Self-limited epilepsy with centrotemporal spikes (SeLECTS), previously known as benign childhood epilepsy with centrotemporal spikes (BCECTS) or rolandic epilepsy, is an epilepsy syndrome that appears in school-aged children who are otherwise developing normally. The seizures associated with SeLECTS are typically brief and involve the face and throat area, potentially progressing to broader tonic-clonic seizures. A key diagnostic feature, and where Centro Diagnosis plays a crucial role, is the EEG. This test reveals a normal brain wave background punctuated by distinctive, high-amplitude epileptiform discharges in the centrotemporal regions, especially during drowsiness and sleep. Importantly, these seizures naturally resolve by puberty.
It’s vital to understand that “self-limited” signifies the high likelihood of these seizures disappearing on their own as the child reaches a certain age. Furthermore, SeLECTS is considered to be on a spectrum with developmental and epileptic encephalopathy with spike-wave activation in sleep. In some instances, a child might transition from SeLECTS to this related, but more severe, condition over time.
It’s crucial to note that if a child with suspected SeLECTS shows any signs of cognitive or language regression, a sleep EEG is immediately warranted to evaluate for developmental and/or epileptic encephalopathy with spike-wave activation in sleep.
Clinical Presentation and Diagnostic Significance of Centro Diagnosis
SeLECTS is a common epilepsy syndrome in children, accounting for 6-7% of all childhood epilepsy cases. Onset typically occurs between 4 and 10 years of age, with a range from 3 to 14 years. It affects both sexes, with a slight tendency to be more prevalent in males. Children with SeLECTS usually have normal developmental histories, and neurological examinations are normal, including head size. Some may have a history of ADHD or specific learning difficulties prior to seizure onset. A history of febrile seizures is present in a minority (5-15%), and rarely, a history of self-limited epilepsy with autonomic seizures may be reported.
During the active phase of epilepsy, it’s possible for behavioral and neuropsychological issues to emerge or worsen, particularly affecting language and executive functions. These deficits often improve as the child gets older. Seizures in SeLECTS generally respond well to medication and typically cease by puberty, although in rare cases, they might persist until age 18. The centro diagnosis, therefore, is not just about identifying the characteristic EEG pattern but also about understanding the typical clinical course and prognosis associated with this syndrome.
For male patients exhibiting intellectual impairment alongside features suggestive of SeLECTS, particularly if the EEG shows background slowing, Fragile X syndrome should be considered as a possible underlying cause. This highlights that while centro diagnosis points towards SeLECTS, a comprehensive evaluation is crucial to rule out other potential conditions.
