Broad clinical prognostic spectrum of Rolandic epilepsy: agreement, disagreement and open questions

In this study we emphasize the great variety of epileptic syndromes found within the broad spectrum of the Rolandic epilepsies. We point out the studies which show, in some, children transient involvement of awareness associated with subclinical paroxystic activity on the EEG. Several studies show the involvement of cognitive function in children with EEG changes who did not have simultaneous epileptic seizures. This occurred in children with paroxystic Rolandic disorders whilst awake. Usually it was increased and became generalized during sleep, sometimes showing recordings similar to those seen in electrical status. Rolandic epilepsies make up a broad spectrum of epileptic syndromes with very varied prognosis. They may be of very benign type, with no repercussion on awareness or be very serious in their effects. Therefore: 1. it is necessary to identify the patient s precise electroclinical state making prolonged sleep EEG recordings; 2. periodical neuropsychological assessment of these children should be done; 3. in cases of transient or permanent cognitive involvement long term treatment should be considered in spite of the absence of epileptic seizures; 4. we suggest that only the Rolandic epilepsies in which there is no cognitive involvement at all before starting medication may be considered to be benign.