A 7-year-old boy is brought for nocturnal events: twitching of the right corner of the mouth with drooling, sometimes progressing to clonic jerking of the right arm, occurring within an hour of falling asleep. He is otherwise developmentally normal with normal examination. EEG shows centrotemporal spikes. What is the most appropriate management?

• A Start carbamazepine at low dose ✓
• B Reassure the parents without antiepileptic drugs
• C Start valproate and obtain brain MRI
• D Start phenytoin and admit for video EEG monitoring

Explanation

This is benign epilepsy with centrotemporal spikes (rolandic epilepsy), the commonest childhood focal epilepsy syndrome. Seizures are infrequent, nocturnal, orofacial, and the syndrome remits by mid-adolescence. Because many children have few seizures, some clinicians observe without treatment, but when treatment is required a single narrow-spectrum agent such as carbamazepine or oxcarbazepine is used. Valproate is a broad-spectrum agent reserved for generalized epilepsies, and routine MRI or prolonged monitoring adds nothing to this classic electroclinical diagnosis.

Reference: Nelson Textbook of Pediatrics, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.