Self-limited epilepsy of childhood with centrotemporal spikes (SeLECTS) is one of the most common forms of epilepsy in children. Most seizures occur from sleep. The child has focal onset seizures with a characteristic EEG pattern in the centrotemporal region of the brain. Males are more commonly affected than females.
The outlook for a child with BECTS is very good. Seizures are usually sporadic and easy to control with medications. In most cases, seizures will eventually stop before adulthood.
What are other terms for SeLECTS?
Other terms for SeLECTS include:
- benign childhood epilepsy with centrotemporal spikes
- benign epilepsy of children with rolandic (centrotemporal) paroxysmal foci
- benign rolandic epilepsy
- benign rolandic epilepsy of childhood
- centrotemporal epilepsy
What are the features of SeLECTS?
SeLECTS is a type of age-related epilepsy with seizures starting in a specific area of the brain called the centrotemporal region (or Rolandic). It usually begins between the ages of four and 10 years, with a peak around seven years of age. Children with SeLECTS are otherwise healthy, with normal cognitive and neurological development.
Most seizures happen while the child is asleep. They are usually focal motor seizures, often beginning in the face. However, secondary generalized seizures (progression of focal symptoms) are seen fairly often, especially in younger children.
A typical seizure with SeLECTS may include:
- gurgling or guttural sounds; often, these sounds are what let parents know their child is having a seizure at night
- movements or jerking of the tongue or jaw
- brief twitches on one side of the face
- drooling and trouble swallowing
- numbness or weakness on one side of the tongue, lips, gums or cheek
- trouble speaking
- sensory symptoms in one leg or one side of the body
A seizure that begins on one side of the face may spread to an arm or leg or may become secondarily generalized. Different seizures may begin on different sides of the child’s body.
Most children with SeLECTS usually have the same type of seizure each time, but a quarter of children have more than one type of seizure.
Some children with SeLECTS have atypical symptoms, including seizures in the daytime, Todd paralysis (weakness affecting one side of the body following a seizure), prolonged seizures or unusual EEG features. Rarely, children with SeLECTS have other complications, including status epilepticus or behaviour or learning problems.
About 10% to 20% of children with SeLECTS only ever have one seizure, and most children do not have very many seizures. However, about 20% of children with SeLECTS have frequent seizures. The seizures associated with SeLECTS usually go away by age 16.
What causes SeLECTS?
This particular type of epilepsy is age-related and presumably has a genetic cause. About one third of children with SeLECTS have a family history of the condition.
The EEG pattern seen in SeLECTS can also be present in first degree relatives, even with no history of clinical seizures. Several different possible gene mutations seem to cause this pattern. Only about a quarter of children who inherit this EEG pattern have seizures. Interactions of genes and environmental factors likely play a role in the development of seizures.
There is usually no structural brain abnormality associated with SeLECTS, but about 10 per cent of children with the condition have a history of birth difficulties, central nervous system infections, head trauma or other such problems. This could just be a coincidence, given that SeLECTS is very common.
How many other children have SeLECTS?
SeLECTS is a common type of epilepsy. It is estimated that 6% to 7% of all children with epilepsy have SeLECTS. Because parents and children do not always realize that the child is having seizures at night, SeLECTS may be even more common than this.
SeLECTS has a strong genetic component. Close relatives of children with SeLECTS are also likely to have either SeLECTS or the classic EEG pattern related to it but not with accompanying seizures.
How do you know that a child has SeLECTS?
If a child’s symptoms are typical of SeLECTS, meaning that they have seizures at night and have the classic EEG pattern between seizures, it is easy to make a diagnosis of SeLECTS. Usually, an MRI is not needed. If their symptoms are not typical, their health-care provider may want to do more tests to see if they have another cause of seizures, such as a structural brain problem. Also, SeLECTS has a genetic basis that health-care providers and researchers do not yet fully understand. A genetic test is not currently indicated in these children.
How is SeLECTS treated?
The treatment for SeLECTS depends on how severe and frequent the seizures are. The treatment should be considered individually for each child. If the child is having frequent seizures, it may be necessary to give them daily anti-seizure medication for a couple of years. For some children, treatment is not necessary.
Many anti-seizure medications are effective for SeLECTS . It is rare for SeLECTS to be resistant to anti-seizure medications. If this is the case with your child, it is important to talk to your child’s health-care provider and discuss how best to optimize treatment.
The seizures nearly always go away by the time the child is 16 years old, so anti-seizure medications can usually be tapered off when the child has been seizure-free for a few years or more. However, if the child stops taking medication too soon, the seizures may reappear.
It is usually not necessary to restrict a child’s activities or over-protect them, however general precautions on safety in children with epilepsy apply.
What is the outlook for a child with SeLECTS?
As with other epilepsy syndromes, it is not possible to predict the outlook for a child who has just been diagnosed with SeLECTS for certain. Overall, SeLECTS has an excellent prognosis. The seizures associated with SeLECTS are usually easy to control with medications, and they usually go away by the time the child is 16 years old. Even if the seizures are resistant to drug therapy, they usually go away in late adolescence.
Once the child has been seizure-free for a few years, their health-care provider will usually try to gradually discontinue their anti-seizure medication. This should only be done with a health-care provider’s supervision, since sudden or early withdrawal may trigger seizures.
Recent studies suggest that one-third of children with SeLECTS have some school difficulties, including academic or behavioural issues. If you think your child is showing worsened academic performance or behaviour, consult your child’s health-care provider. Health-care providers are still learning about the causes of these problems. It appears that they are worsened by frequent seizures or significant EEG abnormalities. It is still unclear whether they get better over time, but most likely they do.
Behavioural problems are less common with SeLECTS than with other forms of childhood epilepsy. In fact, if the child’s family and teachers know that the syndrome has a favourable course and treat the child like other children, it helps prevent the psychosocial consequences of a child being treated differently than their peers or feeling over-protected.
SeLECTS may affect a child’s sense of self-worth if it interferes with their social activities. For instance, if a child with SeLECTS wants to stay overnight at a friend’s house, their friend’s parents may not want the responsibility of looking after them in case they have a seizure at night. It is important to communicate with the parents of their friends to address their concerns and reassure them that the risks are low. The uncertainty of not knowing when a seizure might happen may decrease the child’s self-confidence because of worry about when the next seizure might occur or may increase parental monitoring because of safety concerns. In either case, these factors may prevent the child from participating in age-appropriate activities, even during the day.
Follow up studies have shown that most children with SeLECTS grow to be healthy adults. Most adults seem to recover from academic and behavioural problems after they outgrow their seizures.