Management of benign rolandic epilepsy of childhood

Sometimes this condition needs no treatment, especially if the seizures are simple partial in type, occur only at night and are infrequent.

Families should be counseled about relation to sleep deprivation, good sleep hygiene, and implications for sleepovers.

Neurodevelopmental screen is essential to detect possible speech and language problems, dyslexia or attentional impairment; further assessment by psychologist or speech therapist may be required.

Treatment practice varies - antiepileptic drugs are sometimes not prescribed when seizures are few, exclusively nocturnal and do not involve loss of consciousness.

Where drug treatment is indicated NICE suggest (1):

• seek expert advice
• consider lamotrigine or levetiracetam as first-line monotherapy treatment for self-limited epilepsy with centrotemporal spikes
  • if either lamotrigine or levetiracetam is unsuccessful, try the other of these options
• second-line treatment
  • consider sultiame monotherapy treatment if first-line treatments for self-limited epilepsy with centrotemporal spikes are unsuccessful. Sultiame should only be prescribed by, or on the advice of, a paediatric epilepsy specialist
  • if sultiame is unsuccessful or unsuitable, consider either carbamazepine, oxcarbazepine or zonisamide as monotherapy treatment. If the first choice is unsuccessful, consider the other second-line monotherapy options

Rescue medication (buccal Midazolam) is indicated if generalized seizures have occurred.

Download free parental guide from https://childhoodepilepsy.org.

Reference:

1. NICE (August 2026). Epilepsies in children, young people and adults