Atypical benign epilepsy of childhood with rolandic spikes: features of a subset requiring more than one medication for seizure control.

The objective of this study was to compare the clinical and electroencephalographic features of two groups of children with benign epilepsy of childhood with rolandic spikes: those in whom seizure control was attained either without the use of medication or with a single medication (group 1) and those requiring two medications for seizure control (group 2). A consecutive series of children with benign epilepsy of childhood with rolandic spikes was identified in a single pediatric neurology practice. Medical charts were then systematically retrospectively reviewed. A total of 66 children with benign epilepsy of childhood with rolandic spikes was identified; 52 (78.8%) required either no medication (n = 7) or a single medication (n = 45) for seizure control, whereas 14 (21.2%) required two medications. The two groups did not differ with respect to gender, age of onset, type (generalized or partial) of initial seizure, or whether EEG abnormalities were unilateral or bilateral. They did differ significantly with respect to the mean number of seizures experienced prior to initiating treatment (group 1, 2.06, versus group 2, 4.36; t = 3.40, P = .005). In those treated (n = 59), the initial medication selected (carbamazepine versus noncarbamazepine) in the two groups was significantly different: group 1, 40 (carbamazepine)/45, versus group 2, 9 (carbamazepine)/14; chi2 = 4.59; P = .03. The difference in frequency between the two groups of associated comorbid conditions (tics, attention-deficit hyperactivity disorder [ADHD], learning disability) almost reached the threshold of statistical significance: group 1, 7/52, versus group 2, 5/14 (chi2 = 3.67, P = .06). A subset of children with benign epilepsy of childhood with rolandic spikes may require more than one medication for effective seizure control. This subset experiences more seizures prior to the initiation of treatment, is more likely to be treated initially with a noncarbamazepine medication, and tends to have a higher frequency of associated conditions.