Language Development in Children with Benign Rolandic Epilepsy (bre)

Abstract

Currently, benign rolandic epilepsy (BRE) is considered a benign disorder in children between the ages of 2 to 13 (Holmes, 2006). Typically, children overcome BRE at a relatively young age without issue. However, evidence suggests that children with BRE are at risk for language impairment. While most medical experts agree this syndrome is benign, the results of recent studies have led researcher to question the benign nature of this disorder (e.g., Northcott et al., 2007). This review addresses the effect on language development in children with benign rolandic epilepsy. This examination of language development in BRE illuminates a lack of consistent findings and suggests a need for further longitudinal studies. With future research, improvements in intervention and evaluation may promote language development and prevent future language deficits.

Keywords: benign rolandic epilepsy, language development, language delay, early language intervention, treatment

How is language development affected in children with epilepsy, specifically Benign Rolandic

Epilepsy (BRE)?

Benign rolandic epilepsy is considered one of the most common types of childhood epilepsy (Verrotti et al., 2011). It is found in 15% of all childhood epilepsies (Holmes, 2006). The syndrome is also known as benign childhood epilepsy with centrotemporal spikes (BCECTS), or sylvian seizures. This is because of the focus of epileptic activity, or "spikes," along the rolandic and sylvian fissures. Typically, age of onset is between 2 and 13, with recovery being reached by no later than 16 (Danielsson & Petermann, 2009, p. 646). The relatively early age of recovery characterizes this syndrome to be benign in nature.

BRE has a promising outcome; however, the literature indicates several vulnerable cognitive functions. During the active stage of epilepsy, studies have shown behavioral and language impairments (e.g., Völkl-Kernstock, Bauch-Prater, Ponocny-Seliger, & Feucht, 2008). This literature review will focus on the latter. Aspects of language that are most commonly associated with impairment are phonological and literacy skills (Overvliet, Aldenkamp, Klinkenberg, Vles, & Hendriksen, 2010, p. 71). The development of basic linguistic skills is an important factor in academic achievement. Linguistic skills build upon one another. As a result, language impairment jeopardizes skills acquired later. Although the prognosis for benign rolandic epilepsy is good, research suggests that language is impaired during active epilepsy. Therefore, the benign nature of BRE should be re-evaluated.

Benign rolandic epilepsy and its relation to language

Typically, BRE is a syndrome that occurs during sleep patterns (reference). Wakeful seizures are considered atypical, but are common. Episodes can be mild (simple partial seizures) or severe (tonic-clonic seizures ). This disorder has no known cause and as previously stated, occurs in childhood, between the ages of 2 to 13. Generally, these children have normal IQs and outgrow BRE without issue. However, several studies show children with atypical features are at risk for impaired language development (Danielsson & Petermann, 2009; Monjauze, Tuller, Hommet, Barthez, & Khomsi, 2005; Northocott et el., 2005; Northcott et el., 2007; Overvliet, Aldenkamp, Klinkenberg, Vles, & Hendriksen, 2011; Papavasiliou, Mattheou, Bazigou, Kotsalis, & Paraskevoulakos, 2004; Verrotti, Egidio, Agostinelli, Parisi, Chiarelli, & Coppola, 2011; Völkl-Kernstock, Bauch-Prater, Ponocny-Seliger, & Feucht, 2009). Research indicates that children at risk for language impairment should be evaluated longitudinally (e.g., Northcott et al., 2005). Impairment may not fully manifest until later in these children's education. That is why early intervention is vital.

The majority of research focuses on the ages of 4 to 12 years old. This is because BRE has been diagnosed and active for some time. Although BRE is considered a benign disorder, some children exhibit significant impairment in articulation, language comprehension, auditory memory, sentence memory (Danielsson et al., 2009), expressive grammar, mophosyntaxex, literacy skills (Monjauze et al., 2005; Northcott et al., 2005), verbal memory, phonological awareness (Northcott et al., 2005; Overvliet et al., 2011), spelling, reading and reading comprehension (Papavasiliou et al., 2004). These studies recruited children with atypical or severe features of BRE. Children were then observed, against controls, in a battery of tests to assess language development. In addition, several longitudinal studies have found children in remission to have continuous language impairment (e.g., Northcott et al., 2005). Because phonological skills are needed for successful literacy, continued language delay may be a consequence of previous impairment in phonological awareness (Northcott et al., 2007). Phonological awareness refers to the ability one has to understand sound structure. This skill is vital for a person to identify and use language. Without it, a child will struggle to read and spell. Thus, the benign nature of this syndrome cannot go unnoticed. Furthermore, consistent evaluation and intervention by parents and teachers should be performed during a child's academic career (Northcott et al., 2005; 2007). These measures may help developing language skills and prevent future problems in language.

Studies are inconsistent on this topic and therefore, further research is needed to construct a better understanding of the effects of BRE. However, current research shows that important aspects of language are not developing in children