Effectiveness of levetiracetam (LEV) in treatment of typical benign rolandic epilepsy and variants of benign idiopathic focal epilepsies was studied in 32 children (mean age 10.6 years, range 4-14) by researchers at Epilepsy Centre for Children and Young People, Vogtareuth, Germany. Patients with a reduction in seizure frequency >50% and/or reduction in benign idiopathic focal epileptiform discharges (BIFEDC) >90% 3 months after starting LEV therapy were defined as responders. The average dose of LEV was 39 mg/kg/d, and monotherapy was used in 31.3% of patients. Twenty (62.5%) of 32 patients benefited: 12 of 24 had a >50% reduction in seizure frequency, 2 of 24 (8.3%) were completely seizure free, 18 of 32 (56.3%) had a >90% reduction in BIFEDC (including continuous spikes and waves during sleep), 6 of 32 (18.8%) had an EEG completely free of epileptiform discharges, and 17 of 32 (53.1%) showed improvement in cognition and/or language functions and/or behavior. [1]

COMMENT. The arguments opposed and general reluctance to treat the EEG abnormality in children with cognitive and behavioral disorders associated with subclinical rolandic epilepsy and atypical variants are gradually being eroded by the above and other reports. Several studies have shown that up to 50% of children with benign idiopathic focal epileptiform discharges without clinical seizures may have cognitive deficits and/or behavioral problems such as ADHD, related in part to the abnormal EEG. [2, 3, 4, 5]

In a prospective trial of levetiracetam, up to 40 mg/kg/d, in 6 children (mean age 9.8 years) with subclinical spikes associated with attention and learning difficulties, 4 children showed statistically significant improvements in Wide Range Assessment of Memory and Learning after 10 weeks [6]. Cognitive improvement was associated with concomitant EEG spike suppression.

Epileptiform discharges, especially centro-temporal spikes, are recorded in 25% of sleep deprived EEGs obtained in children referred with ADHD and without clinical seizures. (Millichap, John J; Stack, Cynthia, et al. personal communication). EEGs were indicated because of episodic inattention and transient lack of awareness.