Rolandic Epilepsy Research Articles

Study of Eye Movements Abnormalities in Epilepsy

ABSTRACT Idiopathic epilepsy (IE), is a group of epileptic syndromes with no structural brain lesion, but with microstructural changes in neuronal networks leading to neuropsychological consequences. Therefore, the assessment of saccadic eye movements can provide insight into the integrity of cerebral networks as it involves large cortical and subcortical brain areas and circuitries. Describe saccadic eye movement abnormalities in patients with IE and correlate them with disease characteristics and antiseizure medication. Case–control study including IE patients followed in the Neurology Department of Razi University Hospital and healthy controls matched. Participants underwent a recording of saccadic eye movements. Pursuit, prosaccade, and anti-saccade tasks were performed. 115 patients and 98 matched healthy controls were included. The gender ratio (male to female) was 0.6. The mean age at onset was 16.3 ± 12 years. Diagnosed epileptic syndromes were juvenile myoclonic epilepsy (JME), epilepsy with generalized tonic-clonic seizures, childhood absence epilepsy, temporal lobe epilepsy, frontal lobe epilepsy, and rolandic epilepsy. Saccadic eye movements were impaired in 52.2% of our patients and significantly more altered in those with JME (p = .021). Prolonged horizontal saccades latencies were the most frequent eye movement abnormalities (32.1%), followed by altered horizontal smooth pursuit (22.6%). A positive correlation was found between age at eye movements recording, age at onset, disease duration, global cognitive impairment, and saccadic eye movements. However, no definite relationship was identified. Saccadic eye movement illustrates extending anatomic alterations in IE including frontal and temporoparietal cortical areas and cortico-subcortical circuits. Eye movement recording is a useful and reproducible tool in the assessment of epileptic patients and provides a better understanding of neuronal mechanisms in epilepsy.

Diagnosis of Rolandic Epilepsy in a Patient Presenting with Attention Deficit Hyperactivity Disorder

Diagnosis of Rolandic Epilepsy in a Patient Presenting with Attention Deficit Hyperactivity Disorder

Individual-based morphological brain network changes in children with Rolandic epilepsy

ObjectiveTo investigate the local cortical morphology and individual-based morphological brain networks (MBNs) changes in children with Rolandic epilepsy (RE). MethodsBased on the structural MRI data of 56 children with RE and 56 healthy controls (HC), we constructed four types of individual-based MBNs using morphological indices (cortical thickness [CT], fractal dimension [FD], gyrification index [GI], and sulcal depth [SD]). The global and nodal properties of the brain networks were analyzed using graph theory. The between-group difference in local morphology and network topology was estimated, and partial correlation analysis was further analyzed. ResultsCompared with the HC, children with RE showed regional GI increases in the right posterior cingulate gyrus and SD increases in the right anterior cingulate gyrus and medial prefrontal cortex. Regarding the network level, RE exhibited increased characteristic path length in CT-based and FD-based networks, while decreased FD-based network node efficiency in the right inferior frontal gyrus. No significant correlation between altered morphological features and clinical variables was found in RE. ConclusionsThese findings indicated that children with RE have disrupted morphological brain network organization beyond local morphology changes. SignificanceThe present study could provide more theoretical basis for exploring the neuropathological mechanisms in RE.

Impaired sleep-dependent memory consolidation predicted by reduced sleep spindles in Rolandic epilepsy.

