Rolandic epilepsy is the most common form of this type of pathology. It occurs in 15 percent of patients under the age of 15 years with recurring epileptic seizures. Benign rolandic epilepsy is diagnosed in 21 cases out of 100,000. Most of the disease is detected in children aged 4 to 10 years and provokes neuropsychiatric disorders.
Disease Description
Most often, benign rolandic epilepsy passes independently by the age of 15-18 years. For this reason, such a disease is usually called benign. The name is also associated with the location of the epileptic focus. Roland sulcus is a part of the brain.
Boys are exposed to this condition several times more often than girls. The ratio of boys to girls is 6: 4. Seizures differ in partial character, in another way - focal. This can be explained by the fact that the diseased area is located on the site of the roller groove. The international classification classifies this disease as G40.
Causes of the disease in childhood
The exact cause of the development of epilepsy of this form by doctors has not been established. The impact on the body of a hereditary factor is not excluded. According to statistics, about 60 percent of patients with this diagnosis have a genetic predisposition to it. But there is no exact answer to the question of how exactly the inheritance of pathology occurs - autosomal dominant or recessive. It was this factor that gave impetus to the development of rolandic epilepsy with polygenic factors.
In another way, one can say that the cause of the development of such a disease is genetic changes, the deformation of several genes at once. It is also believed that benign epilepsy of the rolandic form is formed with excessive excitability of the brain. Modern neuralgia suggests that the lesion develops due to problems with the maturation of the cerebral cortex.
At the biochemical level, the causes of rolandic epilepsy include:
- Active proliferation of neurotransmitters.
- Reducing the amount of GABA.
- Increasing the level of exciting age-related synapses.
Due to the growing up of the child, the foci of activity in his brain begin to sharply decrease, which leads to the fact that all the symptoms of epilepsy in children pass independently with time. As a result, epileptic seizures pass by themselves, or their frequency of manifestation is significantly reduced.
The main symptoms of the disease
The first symptoms of rolandic epilepsy begin to appear between the ages of 2 to 14 years. In 90 percent of all cases, the disease develops actively in 4-10 years. Doctors distinguish the following signs of epilepsy in children:
- partial partial seizures - vegetative, sensory or motor. This condition occurs in 80 percent of patients;
- complex seizures;
- secondarily generalized.
As a rule, before epilepsy, the patient has a somatosensory aura. This condition is described by very specific sensations. These include a burning sensation, numbness and tingling sensation, which can be compared to electric shock.
Such sensations are localized in the throat, tongue and gums. After the aura disappears, a partial seizure begins.
Forms of the disease
Rolandic epilepsy in children is divided into the following forms:
- unilateral tonic;
- hemifacial, which are found in 37% of patients;
- clonic;
- tonic-clonic convulsions of the muscles of the face, which in 20 percent of cases are complicated and go to the lower extremities;
- pharyngooral - common in 53 percent of patients.
Other signs of epilepsy in children: at night, the child begins to make specific sounds, which are more like gurgling, rinsing the mouth or grunting. Generalized seizures occur in 20 percent of cases in children under the age of 13 years. Epileptic seizures begin at night. But it should be noted that for this type of epilepsy one constant symptom is not characteristic, all the symptoms of the disease change quickly, and new ones are added to them.
Features of the development of pathology
The duration of rolandic epilepsy in a teenager is small. The seizure lasts no longer than 2-3 minutes. In rare cases, exceeds 15 minutes. More than 80 percent of patients have a benign course of the disease. Only 15 percent of young children suffer from a severe form of prolonged epileptic seizure, which often results in serious complications, such as Todd's paralysis.
Seizures of rolandic epilepsy appear infrequently in a child. On average, only 2 seizures can occur in a year. At the initial stage of the development of the disease, epileptic seizures can occur more often, but over time, as a child grows up, their number decreases sharply.
It should be noted that attacks are distinguished by their direct relationship with nighttime sleep and wakefulness, therefore parents are diagnosed most often at the time of the child’s sleep or during his awakening. Only 20 percent of children suffer from seizures that suddenly begin in the daytime.
Diagnostic measures
Determining the presence of benign rolandic epilepsy by signs alone is quite difficult. Due to the fact that epileptic seizures are distinguished by their short duration and onset at night, they continue for a long time simply not to be seen by parents. The child himself does not notice what is happening to him, because at this time he is in a state of sleep. It is possible to attract attention to a more severe form of RE, in which the baby will appear tonic-clonic convulsions.
Research methods
A doctor examining a child for the presence of rolandic epilepsy, prescribes the following set of examinations:
- Electroencephalography (EEG), which helps to register the electrical impulses emanating from the focus of increased excitation in the patient's brain.
- Magnetic resonance imaging is the most effective and high-quality examination method, which is particularly sensitive and helps to get all the necessary information. With this procedure, the doctor determines even the most minor changes in the organ.
- Polysomnography is a procedure that is performed at the time of a child’s sleep.
Most of the information can be obtained using a neurological examination, which is carried out by the attending specialist. EEG is an informative study for people who are suspected of having this form of epilepsy. RE often appears at night, so polysomnography is additionally recommended.
Survey results
A specific symptom of epilepsy in children during an instrumental study is the identification of a high-amplitude acute wave or squeaks localized in the central temporal region. With the combined development of such formations with subsequent slow waves, a whole Rolandic complex is formed. External signs of the disease can be very similar to the clinical picture obtained during the ECG.
Most often, the disease is diagnosed on the side opposite to convulsive seizures, but sometimes the doctor finds a bilateral picture. The main distinguishing features of benign rolandic epilepsy are the variability of indications from one ECG record to another.
What help can be provided at the onset of a seizure?
An epileptic seizure often goes unnoticed due to the fact that it develops at night. But if the parent still managed to notice an attack, then he needs to help the child. Act immediately, without understanding the situation, in this case should not be. To begin with, it is important to determine the nature of epilepsy - simple or complex, which is complicated by tonic-clonic seizures.
The first is notable for its high quality and does not require any medical measures. He leaves on his own in a short time and does not pose a particular danger to the patient's life.
But the second type of seizure can cause significant harm to the condition of the child. As the seizure progresses, the child may accidentally earn serious injury by falling out of bed due to cramps or bumping in the fall if the place of sleep is at a height.
If the child suffers from this form of illness, then the main goal of the parent is to provide him with atraumatic conditions. This means that it is important to get rid of all potentially dangerous objects in the room that are in close proximity to the bed. In addition, paroxysms often pass against the backdrop of a retraction of the tongue. To prevent this condition, it is important to turn the child’s head to the side and put a soft object in his mouth to help him not bite his tongue.
But not in all cases it turns out to open the jaw of a child who is in a state of attack. At the same time, it is forbidden to put too much pressure on the mouth, trying to unclench it by force. If it does not open, you should wait until the seizure is over, minimizing the risk of bodily injury. You should not try to restrain the child’s body or even bind him. It is important at the time of the attack to carefully monitor that the child does not accidentally injure himself or fall out of bed.
Obligation to visit a doctor
An epileptic seizure of a rolandic form or any other should not go unnoticed. It is important to immediately call an ambulance and go to an appointment with your doctor. Epilepsy needs a comprehensive diagnosis, monitoring by and prescribing treatment. Treatment measures will be selected individually for each patient.
To choose effective medications and accurately calculate the dosage, the doctor will need to meet with the patient from time to time and check his general condition. This will help prevent complications.