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PubMed This is a summary of 16 peer-reviewed journal articles Updated
Pediatric Neurology

Are Follow-Up EEGs Necessary for Rolandic Epilepsy?

At a Glance

For a child with Rolandic epilepsy who is seizure-free and developing normally, routine follow-up EEGs are often unnecessary. New, persistent, or worsening changes in language, learning, memory, behavior, or motor skills should prompt a sleep EEG discussion with the neurologist.

If your child has been diagnosed with Self-Limited Epilepsy with Centrotemporal Spikes (SeLECTS)—commonly known as Rolandic epilepsy—you might wonder if follow-up EEGs are necessary once their observable, physical seizures have stopped.

The short answer is that for a stable child who is developing normally, routine EEGs are often not required [1][2]. However, a follow-up sleep EEG should be discussed promptly with your neurologist if you notice any new, persistent loss of cognitive, language, or behavioral skills, even if your child is completely seizure-free [3][4].

What If My Child Is Doing Well?

It is very common for abnormal electrical brain activity (interictal spikes) to persist on an EEG for years after observable seizures have stopped [1][5]. These lingering spikes do not necessarily cause problems and will often resolve on their own [1].

Because of this, if your child is doing well—developing normally, performing well in school, and showing no behavioral changes—there is no universal rule that an EEG must be repeated simply to “prove” the spikes are gone [1][2]. The decision to order a follow-up EEG is individualized, based on your child’s age, medical history, and clinical stability. Ongoing monitoring of their learning and behavior is often more valuable than scheduled routine EEGs.

Understanding SWAS and DEE-SWAS

While most children with SeLECTS recover without complications, an uncommon subset of children experience an intensification of electrical spikes while they sleep [3][6]. Estimates of how often this happens vary depending on the study population, but it is a known risk [3][7].

When these electrical discharges become highly abundant during non-rapid eye movement (NREM) sleep, the EEG pattern is called Spike-Wave Activation in Sleep (SWAS) [3]. If this activity begins to interfere with a child’s learning, memory, or behavior, the condition is referred to as Developmental and Epileptic Encephalopathy with Spike-Wave Activation in Sleep (DEE-SWAS) [3][8]. (Historically, this was often called ESES).

These spikes are not clinical, physical seizures, but they can disrupt the brain’s ability to process information during rest. Crucially, SWAS can develop without any physical seizures at all [3][7].

Warning Signs to Watch For

Because this complication occurs during sleep without visible convulsions, developmental changes are often the first clue. You do not need to become hypervigilant over a single bad day at school. Instead, look for a new, persistent, and progressive loss of previously acquired skills [3][9].

Watch for trends in the following areas:

  • Language and Speech: Losing vocabulary, worsening verbal comprehension, or struggling with reading skills they previously mastered [10][11].
  • Cognitive and Learning: A noticeable and sustained decline in school performance, memory issues, or difficulty learning new concepts [3][12].
  • Behavioral and Attention: Marked, persistent changes in personality, new extreme impulsivity, or severe attention difficulties [3][13].
  • Motor Skills: Unexplained clumsiness or a decline in fine motor skills, such as deteriorating handwriting [14].

Note: A gradual decline in skills is not an acute medical emergency like a prolonged physical seizure, but it does require prompt communication with your child’s neurology team.

Advocating for the Right Test and Treatment

If you and your child’s teachers notice these persistent changes, contact your neurologist. They will likely recommend an EEG that successfully captures adequate NREM sleep, as an awake-only EEG cannot accurately detect SWAS [6][15]. Depending on the neurologist’s assessment, this might be a routine EEG scheduled during nap time, or a prolonged overnight video-EEG [16].

If SWAS is found, treatment is not based purely on the EEG crossing an arbitrary numerical threshold [3][2]. Instead, the neurologist will consider the EEG pattern alongside your child’s clinical regression to determine if medication changes are necessary to support their cognitive development [3][9].