Sleep spindles are prominent thalamocortical brain oscillations during sleep that have been mechanistically linked to sleep-dependent memory consolidation in animal models and healthy controls. Sleep spindles are decreased in Rolandic epilepsy and related sleep-activated epileptic encephalopathies. We investigate the relationship between sleep spindle deficits and deficient sleep dependent memory consolidation in children with Rolandic epilepsy. In this prospective case-control study, children were trained and tested on a validated probe of memory consolidation, the motor sequence task (MST). Sleep spindles were measured from high-density EEG during a 90-minute nap opportunity between MST training and testing using a validated automated detector. Twenty-three children with Rolandic epilepsy (14 with resolved disease), and 19 age- and sex-matched controls were enrolled. Children with active Rolandic epilepsy had decreased memory consolidation compared to control children (p=0.001, mean percentage reduction: 25.7%, 95% CI [10.3, 41.2]%) and compared to children with resolved Rolandic epilepsy (p=0.007, mean percentage reduction: 21.9%, 95% CI [6.2, 37.6]%). Children with active Rolandic epilepsy had decreased sleep spindle rates in the centrotemporal region compared to controls (p=0.008, mean decrease 2.5 spindles/min, 95% CI [0.7, 4.4] spindles/min). Spindle rate positively predicted sleep-dependent memory consolidation (p=0.004, mean MST improvement of 3.9%, 95% CI [1.3, 6.4]%, for each unit increase in spindles per minute). Children with Rolandic epilepsy have a sleep spindle deficit during the active period of disease which predicts deficits in sleep dependent memory consolidation. This finding provides a mechanism and noninvasive biomarker to aid diagnosis and therapeutic discovery for cognitive dysfunction in Rolandic epilepsy and related sleep activated epilepsy syndromes.

Efficacy and tolerability of sulthiame in the treatment of epilepsy: a literature review

This review aims to summarize the available evidence on the efficacy and tolerability of sulthiame for different forms of epilepsy. The analysis of international publications suggests that sulthiame is considered as a first-line drug for the treatment of age-dependent epilepsy with central temporal spikes (rolandic epilepsy). Sulthiame is highly effective in children with epileptic encephalopathies manifesting with spike-and-wave activity during sleep, including Landau-Kleffner syndrome, as well as in patients with myoclonic seizures. The drug might be also effective in patients with other forms of focal epilepsy, including those resistant to therapy. The tolerability of sulthiame is higher that that of old antiepileptic drugs and even levetiracetam; thus, it is associated with a lower risk of treatment interruptions due to adverse events. Moreover, sulthiame can be used for behavioral disorders (such as hyperkinetic behavior, aggressiveness) and cognitive impairments. Sulthiame can be effective in patients with epilepsy and sleep apnea.

Interictal magnetic signals in new-onset Rolandic epilepsy may help with timing of treatment selection.

With research progress on Rolandic epilepsy (RE), its "benign" nature has been phased out. Clinicians are exhibiting an increasing tendency toward a more assertive treatment approach for RE. Nonetheless, in clinical practice, delayed treatment remains common because of the "self-limiting" nature of RE. Therefore, this study aimed to identify an imaging marker to aid treatment decisions and select a more appropriate time for initiating therapy for RE. We followed up with children newly diagnosed with RE, classified them into medicated and non-medicated groups according to the follow-up results, and compared them with matched healthy controls. Before beginning follow-up visits, interictal magnetic data were collected using magnetoencephalography in treatment-naïve recently diagnosed patients. The spectral power of the whole brain during initial diagnosis was determined using minimum normative estimation combined with the Welch technique. A difference was observed in the magnetic source intensity within the left caudal anterior cingulate and precentral and postcentral gyri in the delta band between the medicated and non-medicated groups. The results revealed good discriminatory ability within the receiver operator characteristic curve. In the medicated group, there was a specific change in the frontotemporal magnetic source intensity, which shifted from high to low frequencies, compared with the healthy control group. The intensity of the precentral gyrus magnetic source within the delta band showed good specificity. Considering the rigor of initial treatment, the intensity of the precentral gyrus magnetic source can provide some help as an imaging marker for initial RE treatment, particularly for the timing of treatment initiation.

