Sensorimotor seizures of pediatric onset with unusual posteriorly oriented rolandic spikes

Background: Benign childhood epilepsy with centro-temporal spikes (BECCT) is usually associated with anteriorly oriented rolandic discharges. We report an unusual type of childhood-onset epilepsy with sensorimotor seizures associated with posteriorly oriented rolandic discharges. Methods: Among 942 patients who underwent simultaneous electroencephalography and magnetoencephalography (MEG) for epilepsy evaluation, we found 7 patients with sensorimotor seizures aged under 13 years at onset, with no abnormal magnetic resonance imaging findings, and posteriorly oriented rolandic discharges detected by MEG. Ictal and interictal symptoms were evaluated retrospectively. Result: All patients had rolandic seizures as well as atypical seizures, such as falling, head dropping, auditory hallucinations, postural symptoms and/or automatism. Seizures were medically intractable in 5 patients and well controlled in 2, one of whom had behavioral problems and the other had transient graphomotor impairment. Conclusion: Posteriorly oriented rolandic discharges are better detected by MEG, and would exclude BECCT.