Dilemmas in diagnostics and therapy of rolandic epilepsy

Abstract

Introduction. It is considered that around 20%-30% of patients of all ages and in all continents have wrong epilepsy diagnoses. Diagnostic and consequential therapeutic errors appear, most often, when an adequate diagnostics is not applied. Benign focal epilepsy of childhoods with centrotemporal spikes-rolandic epilepsy, brings very often to diagnostic and therapeutic problems because of persistence of epilepticforms changes in an electroencephalography (EEG) recording, several years after establishment of good control over seizures. Case report. We presented 8.5 years-old girl, with the first and the only epileptic seizure at the age of 5, during her sleep. With a clear correlation of EEG record, benign rolandic epilepsy was diagnosed, so the therapy with valproate was introduced. There were no seizures after three years of its implementation. Because of epileptic-forms changes that still persisted in EEG record during her sleep, it was suggested to further use valproate. However, after reconsidering all circumstances it was concluded that the AED should bee slowly reduced up to its exclusion. After a complete stoppage of the therapy, the patient did not have any epileptic seizure for nine months, although EEG still remained pathologically changed during her sleep. Conclusion. A changed EEG record in a patient with rolandic epilepsy must not be a predictor of continuation of antiepileptic drugs therapy, after 2-3 years of successful seizures remission.Uvod. Smatra se da oko 20-30% bolesnika svih uzrasta i na svim kontinentima ima pogresnu dijagnozu epilepsije. Dijagnosticke i, posledicno, terapijske greske najcesce nastaju kada se ne sprovede adekvatna dijagnostika. Benigna fokalna epilepsija u detinjstvu sa centrotemporalnim siljcima - rolandicna epilepsija, cesto dovodi do dijagnostickih i terapijskih problema zbog perzistiranja epileptiformnih promena na elektroencefalogramu (EEG zapisu), nekoliko godina nakon uspostavljanja dobre kontrole napada. Prikaz bolesnika. Prikazana je devojcica stara 8,5 godina, koja je u petoj godini, tokom spavanja, dobila prvi i jedini epilepticki napad. Uz jasnu korelaciju sa EEG nalazima zakljuceno je da se radi o benignoj rolandicnoj epilepsiji i uvedena je terapija valproatom, zahvaljujuci kojoj u sledece tri godine nije bilo napada. Zbog epileptiformnih promena koje su i dalje perzisrirale na EEG snimku, tokom spavanja, predlozen je nastavak uzimanja valproata. Medjutim, posle ponovnog razmatranja svih okolnosti odluceno je da se postepeno obustavi dalja primena antiepileptika. Po ukidanju terapije devojcica nije imala niti jedan epilepticni napad u narednih 9 meseci, iako je njen EEG tokom sna i dalje bio abnormalan. Zakljucak. Izmenjen EEG nalaz kod bolesnika sa rolandicnom epilepsijom ne sme biti prediktor nastavka antiepilepticku terapije, nakon 2-3 godine uspesne remisije napada.