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Benign Rolandic Epilepsy—Perhaps Not So Benign: Use of Magnetic Source Imaging as a Predictor of Outcome

Department of Pediatrics, Division of Child Neurology, University of Tennessee Health Science Center at Memphis/Le Bonheur Comprehensive Epilepsy Program, fperkins{at}utmem.edu

Joshua Breier, PhD

Department of Neurosurgery, University of Texas Health Science Center at Houston/ Texas Comprehensive Epilepsy Program

Mark H. McManis, PhD

Department of Pediatrics, Division of Child Neurology, University of Tennessee Health Science Center at Memphis/Le Bonheur Comprehensive Epilepsy Program

Eduardo Castillo, PhD

Department of Neurosurgery, University of Texas Health Science Center at Houston/ Texas Comprehensive Epilepsy Program

James Wheless, MD

Department of Pediatrics, Division of Child Neurology, University of Tennessee Health Science Center at Memphis/Le Bonheur Comprehensive Epilepsy Program

Amy L. McGregor, MD

Department of Pediatrics, Division of Child Neurology, University of Tennessee Health Science Center at Memphis/Le Bonheur Comprehensive Epilepsy Program

Monica Chacon, MD

Department of Neurosurgery, University of Texas Health Science Center at Houston/ Texas Comprehensive Epilepsy Program

Dave F. Clarke, MD

Department of Pediatrics, Division of Child Neurology, University of Tennessee Health Science Center at Memphis/Le Bonheur Comprehensive Epilepsy Program

The purpose of this study was to evaluate children with benign rolandic epilepsy, a childhood epilepsy characterized by centrotemporal/rolandic spike-wave discharges with infrequent partial seizures that may secondarily generalize. Recently, some investigators have questioned whether benign rolandic epilepsy is indeed "benign" or whether long-term cognitive outcome may be adversely affected. We initiated an ongoing study to identify children with benign rolandic epilepsy. The children were evaluated in the Texas Comprehensive Epilepsy Program using outpatient or continuous video-electroencephalographic monitoring, brain magnetic resonance imaging, magnetoencephalography, and neuropsychological testing. Neuropsychological testing revealed fine motor dysfunction, visuomotor integration deficits, dyscalculia, and/or expressive language deficits in all of the 9 patients evaluated, reaffirming that benign rolandic epilepsy is not necessarily a benign disorder. Our study shows a high concordance of motor and cognitive deficits in benign rolandic epilepsy, as others have previously suggested. Furthermore, magnetic source imaging shows a higher resolution of dipole localization compared with conventional electroencephalography, which may ultimately improve prediction of deficits. This reaffirms that magnetoencephalography is a valuable diagnostic tool in the evaluation of children with benign rolandic epilepsy.

Key Words: benign rolandic epilepsy • magnetoencephalography • single equivalent current dipole • epileptiform • somatosensory • language

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