Insights into epileptic aphasia: Intracranial recordings in a child with a left insular ganglioglioma

Intracranial EEG was recorded during a dialog-based task in a 16-year-old boy with a left insular ganglioglioma, medically intractable epilepsy, epileptic foci in auditory cortex on the lateral superior temporal gyrus (STG) and language deficiencies. Performance of the task was highly erratic, characterized by rapid cycling between providing correct answers, incorrect answers and failure to respond. There was no relationship between performance and the degree of concurrent epileptic activity in auditory cortex. High gamma activity in core auditory cortex (posterior medial Heschl’s gyrus, HGPM) was markedly diminished during listening and, with two exceptions, was less than activity from 17 control subjects. The two exceptions also had seizure onset zones in perisylvian cortex. Responses during listening were of smaller amplitude than those occurring during speaking, a pattern opposite that typically seen in the left HGPM. Within HGPM, lateral STG and pars opercularis of the inferior frontal gyrus, high gamma activity while listening was greatest when questions were correctly answered and least when the subject failed to respond. Alpha activity preceding utterances was lowest in pars opercularis when the subject failed to respond. Comparisons between resting state activity in another cohort of controls and the subject were most disparate in HGPM. Alpha activity during performance of the task was greatest in the mid-anterior cingulate when the subject failed to respond, suggesting dysfunction beyond the speech network and into the salience network. Multiple abnormalities noted in this patient paralleled those seen in epileptic aphasia and Rolandic epilepsy.

Atonic‐BECTS: An unusual presentation of self‐limited epilepsy in childhood

AbstractObjectivesWe describe an unusual patient with self‐limited epilepsy in childhood to aid in the accurate diagnosis and timely treatment of an atonic variant of self‐limited focal epilepsy of childhood with centrotemporal spikes.MethodsWe reviewed the medical records documenting the clinical presentation, diagnostic evaluation, and treatment. We also reviewed the relevant video electroencephalograms (EEGs).Patient DescriptionThis 3‐year‐old girl with self‐limited focal epilepsy of childhood (formerly called benign rolandic epilepsy) began having recurrent falls. Multiple clinical seizures were recorded on video EEG. The video documented generalized loss of tone resulting in falls, while the ictal EEG revealed one‐second paroxysms of 4 Hz spike‐slow‐wave discharges in the left centrotemporal region, followed by a brief generalized electrodecrement for 400 milliseconds. These findings support the diagnosis of an atypical variant of benign epilepsy with centrotemporal spikes (BECTS), known as atonic‐BECTS. Valproic acid was maximized. On follow‐up, the patient was seizure‐free with a normal EEG and normal development.DiscussionFew prior publications describe atonic‐BECTS. We present a child with atonic‐BECTS whose ictal video EEG confirms atonic seizures. While atonic seizures typically occur with generalized epilepsies, our report highlights that they can present as an atypical manifestation of self‐limited focal epilepsy in childhood.

A variant in SLC12A5 for a familial benign Rolandic epilepsy

Benign Rolandic epilepsy (BRE) is the most common cause of epilepsy in childhood. Childhood epilepsies have high heritability, and many BRE cases show an autosomal dominant inheritance pattern. Thanks to the advancement of genomics, the causal genes of BRE were being elucidated. Although BRE is a genetic disorder, most BRE cases cannot be explained by known causal genes. Pleiotropy is a common phenomenon in genes related to epilepsy. For example, the same variant in a gene related to BRE can cause diverse epileptic syndromes from mild BRE to Landau-Kleffner syndrome, a severe form of epilepsy. Although BRE is classified as idiopathic focal epilepsy, BRE can be caused by the same genes or loci related to idiopathic generalized epilepsy (IGE). Using whole exome sequencing, we tried to find causal variants and copy number variations in the known genes for BRE and IGE. We found a novel missense variant in SLC12A5 as a cause of a familial BRE. Although SLC12A5 is a known causal gene for IGE, it may cause BRE, because many genes related to BRE can cause diverse epilepsy syndromes including IGE.

A prospective 5-year longitudinal study detects neurocognitive and imaging correlates of seizure remission in self-limiting Rolandic epilepsy

