Describe typical semiology and EEG finding of Rolandic (centrotemporal) epilepsy.

• A. Focal seizures with unilateral face and speech involvement, often nocturnal; EEG shows centrotemporal spikes or sharp waves
• B. Absence seizures with generalized 3 Hz spike-and-wave
• C. Myoclonic jerks in mornings
• D. Tonic seizures in trunk

Answer: (A)

Rolandic epilepsy presents with focal seizures that start in the face and mouth region. Clinically you often see unilateral orofacial motor activity—rhythmic contractions around the mouth, drooling, possibly speech arrest or a temporary inability to speak. The seizures are frequently nocturnal, may involve the ipsilateral arm, and awareness is usually preserved, though brief sensory or motor symptoms on one side can accompany the event. This pattern points to seizure onset in the rolandic (centrotemporal) area, which governs the face and mouth movements.

The EEG hallmark is spikes or sharp waves arising from the centrotemporal region, typically maximal over the hemisphere opposite the involved side. These centrotemporal spikes often become more evident during sleep, which aligns with the nocturnal tendency of these seizures.

So, the combination of focal orofacial motor seizures with speech involvement that often occurs at night, plus centrotemporal spikes on EEG, best fits Rolandic epilepsy. Other options describe different syndromes with distinct EEG signatures (for example, generalized 3 Hz spike-and-wave in absence, morning myoclonic jerks in juvenile myoclonic epilepsy, or trunk-focused tonic seizures), which don’t match this pattern.