A 9-year-old boy has brief episodes during sleep in which the right side of his face twitches, he drools, and his speech is temporarily arrested, with full awareness preserved. Neurological examination is normal. EEG shows unilateral centrotemporal sharp waves activated by sleep. What is the most appropriate management?

• A Start carbamazepine and obtain annual MRI
• B Start valproate and restrict physical activity
• C Reassure; antiepileptic drugs may be deferred as remission is expected ✓
• D Refer for epilepsy surgery evaluation

Explanation

This is self-limited epilepsy with centrotemporal spikes (benign rolandic epilepsy), the most common childhood epilepsy syndrome. Seizures are infrequent, predominantly nocturnal, focal with orofacial features, and the syndrome almost always remits spontaneously by mid-adolescence with normal cognition. Because the course is so benign and seizures are often rare, treatment can be withheld or limited to short courses of carbamazepine if events are frequent. Surgery is never indicated.

Reference: Nelson Textbook of Pediatrics, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.