ObjectiveSelf-limiting Rolandic epilepsy (RE) is the most common epilepsy in school-age children. Seizures are generally infrequent, but cognitive, language, and motor coordination problems can significantly impact the child’s life. To better understand brain structure and function changes in RE, we longitudinally assessed neurocognition, cortical thickness, and subcortical volumes. MethodsAt baseline, we recruited 30 participants diagnosed with RE and 24-healthy controls and followed up for 4.94 ± 0.8 years when the participants with RE were in seizure remission. Measures included were as follows: T1-weighted magnetic resonance brain imaging (MRI) with FreeSurfer analysis and detailed neuropsychological assessments. MRI and neuropsychological data were compared between baseline and follow-up in seizure remission. ResultsLongitudinal MRI revealed excess cortical thinning in the left-orbitofrontal (p = 0.0001) and pre-central gyrus (p = 0.044).There is a significant association (p = 0.003) between a reduction in cortical thickness in the left-orbitofrontal cluster and improved processing of filtered words.Longitudinal neuropsychology revealed significant improvements in the symptoms of developmental coordination disorder (DCD, p = 0.005) in seizure remission. ConclusionsThere is evidence for altered development of neocortical regions between active seizure state and seizure remission in RE within two clusters maximal in the left-orbitofrontal and pre-central gyrus. There is significant evidence for improvement in motor coordination between active seizures and seizure remission and suggestive evidence for a decline in fluid intelligence and gains in auditory processing.

Dyslexia Antedating and Postdating Epilepsy Onset

IntroductionIn children with epilepsy, comorbidities are frequent. In dyslexia, comorbidities are increasingly acknowledged. Little is known about temporal aspects (dyslexia antedating or postdating epilepsy onset, time interval), epilepsy types, and dyslexia phenotypes.MethodFrom over 1000 files of children with epilepsy, 51 cases were retrospectively identified with a formal diagnosis of dyslexia. Ages at diagnoses of dyslexia and epilepsy, epilepsy variables, and dyslexia-related neuro-cognition (phoneme deletion and rapid letter naming) were recorded.AnalysesTemporal variables, epilepsy variables, and neuro-cognition were analyzed with chi-squared, t tests, ancova, and generalized linear models.ResultsDuration of epilepsy to diagnosis of dyslexia ranged from − 5.5 years (dyslexia antedating epilepsy) to 10.1 years. In 35% of the children, diagnosis of dyslexia antedated the emergence of epilepsy. Dyslexia was seen across seizure types, with some preference for temporal lobe and rolandic epilepsy; rates for antedating and postdating dyslexia were similar. Notably, encephalopathic development was also seen. No specific dyslexia phenotype was seen. Children with dyslexia diagnoses after or in close temporal relationship to diagnoses of epilepsy (shortly before or after) scored lower on phonology and naming.ConclusionAntedating and postdating dyslexia can be seen in all epilepsy types. In a natural setting, dyslexia may antedate or postdate the emergence of epilepsy by several years. Around the time the epilepsy is about to surface, scores on dyslexia-related neuro-cognitive tasks are lowest, suggesting a bidirectional effect of the seizure condition on cognition. Encephalopathic development may be mimicking dyslexia criteria in some cases.

Atypical functional connectivity hierarchy in Rolandic epilepsy

Functional connectivity hierarchy is an important principle in the process of brain functional organization and an important feature reflecting brain development. However, atypical brain network hierarchy organization in Rolandic epilepsy have not been systematically investigated. We examined connectivity alteration with age and its relation to epileptic incidence, cognition, or underlying genetic factors in 162 cases of Rolandic epilepsy and 117 typically developing children, by measuring fMRI multi-axis functional connectivity gradients. Rolandic epilepsy is characterized by contracting and slowing expansion of the functional connectivity gradients, highlighting the atypical age-related change of the connectivity hierarchy in segregation properties. The gradient alterations are relevant to seizure incidence, cognition, and connectivity deficit, and development-associated genetic basis. Collectively, our approach provides converging evidence for atypical connectivity hierarchy as a system-level substrate of Rolandic epilepsy, suggesting this is a disorder of information processing across multiple functional domains, and established a framework for large-scale brain hierarchical research.

