BECTS. The goal of this study is to identify factors that appear relevant to decide prophylactic treatment with AEDs. Methods: Over a period of 2 years, we continuously retrospectively reviewed patients with benign focal epilepsy of childhood with centrotemporal spikes (BECTS) from July 2010 to June 2012. All patients were identified based on clinical seizure semiology and EEG findings with sleep potentiated centrotemporal spikes. Children who had structural brain abnormalities, focal neurological deficits, known other neurological disorders and pre-existing developmental delay were excluded, as such may suggest underlying encephalopathy beyond typical BECTS. Clinical information was assessed for demographics, unilateral or bilateral centrotemporal spikes, presence of secondary generalized seizures. These data were correlated with treatment with prophylactic antiepileptic medications. Results: We reviewed the identified 114 patients with BECTS (63 Boys, 51 Girls, mean age = 7.4 +/- 2.1 years). 64 had secondary generalized seizures (group A) while 50 had only simple partial seizures (groups B). In group A, 44 out of 64 (68.8%%) were treated with AEDs. 20 (31.2%) were not treated with AEDs, but 12 patients had 1 seizure , 4 had only 2 seizures, 1 had 3 seizures, 1 had 4 seizures, 1 was lost for follow up and 1 had 10 seizures but was not treated due to parental preference. In group B, 17 out of 50 (34%) were treated with AEDs, and 33 (66%) were not. AEDs used in the following number of patients: oxcarbazepine (29), levetiracetam (28), carbamazepine (3), valproate (6), lamotrigine (2) gabapentin (2), sulthiame (1). A total of 8 patients were on multiple antiepileptic medications during the clinical course. Conclusions: While no consensus exists in guidelines for when to start prophylactic AEDs in BECTS, our study shows that AEDs are started when patients have multiple secondary generalized seizures (60 out of 64 patients with more than 2 secondary generalized seizures) . AEDs were started on 1/3 even when seizures are not secondary generalized, which may be potentially associated with seizure frequency and family preference. Further prospective studies will be necessary to confirm such trend.