Postictal paresis in children with benign rolandic epilepsy

Following a search for the presence of postictal paresis in a cohort of 70 patients with benign rolandic epilepsy of childhood, the symptomatology of the seizures and the presence of postictal paresis were reviewed. All children underwent a neurologic evaluation, including electroencephalography (EEG) and neuroimaging. Eight of the 70 patients (3 girls and 5 boys) were found to have postictal paresis. All patients had partial motor seizures involving predominantly the upper extremities and, to a lesser degree, the face and lower extremities. In all eight patients, the motor deficits resolved within 60 minutes. Follow-up neurologic examination was nonfocal in all patients. Seven of the eight patients experienced postictal paresis once, and one patient had two such episodes. Three of the eight patients experienced a brief speech arrest. The EEG in all patients demonstrated centrotemporal sharp waves. In seven patients, the sharp waves were bilateral and independent, and in one patient, the rolandic sharp waves were unilateral. A horizontal dipole with positivity at the central region was found in all patients using an average montage. In conclusion, we found an 11.5% association of postictal paresis in children with benign rolandic epilepsy of childhood, whereas 38% of children also had a brief speech arrest. The EEG was characteristic for benign rolandic epilepsy of childhood with bilateral asynchronous discharges in seven of eight patients (83%) and the presence of dipole in all patients. The presence of postictal paresis should not exclude the diagnosis of benign rolandic epilepsy of childhood.