ScatterFormer: Locally-Invariant Scattering Transformer for Patient-Independent Multispectral Detection of Epileptiform Discharges

Patient-independent detection of epileptic activities based on visual spectral representation of continuous EEG (cEEG) has been widely used for diagnosing epilepsy. However, precise detection remains a considerable challenge due to subtle variabilities across subjects, channels and time points. Thus, capturing fine-grained, discriminative features of EEG patterns, which is associated with high-frequency textural information, is yet to be resolved. In this work, we propose Scattering Transformer (ScatterFormer), an invariant scattering transform-based hierarchical Transformer that specifically pays attention to subtle features. In particular, the disentangled frequency-aware attention (FAA) enables the Transformer to capture clinically informative high-frequency components, offering a novel clinical explainability based on visual encoding of multichannel EEG signals. Evaluations on two distinct tasks of epileptiform detection demonstrate the effectiveness our method. Our proposed model achieves median AUCROC and accuracy of 98.14%, 96.39% in patients with Rolandic epilepsy. On a neonatal seizure detection benchmark, it outperforms the state-of-the-art by 9% in terms of average AUCROC.

Decreased thalamocortical connectivity in resolved Rolandic epilepsy

ObjectiveMedian nerve somatosensory evoked fields (SEFs) conduction times reflect the integrity of neural transmission across the thalamocortical circuit. We hypothesized median nerve SEF conduction time would be abnormal in children with Rolandic epilepsy (RE). Methods22 children with RE (10 active; 12 resolved) and 13 age-matched controls underwent structural and diffusion MRI and median nerve and visual stimulation during magnetoencephalography (MEG). N20 SEF responses were identified in contralateral somatosensory cortices. P100 were identified in contralateral occipital cortices as controls. Conduction times were compared between groups in linear models controlling for height. N20 conduction time was also compared to thalamic volume and Rolandic thalamocortical structural connectivity inferred using probabilistic tractography. ResultsThe RE group had slower N20 conduction compared to controls (p = 0.042, effect size 0.6 ms) and this difference was driven by the resolved RE group (p = 0.046). There was no difference in P100 conduction time between groups (p = 0.83). Ventral thalamic volume positively correlated with N20 conduction time (p = 0.014). ConclusionsChildren with resolved RE have focally decreased Rolandic thalamocortical connectivity. SignificanceThese results identify a persistent focal thalamocortical circuit abnormality in resolved RE and suggest that decreased Rolandic thalamocortical connectivity may support symptom resolution in this self-limited epilepsy.

Self-limited childhood epilepsies are disorders of the perisylvian communication system, carrying the risk of progress to epileptic encephalopathies-Critical review.

"Sleep plasticity is a double-edged sword: a powerful machinery of neural build-up, with a risk to epileptic derailment." We aimed to review the types of self-limited focal epilepsies..."i.e. keep as two separate paragraphs" We aimed to review the types of self-limited focal epilepsies: (1) self-limited focal childhood epilepsy with centrotemporal spikes, (2) atypical Rolandic epilepsy, and (3) electrical status epilepticus in sleep with mental consequences, including Landau-Kleffner-type acquired aphasia, showing their spectral relationship and discussing the debated topics. Our endeavor is to support the system epilepsy concept in this group of epilepsies, using them as models for epileptogenesis in general. The spectral continuity of the involved conditions is evidenced by several features: language impairment, the overarching presence of centrotemporal spikes and ripples (with changing electromorphology across the spectrum), the essential timely and spatial independence of interictal epileptic discharges from seizures, NREM sleep relatedness, and the existence of the intermediate-severity "atypical" forms. These epilepsies might be the consequences of a genetically determined transitory developmental failure, reflected by widespread neuropsychological symptoms originating from the perisylvian network that have distinct time and space relations from secondary epilepsy itself. The involved epilepsies carry the risk of progression to severe, potentially irreversible encephalopathic forms.

