Introduction: Rolandic epilepsy is the most frequent epileptic syndrome in childhood, electroencephalographically characterized by focal sharp waves, so called rolandic spikes (benign epileptiform discharges of childhood). These discharges occur in about 1.5 to 2.4% of children; only 10% of them suffer from epileptic seizures.
Methods: This paper reviews genetic, epidemiological, radiological, neurophysiologic, metabolic and neuropsychological findings in children with rolandic discharges.
Results: The epileptologic course is favorable, seizures and EEG features usually resolve completely at puberty. In contrast to former assumptions, symptoms range from infrequent seizures to neuropsychological deficits and behavior problems, even in children without overt seizures. The impact of rolandic spikes on the development of affected children and their behavior is unclear. Two models try to elucidate the relation between EEG discharges and neuropsychological disorders. The first regards neuropsychological disturbances as transient cognitive impairment due to epileptiform discharges; the second model strengthens the role of a hereditary impairment of brain maturation.
Conclusions: The benefit of pharmacotherapy for treating neuropsychiatric symptoms in children with rolandic spikes but without overt seizures remains to be clarified.