A 7-year-old boy has had three nocturnal seizures during which his face twitches on one side, he drools excessively, and he cannot speak, lasting about 90 seconds each. Development is normal. Interictal EEG shows sharp waves over the right mid-temporal and central regions. What is the most likely diagnosis?

• A Temporal lobe epilepsy with mesial temporal sclerosis
• B Juvenile myoclonic epilepsy
• C Landau-Kleffner syndrome
• D Benign epilepsy with centrotemporal spikes ✓

Explanation

Nocturnal focal seizures with unilateral facial twitching, drooling, and speech arrest in a neurologically normal school-aged child, with centrotemporal sharp waves on EEG, define benign rolandic epilepsy (BECTS). It often remits by adolescence and may not need treatment if infrequent. Temporal lobe epilepsy usually produces automatisms and deja vu with mesial temporal sclerosis on MRI, while Landau-Kleffner presents with acquired aphasia rather than drooling and facial motor features.

Reference: Nelson Textbook of Pediatrics, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.