Children with Rolandic epilepsy have micro- and macrostructural abnormalities in white matter constituting networks necessary for language function

IntroductionSelf-limited epilepsy with centrotemporal spikes is a transient developmental epilepsy with a seizure onset zone localized to the centrotemporal cortex that commonly impacts aspects of language function. To better understand the relationship between these anatomical findings and symptoms, we characterized the language profile and white matter microstructural and macrostructural features in a cohort of children with SeLECTS. MethodsChildren with active SeLECTS (n = 13), resolved SeLECTS (n = 12), and controls (n = 17) underwent high-resolution MRIs including diffusion tensor imaging sequences and multiple standardized neuropsychological measures of language function. We identified the superficial white matter abutting the inferior rolandic cortex and superior temporal gyrus using a cortical parcellation atlas and derived the arcuate fasciculus connecting them using probabilistic tractography. We compared white matter microstructural characteristics (axial, radial and mean diffusivity, and fractional anisotropy) between groups in each region, and tested for linear relationships between diffusivity metrics in these regions and language scores on neuropsychological testing. ResultsWe found significant differences in several language modalities in children with SeLECTS compared to controls. Children with SeLECTS performed worse on assessments of phonological awareness (p = 0.045) and verbal comprehension (p = 0.050). Reduced performance was more pronounced in children with active SeLECTS compared to controls, namely, phonological awareness (p = 0.028), verbal comprehension (p = 0.028), and verbal category fluency (p = 0.031), with trends toward worse performance also observed in verbal letter fluency (p = 0.052), and the expressive one-word picture vocabulary test (p = 0.068). Children with active SeLECTS perform worse than children with SeLECTS in remission on tests of verbal category fluency (p = 0.009), verbal letter fluency (p = 0.006), and the expressive one-word picture vocabulary test (p = 0.045). We also found abnormal superficial white matter microstructure in centrotemporal ROIs in children with SeLECTS, characterized by increased diffusivity and fractional anisotropy compared to controls (AD p = 0.014, RD p = 0.028, MD p = 0.020, and FA p = 0.024). Structural connectivity of the arcuate fasciculus connecting perisylvian cortical regions was lower in children with SeLECTS (p = 0.045), and in the arcuate fasciculus children with SeLECTS had increased diffusivity (AD p = 0.007, RD p = 0.006, MD p = 0.016), with no difference in fractional anisotropy (p = 0.22). However, linear tests comparing white matter microstructure in areas constituting language networks and language performance did not withstand correction for multiple comparisons in this sample, although a trend was seen between FA in the arcuate fasciculus and verbal category fluency (p = 0.047) and the expressive one-word picture vocabulary test (p = 0.036). ConclusionWe found impaired language development in children with SeLECTS, particularly in those with active SeLECTS, as well as abnormalities in the superficial centrotemporal white matter as well as the fibers connecting these regions, the arcuate fasciculus. Although relationships between language performance and white matter abnormalities did not pass correction for multiple comparisons, taken together, these results provide evidence of atypical white matter maturation in fibers involved in language processing, which may contribute to the aspects of language function that are commonly affected by the disorder.

Changing Agendas on Sleep, Treatment and Learning in Epilepsy (CASTLE) Sleep-E: a protocol for a randomised controlled trial comparing an online behavioural sleep intervention with standard care in children with Rolandic epilepsy

IntroductionSleep and epilepsy have an established bidirectional relationship yet only one randomised controlled clinical trial has assessed the effectiveness of behavioural sleep interventions for children with epilepsy. The intervention was...

Alternations of neuromagnetic activity across neurocognitive core networks among benign childhood epilepsy with centrotemporal spikes: A multi-frequency MEG study.

We aimed to investigate the alternations of neuromagnetic activity across neurocognitive core networks among early untreated children having benign childhood epilepsy with centrotemporal spikes (BECTS). We recorded the Magnetoencephalography (MEG) resting-state data from 48 untreated children having BECTS and 24 healthy children. The fourth edition of the Wechsler Intelligence Scale for Children (WISC-IV) was utilized to divide the children with BECTS into two groups: the cognitive impairment (CI) group with a full-scale intelligence quotient (FSIQ) of < 90 and the cognitive non-impairment (CNI) group with an FSIQ of > 90. We selected 26 bilateral cognitive-related regions of interest based on the triple network model. The neurocognitive core network spectral power was estimated using a minimum norm estimate (MNE). In the CNI group, the spectral power inside the bilateral anterior cingulate cortex (ACC) and the bilateral caudal middle frontal cortex (CMF) enhanced within the delta band and reduced within the alpha band. Both the CI and the CNI group demonstrated enhanced spectral power inside the bilateral posterior cingulate cortex (PCC), bilateral precuneus (PCu) region, bilateral superior and middle temporal cortex, bilateral inferior parietal lobe (IPL), and bilateral supramarginal cortex (SM) region in the delta band. Moreover, there was decreased spectral power in the alpha band. In addition, there were consistent changes in the high-frequency spectrum (> 90 Hz). The spectral power density within the insula cortex (IC), superior temporal cortex (ST), middle temporal cortex (MT), and parahippocampal cortex (PaH) also decreased. Therefore, studying high-frequency activity could lead to a new understanding of the pathogenesis of BECTS. The alternations of spectral power among neurocognitive core networks could account for CI among early untreated children having BECTS. The dynamic properties of spectral power in different frequency bands could behave as biomarkers for diagnosing new BECTS.

