As the name suggests, benign Rolandic epilepsy (BRE) is generally a benign condition, seizures almost always resolve by adolescence, and are often not treated. This is especially true if the seizures are partial, infrequent, occur only at night, and the patient and family/parents are agreeable.[26] Treatment is considered if seizures are frequent, severe, happen during daytime, are generalized, associated with language and neurocognitive decline/changes, or learning disorder. The patient and family should decide whether or not to treat the seizures in consultation with their treating physician. If treatment is necessary, a single anti-epileptic drug (AED) is usually sufficient, and multiple AEDs are rarely required.[2] Many physicians lean toward giving only a nighttime dose of the medication. Given the focal nature of seizures, carbamazepine is frequently used as a first-line agent. Other drugs that have been used include oxcarbazepine, gabapentin, levetiracetam, valproate, phenytoin, lacosamide, and zonisamide.[27][28][29] Treatment is of short duration and can be discontinued after 1 to 2 years free of seizures. Electroencephalogram (EEG) findings (normal versus abnormal) can be helpful in the decision of tapering and eventually stopping the AEDs. It is possible that seizures can recur after stopping the AEDs. Patient and the family should be aware of the possibility of recurrence and should maintain vigilance.
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