Common questions in this guide

Does my child need regular EEGs after Rolandic seizures stop?
Not always. If a child is seizure-free, developing normally, doing well in school, and has no behavior changes, routine repeat EEGs are often not required. The neurologist should individualize the decision based on the child’s history and current development.
Can an EEG still be abnormal after Rolandic seizures have ended?
Yes. Electrical spikes can remain on an EEG for years after observable seizures stop, and their presence does not necessarily mean the child is having problems. These spikes often decrease or resolve over time without causing symptoms.
What changes mean my child may need a sleep EEG?
Contact the child’s neurologist about a sleep EEG if there is a new, persistent, or worsening loss of previously learned skills. Warning signs can include declining language, reading, learning, memory, behavior, attention, handwriting, or coordination.
Why does the EEG need to record sleep?
Some children develop increased electrical discharges during non-rapid eye movement sleep, and an awake-only EEG may miss this pattern. A nap EEG or overnight video-EEG may be used when the neurologist needs to assess sleep activity.
Are sleep-related EEG spikes the same as a physical seizure?
No. Sleep-related spikes are abnormal electrical discharges and may occur without visible convulsions or other physical seizures. If they are linked with developmental or learning regression, the neurologist may consider medication changes based on the child’s symptoms and EEG findings together.

Questions to Ask Your Doctor

Curated prompts to bring to your next appointment.

  1. 1.Based on my child's history, do you recommend any scheduled follow-up EEGs, or should we only test if symptoms change?
  2. 2.If we notice behavioral or learning changes, what is the best way to contact you to discuss scheduling a sleep EEG?
  3. 3.How long of an EEG recording would you recommend to ensure we capture enough NREM sleep?
  4. 4.If an EEG shows increased spikes during sleep, how will we decide together whether the benefits of medication outweigh the side effects?

Questions For You

Tap a prompt to share your answer — we'll use it plus this page's context to start a tailored conversation.

Related questions

At What Age Does Rolandic Epilepsy Usually Go Away?Can Seizure Medication Make Rolandic Epilepsy or ESES Worse?Can Rolandic Epilepsy Cause Full-Body Seizures in Children?Does ADHD Go Away After Rolandic Epilepsy Resolves?Does Watchful Waiting in Rolandic Epilepsy Damage the Brain?Can EEG Spikes Cause Learning Problems in SeLECTS?Is Ospolot (Sulthiame) Used for Rolandic Epilepsy in the US?Is Rolandic Epilepsy Genetic? Heredity and Sibling RiskWhat Is the Spike-Wave Index (SWI) on a Child's EEG?Why Does SeLECTS Cause Drooling and Facial Twitching?Why Do Rolandic Epilepsy Seizures Happen During Sleep?Why Is a Brain MRI Usually Normal in Rolandic Epilepsy?

References

References (16)
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    Change of centrotemporal spikes from onset to remission in self-limited epilepsy with centrotemporal spikes (SLECTS).

    Han JY, Choi SA, Chung YG, et al.

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    Evolution into spike-and-wave activation in sleep in patients with self-limited focal epilepsies.

    İriş M, Yaşgüçlükal MA, Yalçınkaya C, Demirbilek V

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    Electroclinical biomarkers predicting EEG normalization and polytherapy needs in self-limited epilepsy with centrotemporal spikes.

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    Brain & development 2025; (47(5)):104449 doi:10.1016/j.braindev.2025.104449.

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    The Prevalence and Risk Factors of Electrical Status Epilepticus During Slow-Wave Sleep in Self-Limited Epilepsy With Centrotemporal Spikes.

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    Clinical EEG and neuroscience 2024; (55(2)):265-271 doi:10.1177/15500594231182758.

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    Short-term EEG Outcomes in Children With Developmental and/or Epileptic Encephalopathy With Spike and Wave Activation in Sleep (DEE-SWAS) Treated With High-Dose Diazepam.

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    Successful Treatment of a Child With Epileptic Encephalopathy With Spike-Wave Activation in Sleep and GRIN2A Variant Using Sulthiame.

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    Relationship between brain activity, cognitive function, and sleep spiking activation in new-onset self-limited epilepsy with centrotemporal spikes.

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    Comparing cortical auditory processing in children with typical and atypical benign epilepsy with centrotemporal spikes: Electrophysiologic evidence of the role of non-rapid eye movement sleep abnormalities.

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    Children with Rolandic epilepsy have micro- and macrostructural abnormalities in white matter constituting networks necessary for language function.

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    The influence of EEG-detected nocturnal centrotemporal discharges on the expression of core symptoms of ADHD in children with benign childhood epilepsy with centrotemporal spikes (BCECTS): A prospective study in a tertiary referral center.

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This page is for informational purposes only and does not constitute medical advice about your child's EEG care. Discuss any developmental, learning, language, or behavior changes with your child's neurologist.

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