Rolandic epilepsy is the most common form of this type of pathology. It occurs in 15 percent of patients under 15 years of age with recurrent 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.
Description of the disease
Most often, benign rolandic epilepsy resolves on its own by the age of 15-18 years. It is for this reason that such a disease is called benign. The name is also associated with the location of the epileptic focus. Roland's sulcus is a part of the brain.
Boys are subject to this condition several times more often than girls. The ratio of boys to girls is 6:4. Seizures are distinguished by a partial character, in another way - focal. This can be explained by the fact that the diseased arealocated on the site of the Roland furrow. The international classification classifies such a disease as G40.
Causes of the development of the disease in childhood
The exact cause of this form of epilepsy has not been established by doctors. 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 pathology is inherited - autosomal dominant or recessive. It was this factor that gave impetus to the development of Rolandic epilepsy with polygenic factors.
In another way, we can say that the cause of the development of such a disease is genetic changes, deformation of several genes at once. It is also believed that benign rolandic epilepsy 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.
- Decrease in GABA.
- Increase in the level of excitatory age-related synapses.
As a child grows older, the activity foci in his brain begin to decrease sharply, which leads to the fact that all the symptoms of epilepsy in children eventually disappear on their own. As a result, epileptic seizures go away on their own, or the frequency of their manifestation is significantly reduced.
The main signs of the disease
The first symptoms of Rolandic epilepsy begin to appear between the ages of 2 and 14. In 90 percent of all cases, the disease actively develops in 4-10 years. Doctors identify the following signs of epilepsy in children:
- seizures are simple partial - 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 state is described by very specific sensations. These include a burning sensation, numbness and tingling that can be compared to an electric shock.
Such sensations are localized in the throat, tongue and gums. After the aura disappears, a partial seizure begins.
Disease forms
Rolandic epilepsy in children is divided into the following forms:
- unilateral tonic;
- hemifacial, which occurs in 37% of patients;
- clonic;
- tonic-clonic spasms of the muscles of the face, which in 20 percent of cases are complicated and go to the lower limbs;
- pharyngooral - common in 53 percent of patients.
Other signs of epilepsy in children: at night, the child begins to make specific sounds that are more like gurgling, rinsing the mouth or grunting. Generalized seizures occur in 20 percent of cases in children younger than 13 years of age. Epileptic seizures begin at night. But it should be noted that this type of epilepsy is not characterized by one constant symptom, all the symptoms of the disease change rapidly, and new ones are additionally added to them.
Features of the development of pathology
The duration of Rolandic epilepsy in a teenager is short. The seizure lasts no longer than 2-3 minutes. In rare cases, it 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 seizures, which often result in serious complications such as Todd's palsy.
Seizures of Rolandic epilepsy appear infrequently in a child. On average, only 2 attacks can occur per year. At the initial stage of the development of the disease, epileptic seizures may occur more often, but over time, as the child grows up, their number decreases sharply.
It should be noted that seizures are distinguished by their direct relationship with night sleep and wakefulness, therefore they are diagnosed by parents most often at the time of the child's sleep or during his awakening. Only 20 percent of children suffer from seizures that come on suddenly during the daytime.
Carrying out diagnostic measures
It is quite difficult to determine the presence of benign rolandic epilepsy by signs alone. Due to the fact that epileptic seizures are distinguished by their short duration andoffensive at night, they continue for a long time simply not to be noticed by their parents. The child himself does not notice what is happening to him, since at this time he is in a state of sleep. A more severe form of RE is capable of attracting attention, in which the baby will have tonic-clonic convulsions.
Research methods
A doctor examining a child for rolandic epilepsy prescribes the following set of examinations:
- Electroencephalography (EEG), which helps to register electrical impulses emanating from a 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 obtain all the necessary information. With the help of this procedure, the doctor determines even the most minor changes in the body.
- Polysomnography is a procedure performed while the baby is sleeping.
Most of the information can be obtained through a neurological examination, which is carried out by the attending specialist. An EEG is an informative test for people suspected of having this form of epilepsy. RE often appears at night, so an additional polysomnography is 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 opposite side of seizures, but sometimes the doctor finds a bilateral picture. The main distinguishing features of benign rolandic epilepsy include the variability of readings from one ECG record to another.
What help can be given when a seizure starts?
An epileptic seizure often goes unnoticed due to the fact that it develops at night. But if the parent still managed to notice the attack, then he needs to help the child. To 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 convulsions.
The first is distinguished by its good quality and does not require any therapeutic measures. He goes away 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 child's condition. As the seizure progresses, the child may inadvertently be seriously injured by falling out of bed due to seizures, or by falling if the sleeping area is at a height.
Ifthe 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 take place against the background of the 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 prevent biting his tongue.
But not in all cases it is possible to unclench 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 with the help of force. If it does not open, then you should wait for the seizure to end, minimizing the risk of injury to the body. Do not try to restrain the child's body or even tie it. It is important at the time of the attack to carefully monitor so that the child does not accidentally get hurt and does not fall out of bed.
Compulsory doctor visits
An epileptic seizure of the Rolandic form or any other should not go unnoticed. It is important to immediately call an ambulance and go to an appointment with a treating specialist. Epilepsy needs complex diagnostics, external control and treatment. Therapeutic measures will be selected individually for each patient.
To select effective drugs 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.
