15-Year-Old Boy Diagnosed With Benign Epilepsy With Centrotemporal Spikes (BECTS) – No Treatment Required?

In this case study, we explore the journey of a 15-year-old boy diagnosed with Benign Epilepsy with Centrotemporal Spikes (BECTS), also known as Rolandic epilepsy. Despite experiencing a seizure-like episode, the patient did not require medication or intensive treatment. This article delves into his symptoms, diagnostic process, and the decision to monitor his condition rather than initiate therapy.

Case Overview

Patient: Male, 15 years oldDiagnosis: Benign Epilepsy With Centrotemporal Spikes (BECTS)Hospital: Beijing Tiantan HospitalVisit Date: July 2019Treatment: Observation and follow-upFollow-Up: 1 year of outpatient monitoringOutcome: No recurrence of seizure-like symptoms

Initial Presentation

The patient, a high school student, was brought in by his parents after experiencing a sudden episode during sleep. He developed facial twitching, drooling, and limb stiffness, followed by a brief loss of consciousness. After about five minutes, he regained awareness but could not recall the event. Upon waking the next morning, he experienced tongue stiffness and mild speech difficulty, though these symptoms resolved by the following day.

A CT scan of the head showed no abnormalities. The patient's medical history was unremarkable—no family history of neurological disorders, no prior surgeries, and no known allergies or chronic conditions like diabetes or heart disease. Given the acute nature of the event and the absence of structural brain abnormalities, further neurological testing was recommended.

Diagnostic Process

Physical examination revealed normal vital signs: respiratory rate of 17 breaths per minute, blood pressure of 115/60 mmHg, and a heart rate of 65 beats per minute. Neurological assessment showed no deficits—pupils were equal and reactive, eye movements were normal, and there was no evidence of nystagmus. Motor strength and tone were within normal limits, and Babinski signs were negative bilaterally.

To rule out structural brain abnormalities, an MRI was performed and showed no pathological findings. However, an electroencephalogram (EEG) revealed frequent sharp wave activity in the left central and temporal regions of the brain. These findings, combined with the patient's clinical presentation, led to a diagnosis of Benign Epilepsy with Centrotemporal Spikes (BECTS).

Management and Follow-Up

Given the benign nature of BECTS and the fact that this was the patient's first episode, a conservative approach was adopted. No antiepileptic drugs were prescribed. Instead, the patient was advised to undergo regular follow-up visits to monitor his neurological status and EEG patterns.

At the six-month follow-up, the patient had not experienced any further episodes. His speech and motor functions were completely normal. Repeat MRI and EEG tests showed no abnormalities. One year after the initial episode, at the age of 16, the patient remained seizure-free. The family was advised to continue observation and to seek medical attention if any new symptoms emerged.

Key Recommendations for Patients With BECTS

Although the patient's condition remained stable, it is important to emphasize that BECTS can sometimes recur. Therefore, the following precautions were recommended:

• Lifestyle Adjustments: Avoid high-risk activities such as roller coasters or extreme sports. Encourage moderate physical activity while avoiding excessive fatigue. Home safety measures, such as padding sharp furniture corners, were also advised. Sleeping on the top bunk of a bed was discouraged to prevent falls during a potential seizure.
• Dietary Guidance: A balanced diet rich in protein (e.g., eggs, milk) and high in vitamins (e.g., fruits and vegetables) was encouraged. The patient was advised to avoid excessive sugar, caffeine, alcohol, and spicy foods, which may act as potential triggers.

Clinical Insights

Benign Epilepsy with Centrotemporal Spikes is a common form of childhood epilepsy, often presenting with focal seizures involving the face and sometimes the limbs. It typically occurs during sleep and is often outgrown by adolescence. The decision to avoid medication in this case was based on the patient's single, isolated episode and normal neurological development.

This case illustrates that not all seizure disorders require pharmacological intervention. In cases like this, where the prognosis is favorable and the risk of recurrence is low, close observation and family education are often sufficient. The absence of further episodes over the following year confirmed that the chosen approach was both safe and effective.