Altered Language-Related Effective Connectivity in Patients with Benign Childhood Epilepsy with Centrotemporal Spikes

Benign childhood epilepsy with centrotemporal spikes (BECTS) is one of the most common childhood epilepsy syndromes and may be associated with language deficits. Resting-state functional magnetic resonance imaging (fMRI) data were collected from a total of 78 children: 52 patients with BECTS (28 drug-naïve and 24 medicated) and 26 healthy controls (HC). Granger causality analysis (GCA) was used to investigate alterations in effective connectivity (EC) between the language network core node (Broca's area) and the whole brain. EC from Broca's area to the left Heschl's gyrus (HG), right putamen, and anterior cingulate cortex (ACC) was significantly increased, while EC from the bilateral putamen and left ACC to Broca's area was significantly decreased in BECTS. Moreover, altered EC of Broca's area to the right putamen was significantly positively correlated with verbal IQ (VIQ), while altered EC of Broca's area to the ACC showed significantly negative correlations with the frequency of seizures. Altered EC from the left putamen to Broca's area was also significantly negatively correlated with performance IQ (PIQ) and full-scale IQ (FSIQ) in the drug-naïve group. In addition, there was a significant positive correlation between the EC of Broca's area to the left HG and the number of seizures, as well as between the EC of Broca's area to the right putamen and the age at onset in the medicated group. These findings suggest abnormal causal effects on the language network related to Broca's area in children with BECTS. Longitudinal investigation of language network development and further follow-up may be needed to illuminate the changes in organization and rebalancing over time.

Poor School Academic Performance and Benign Epilepsy with Centro-Temporal Spikes

Poor academic performance of students with epilepsy seems to be a multifactorial problem related to difficulties in reading, writing, math, and logic skills. Poor school and academic performances refer to learning problems in a specific academic area due to learning disorders and learning difficulties not excluding the ability to learn in a different manner during school and academic life. Sometimes, school, academic difficulties, and Rolandic epilepsy can coexist together, and there may be comorbidities. Consequently, the risk of impaired academic performance in people with epilepsy is high. This review analyzed the relationship between Benign Epilepsy with Centro-Temporal Spikes (BECTS) and poor school and academic performance (PSAP) in children and adolescents (aged 6 to 19), and in adults (aged 20 to no age limit). The PRISMA guideline was used to guide our review strategy. This research shows that Benign Epilepsy with Centro-Temporal Spikes (BECTS) and poor school and academic performances are strongly correlated. An early onset age, as well as a long persistence of seizures, correlate more closely with PSAP. On the other hand, it appears that good pharmacological control of seizures and remission from the acute phase of the pathology support better school performance. This review highlights how neuropsychological aspects are also involved in patients with BECTS and PSAP, both in the greater predisposition to the establishment of other neuropsychiatric conditions and in the possibility that stigma conditions and poor academic results may have repercussions on the adaptation and functioning of these subjects. Global management of the subject with BECTS and PSAP is essential, which also pays attention to the aspects of social and scholastic inclusion, both to achieve age-appropriate educational and behavioral objectives, to give the necessary tools for the growth of the individual, and to allow a serene transition to adulthood, favoring autonomous learning and better outcomes.