ABSTRACT
Case Presentation ................................................................................................... 161 Differential Diagnosis ............................................................................................ 162 Diagnostic Approach ............................................................................................. 162 Treatment Strategy ................................................................................................. 165 Long-Term Outcome .............................................................................................. 166 Pathophysiology/Neurobiology .............................................................................. 166 Clinical Pearls ........................................................................................................ 166 Suggested Reading ................................................................................................. 167
A 6-year-old boy presented with a prolonged generalized convulsion occurring shortly after the child went to bed. The onset was not observed. He was transported to a local emergency department, where his seizure was controlled with intravenous lorazepam. A computed tomography (CT) scan of the head in the emergency room was unremarkable. Discussion with the family revealed a past history of several nocturnal events with right facial and tongue clonic movements with drooling, lasting less than 1 minute. Electroencephalography (EEG) performed the following day showed prominent epileptiform activity with high-amplitude sharp waves with following slow waves, predominantly in the left central-temporal regions but occasionally seen independently on the right. The spike activity was activated (increased in frequency) by light sleep. A diagnosis of benign epilepsy of childhood with central-temporal spikes (BECTS), also known as rolandic epilepsy, was made. After discussion with the family, treatment with oxcarbazepine was initiated. The patient was seizure free on oxcarbazepine monotherapy for 1½ years, at which point the medication was tapered off. The patient has remained seizure free.
