Benign childhood epilepsy with centrotemporal spikes
Benign childhood epilepsy with centrotemporal spikes typically starts in mid-childhood. Seizures usually occur during sleep and begin in the face or mouth, producing a typical glugging sound. Speech arrest is common. The focal (partial) seizure may become generalised. The electroencephalogram is typical, showing epileptiform discharges in the centrotemporal region. The prognosis is excellent and most children are seizure-free by early adolescence.
Carbamazepine, sodium valproate and sulthiame are the drugs of choice. Seizures in benign childhood epilepsy with centrotemporal spikes usually occur during sleep and at low frequency, so treatment is not always indicated (consider the harms of generalised tonic-clonic seizures and the rare occurrence of sudden unexpected death in epilepsy).
When treatment is appropriate, use:
1 carbamazepine (preferably modified-release) 2.5 mg/kg orally, twice daily for 5 days, then increase to initial target dose of 5 mg/kg twice daily. If needed, increase up to 15 mg/kg twice daily1 epilepsy, benign childhood with centrotemporal spikes carbamazepine
OR
1 sodium valproate , child older than 2 years, 5 mg/kg orally, twice daily for 5 days, then increase to 10 mg/kg twice daily; usual maintenance dose 10 to 20 mg/kg twice daily; maximum 2500 mg daily. Avoid in females of childbearing potential (see teratogenic and neurodevelopmental effects of antiepileptic drugs)2 epilepsy, benign childhood with centrotemporal spikes sodium valproate
OR
1 sulthiame 2 mg/kg orally, 3 times daily. If needed, increase up to 5 mg/kg 3 times daily. epilepsy, benign childhood with centrotemporal spikes sulthiame sulthiame sulthiame