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  • Updated 08.10.2023
  • Released 10.18.1993
  • Expires For CME 08.10.2026

Self-limited epilepsy with centrotemporal spikes



Self-limited epilepsy with centrotemporal spikes (SeLECTS) is the new name for the previous epilepsy syndrome of benign epilepsy with centrotemporal spikes. It was first reported in the 1950s and is now recognized as the most frequent epilepsy syndrome in children between the ages of 4 and 13 years. The term “benign” was applied to this syndrome to differentiate it from other sinister causes for focal epilepsies. However, cognitive dysfunction, language impairment, and atypical evolutions with adverse seizure and neurodevelopmental outcomes were rarely seen in this syndrome.

The ILAE Task Force report on the nosology and definitions of childhood-onset epilepsy syndromes proposes the terms “self-limited focal epilepsies” of childhood (SeLFE) for focal epilepsies with onset in childhood and “self-limited epilepsy with centrotemporal spikes” (SeLECTS) for Rolandic epilepsy (168). SeLECTS is the most frequent SeLFE and accounts for 6% to 7% of all childhood epilepsies (196). Its incidence is estimated to be 6.1 per 100,000 children below 16 years of age per year (193).

Key points

• presents with focal seizures with dysarthria, sialorrhea, dysphasia, and unilateral clonic or tonic–clonic movement of the mouth, or nocturnal focal to bilateral tonic-clonic seizures.

• Seizures commonly occur within 1 hour of falling asleep or 1 to 2 hours prior to awakening.

• There are high-amplitude, centrotemporal, biphasic epileptiform abnormalities on EEG.

• There is no developmental regression.

• Remission occurs by mid- to late adolescence.

• Specific cognitive, language, memory, and attention-related disorders are increasingly being reported.

• SeLECTS may atypically evolve into Landau-Kleffner syndrome and epileptic encephalopathy with continuous spike-and-wave activation in sleep (EE-SWAS) with potential for persistent neuropsychological impairments.

Historical note and terminology

The Rolandic (centrotemporal) region is named after Luigi Rolando (1773-1831), an Italian anatomist known for his pioneer research in localization of function in the human brain. A particular EEG pattern with migratory spikes originating over the Rolandic region was first reported in the 1950s (65; 70). In 1958, the first clinical description associated with EEG features was published (132). The same EEG pattern was later correlated with a common form of focal childhood epilepsy, then called "midtemporal epilepsy," characterized by hemifacial and oropharyngeal ictal symptoms and a favorable prognosis (69). Because of the localization of the ictal events, Lombroso proposed the term "sylvian seizures" (121). In the same year, Loiseau and colleagues presented an electroclinical series of 122 children with what they called “a particular form of epilepsy in childhood,” stressing its benign character. Several long-term follow-up studies in the past had confirmed the relatively good prognosis (12; 104; 120). This form of epilepsy was called “benign childhood epilepsy with centrotemporal spikes” and was placed in the group of idiopathic localization-related (focal, local, partial) epilepsies in the International Classification of Epilepsies and Epileptic Syndromes (31; 51).

As new syndromes were recognized within the spectrum of benign childhood focal epilepsies (145), the term “benign” was considered initially acceptable for this syndrome (73). However, the 2017 ILAE Classification of the Epilepsies proposed the term “self-limited” for the “benign” course of epilepsies to reflect a “likely spontaneous resolution of a syndrome” (160). Thus, the new term “self-limited epilepsy with centrotemporal spikes” (SeLECTS) was proposed for this epilepsy syndrome. The word “benign” is sometimes completely omitted to name the syndrome as “childhood epilepsy with centrotemporal spikes” (CECTS) (178). However, the ILAE Task Force on Nosology and Definitions affirms the term SeLECTS for this epilepsy syndrome (168).

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