Original articleBenign childhood epilepsy with centrotemporal spikes: a study of 50 Chinese children
Introduction
Benign childhood epilepsy with centrotemporal spike (BECTS) is the most common focal epilepsy in childhood [1]. Although Martinius Rulandus described the first case of typical benign hemifacial seizures in 1597 [2], the specific clinical and electrographic features were only recognised in the last 40 years. The reasons for the late recognition of this common syndrome despite the characteristic clinical feature and the striking electroencephalographic (EEG) findings are twofold. Firstly, the key symptoms of somatosensory stimulation and motor interference with the tongue and the nearby structures can propagate rapidly and submerges all into the maelstrom of a generalised convulsion [3], [4]. More importantly is that neurologists have been taught over the years to identify partial seizures and focal epilepsy with cortical lesions. Sutherland et al. emphasised in 1974 that ‘It is vital to recognise that partial seizures have an underlying pathology’ [5]. Thus, the concept that focal EEG discharges can be associated with a benign form of epilepsy takes time to evolve.
Since then this benign form of epilepsy had been given a variety of names. Finally, in its revised proposal for classification of epilepsies and epileptic syndromes, the International League Against Epilepsy classified it as an idiopathic localisation-related epilepsy; and renamed it “Benign Childhood Epilepsy with Centrotemporal Spikes” (BECTS) [6]. By definition, it is age-related, without demonstrable anatomic lesions, and is subject to spontaneous remissions. It is an important epileptic syndrome to recognise, as diagnosis of this syndrome allows the clinician to offer the patient and parents a rational plan for treatment and prognosis. However, reports on BECTS are scarce in Chinese children. As there are no local data on this common epileptic syndrome, we undertook a retrospective study to review 50 cases of BECTS in order to describe its characteristics in our locality.
Section snippets
Patients
This was an observational study to examine local Chinese children with BECTS in a retrospective manner. The characteristics of these children were examined by reviewing the EEGs and the case records. The study period was from 01/07/1995 to 31/06/1998. We retrieved all the EEG reports in United Christian Hospital and Princess Margaret Hospital during the study period. The EEG recordings were obtained from 19 surface electrodes according to the international 10–20 electrode placement system. We
Results
Fifty cases of BECTS were retrieved.
Discussion
There was a male predominance (64%) for children with BECTS in our study, which is similar to series reported elsewhere [1], [3], [7], [9], [10], [11], [12]. The age of onset ranged from 3 to 13 years, with a peak age of 7. This is younger than the reported peak age of 8–9 years in most Western series [9], [10], [11], [13], but is similar to that reported by a group of Taiwanese investigators on 94 Chinese children [14]. Approximately 80% of all cases occurred between 5 and 10 years old.
Degen
Conclusion
BECTS is an important childhood epileptic syndrome. It is easy to treat and the majority of patients have good outcome. Early counseling should be given to children with BECTS. Further follow-up of this group of children is warranted to ascertain their long-term prognosis.
Acknowledgements
We would like to acknowledge C.W. Chin (Statistical Officer, Department of Statistics, Prince of Wales Hospital) for his assistance in the statistics and data analysis. We would also like to express our gratitude to the Electro-diagnostic Unit and the Medical Records Office of United Christian Hospital and Princess Margaret Hospital for their help in collecting the EEGs and the case notes. Special thanks are given to Dr P.Ip (COS, Department of Paediatrics, UCH) for her advice.
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