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Benign Epilepsy with Centrotemporal Spikes (BECTS)

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Description

Benign Epilepsy with Centrotemporal Spikes (BECTS) is an idiopathic age-related epileptic syndrome diagnosed by a combination of clinical picture and EEG findings. It is possibly the most common epilepsy syndrome that occurs in typical children, and it is probably genetic in nature. It typically occurs in children 2-13 years of age, although most commonly between age 4 and 11.
Although BECTS is called “benign,” clinicians should be aware that cognitive differences have been found in many areas; refer early for psychological/neuropsychological testing. [Wickens: 2017] [Cheng: 2017] Additionally, sudden death with epilepsy (SUDEP), although rare, has been observed. [Doumlele: 2017]
Features of the seizures that occur as a part of BECTS:
  • Brief, simple partial seizures with associated somatosensory symptoms that often spread, sometimes in the typical "Jacksonian march" or generalized into tonic-clonic seizures
  • Occur mostly at night (50-81%), although in some, during sleep and awake states (5-40%) or only while awake (0-32%)
  • Occur infrequently
  • Show unilateral somatosensory involvement, often of the tongue
  • Interrupt speech
  • May lead to pooling of saliva and gurgling noises (ask specifically about these symptoms)
  • Do not cause confusion or amnesia
The EEG typically shows high-voltage centrotemporal spikes that may be followed by a slow wave; EEG changes may be present without clinical seizures in BECTS families. BECTS may be more common in boys than girls.

Other Names

Benign rolandic epilepsy (BRE)

Prognosis

Remission occurs in the majority of individuals. There are no neurologic precursors or sequelae, although there may be learning differences and cognitive difficulties in these patients. [Wickens: 2017] [Cheng: 2017]

Clinical Assessment

A typical clinical picture and EEG in a child with normal development and neurological exam does not warrant further investigation. Anything atypical should prompt further investigation.

Treatment

If seizures are infrequent and the family is comfortable, the patient may not need antiepileptic drug treatment. Although BECTS may be associated with status epilepticus, treatment does not necessarily alter this possibility. Most patients stop having seizures by adolescence.

Resources

Helpful Articles

PubMed search for BECTS in children, last 3 years

Kramer U, Zelnik N, Lerman-Sagie T, Shahar E.
Benign childhood epilepsy with centrotemporal spikes: clinical characteristics and identification of patients at risk for multiple seizures.
J Child Neurol. 2002;17(1):17-9. PubMed abstract

Wickens S, Bowden SC, D'Souza W.
Cognitive functioning in children with self-limited epilepsy with centrotemporal spikes: A systematic review and meta-analysis.
Epilepsia. 2017;58(10):1673-1685. PubMed abstract

Cheng D, Yan X, Gao Z, Xu K, Zhou X, Chen Q.
Common and Distinctive Patterns of Cognitive Dysfunction in Children With Benign Epilepsy Syndromes.
Pediatr Neurol. 2017;72:36-41.e1. PubMed abstract

Doumlele K, Friedman D, Buchhalter J, Donner EJ, Louik J, Devinsky O.
Sudden Unexpected Death in Epilepsy Among Patients With Benign Childhood Epilepsy With Centrotemporal Spikes.
JAMA Neurol. 2017;74(6):645-649. PubMed abstract / Full Text

Authors & Reviewers

Initial publication: September 2008; last update/revision: January 2019
Current Authors and Reviewers:
Author: Lynne M. Kerr, MD, PhD
Authoring history
2011: first version: Lynne M. Kerr, MD, PhDA; Denise Morita, MDA
AAuthor; CAContributing Author; SASenior Author; RReviewer

Page Bibliography

Cheng D, Yan X, Gao Z, Xu K, Zhou X, Chen Q.
Common and Distinctive Patterns of Cognitive Dysfunction in Children With Benign Epilepsy Syndromes.
Pediatr Neurol. 2017;72:36-41.e1. PubMed abstract

Doumlele K, Friedman D, Buchhalter J, Donner EJ, Louik J, Devinsky O.
Sudden Unexpected Death in Epilepsy Among Patients With Benign Childhood Epilepsy With Centrotemporal Spikes.
JAMA Neurol. 2017;74(6):645-649. PubMed abstract / Full Text

Wickens S, Bowden SC, D'Souza W.
Cognitive functioning in children with self-limited epilepsy with centrotemporal spikes: A systematic review and meta-analysis.
Epilepsia. 2017;58(10):1673-1685. PubMed abstract