SELF-LIMITED EPILEPSY WITH CENTROTEMPORAL SPIKES (SeLECTS)

Mandatory seizures

Seizures with fronto-parietal opercular features: (1) sensorimotor symptoms - unilateral numbness or paraesthesia of the tongue, lips, gums and/or inner cheek with clonic or tonic contractions that may spread to the unilateral face, (2) speech arrest - children have difficulty or are unable to speak (dysarthria) and (3) drooling - it is unclear if this is due to excess salivation and/or inability to swallow. In some cases only sensorimotor tongue involvement may occur.

The seizure may be from sleep and evolve to a clonic seizure (of upper limbs or one side of the body) or to a focal to bilateral tonic-clonic seizure (bilateral upper limb or four limb tonic and/or clonic activity). A Todds paresis may be seen after the seizure.

Seizures are brief (2-3 minutes) in duration and predominantly occur from sleep, <20% of patients have seizures in the awake state only. Most patients have few seizures (< 10 lifetime).

NOTE the terms fronto-parietal opercular, centrotemporal and rolandic seizures are synonymous, referring to seizures involving the region around the lower central sulcus. However, in this syndrome cognitive (e.g. gustatory), emotional (e.g. fear), and autonomic symptoms are not seen.

May have

Focal to bilateral tonic-clonic status epilepticus is rare and should lead to review of the diagnosis.

CAUTION Atypical absence seizures, focal atonic seizures and focal motor seizures with negative myoclonus consider developmental and/or epileptic encephalopathy with spike-wave activation in sleep.

Exclusionary

Generalized tonic-clonic seizures

Other seizure types