Somatotopic distribution of peri-rolandic spikes may predict prognosis in pediatric-onset epilepsy with sensorimotor seizures

Objective: Peri-rolandic spikes are typically seen in benign childhood epilepsy with centro-temporal spikes. However, some cases of epilepsy with peri-rolandic spikes manifest with medical intractability or cognitive dysfunction. The present study evaluated whether spike source localization is predictive of different prognosis of epilepsy and/or cognitive function. Methods: The localization of peri-rolandic spikes was compared between 6 patients whose seizure remitted under age of 15. years with no cognitive impairment (benign group) and 6 patients with either intractable epilepsy or cognitive dysfunction (non-benign group). The sources of epileptic spikes were approximated by the single equivalent current dipole (ECD) model using whole-head magnetoencephalography. Results: The spike locations in the benign group were significantly lateral (14.8 ± 5.3 versus 5.3 ± 3.3 mm, p<0.05), anterior (11.6 ± 2.1 versus 3.7 ± 4.8 mm, p< 0.01), and inferior (27.7 ± 3.6 versus 12.0 ± 10.0 mm, p<0.01) to those in the non-benign group. Seizures tended to involve the laryngo-pharyngo-oro-facial area in the benign group and the facial-hand-foot area in the non-benign group. Conclusion: The clear difference in spike dipole location between benign group and non-benign groups. Significance: Spike localization may be useful for predicting prognosis in epilepsy with sensorimotor seizures and spikes along with central sulcus.