Mughis Sheerani, Sajjad Ali, Bhojo Khealani, Ali Hassan, Hina Punjwani.
Dipole in benign Rolandic Epilepsy.
J Coll Physicians Surg Pak Jan ;15(12):828-9.

We conducted this review to evaluate the reported frequency of characteristic features of BRE recognized on the EEG to convey the message of `good prognosis` to the referring physicians. Three-year data of EEG records of children, aged 1 through 20 years, at the time of first EEG, at the AKUH were identified and reviewed retrospectively. A total of 27 patients that met the criteria. All the EEGs were reviewed by a team of neurologists, neurophysiologists and neurophysiology technologist. The records with frontocentro-temporal spikes were identified, labeled and selected. Then records were reviewed for the `tangential dipole` on different montages, especially on referential montage. The dipole was determined by one reader and then independently verified by the others. The dipole was defined as relative positivity over frontal region and relative negativity over central and / or temporal regions. The mean age was 10 (range 1-20) years. Fiftyfive percent were males and 45% females. RESULTS: By semiology, 44% had focal seizures; 22% had generalized while 33% had secondarily generalized seizures. Fiftyfive percent of the patients had seizures during wakefulness and 45% had the seizures during sleep. Sixteen (59%) of these had the `tangential dipole` on EEG. Seven of these sixteen (44%) patients were already reported as BRE, based on `tangential dipole` on the EEG. However, the EEGs of 9/16 (56%) were concluded as `focal seizures` of `frontocentral` origin without mentioning of a `dipole` or prognostic significance of these findings. In the remaining 11 patients, no dipole was identified either during this review or in the original reports. CONCLUSION: This study highlights the importance of recognizing and reporting a dipole and its significance in BRE. If reported accurately, referring physician can make further management decisions and communicate to the family about a favorable prognosis.

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