Of 80 children with absence epilepsy (CAE) and 42 with Rolandic epilepsy (BECCT), five (3 girls and 2 boys) had both syndromes, in a study at the University of Berne, Switzerland. All 5 patients had both generalized synchronous 3/sec spike and wave complexes and centrotemporal spikes in the EEGs, but the EEG finding did not always correspond with the clinical presentation. Only 2 patients showed both EEG patterns and both types of clinical seizures, absence and focal motor. Clinical manifestation of absences and partial motor seizures in the same patient is extremely rare. [1]

COMMENT. My colleague, Dr Cynthia Stack (Director of Neurophysiology and Electroencephalography at Children’s Memorial Hospital), is in agreement with the rarity of concomitant occurrence of these two common forms of epilepsy. She would prefer to see simultaneous EEG and video recordings to confirm the concomitant clinical manifestations of the syndromes, and questions whether the use of carbamazepine to treat the partial seizures might explain precipitation of a concurrent subclinical childhood absence syndrome. Video recordings were not included in the present series, and carbamazepine (CBZ) was employed in only one child who first presented with focal motor seizures and centrotemporal spikes in the EEG. A failed response to CBZ (at potentially toxic serum levels of 52 mg/L) was associated after 6 months with a change in the EEG to a synchronous generalized 3/sec spike and wave pattern, without clinical absence seizures. Replacement of CBZ with valproic acid was followed by clinical rolandic seizure control. All 5 patients responded to valproic acid.

The authors cite 9 previous reports of concomitant EEG findings (frequency usually 7-12% [25% and 73% in two small studies]) but only two reports (9 patients) of concomitant clinical absences with focal motor seizures in patients with benign rolandic epilepsy. Perhaps the clinical association of these syndromes might be diagnosed more frequently with simultaneous EEG and video recordings. The concurrence of generalized 3/sec spike and wave discharges with centrotemporal spikes in a child presenting with benign rolandic epilepsy should prompt greater hesitation in starting therapy. When treatment is considered essential, valproic acid would be a better choice than carbamazepine.