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Child has numbness in lower face and fingers. History on non-febrile seizures. Caused by benign rolandic epilepsy?

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My 8 year-old-daughter had first been experiencing numbness in the lower part of her face (cheeks, chin, tip of nose) and fingers (began in March). The numbness was first associated with only the right side of her face and would happen only periodically. Then it progressed to her chin and then included the left side of her face.She now has constant numbness in her cheeks, chin, earlobes, tip of nose, eyelids, fingertips, and pads of both feet. numbnessShe has had nonfebrial seizures in the past. Could this be some type of interictal discharges caused by benign rolandic epilepsy? A neurologist we consulted earlier suggested this. He cannot explain the unremitting nature of the numbness, though. An MRI performed in XXXXXXX (with contrast) indicated a "normal" read. I am concerned that she may have MS. My father's sister has MS and, although I realize that my daughter is probably too young to present with MS symptoms, I wanted to mention my aunt just in case it is relevant. Please help.
Posted Sun, 22 Jul 2012 in Brain and Spine
Answered by Dr. Shiva Kumar R 3 hours later
Hello and thank you for sending your question.

Your question is a good one and I will work on providing you with some information and recommendations regarding the symptoms you are experiencing.

From the details provided it looks to me like she is suffering from some form of Neuropathy predominantly affecting the hands and the face with a relapsing remitting course. Rarely benign rolandic epilepsy (BRE) can present only with sensory symptoms without motor manifestations and can confuse with neuropathy. Other causes like brain stem and upper spinal cord problems can present with similar manifestation.

BRE typically presents with focal seizures consisting of unilateral facial sensory motor symptoms, oro-pharyngo symptoms, speech arrest and hypersalivation. Hemifacial sensory-motor seizures are mainly localized in the lower lip and may spread to the ipsilateral hand. Sensory symptoms consist of numbness in the corner of the mouth, numbness or paresthesias (tingling, prickling or freezing) inside the mouth, associated with strange sounds.

So I personally feel though the manifestations in your child mimic MS, I feel MS is rare in pediatrics and MRI would have showed typical demyelination changes if it was MS. VEEG would be required to pick up the classical epileptiform discharges in BRE and to correlate with the events. A repeat MRI of the brain (plain + contrast) along with screening of the upper cervical cord would be required to exclude other structural causes if BRE is excluded.

I thank you again for submitting your question. I hope you have found my response to be helpful.

If you have additional concerns I would be happy to discuss them with you.


Dr Shiva Kumar R
Consultant Neurologist & Epileptologist.
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