Should a child with benign rolandic epilepsy (BRE) have an MRI?

MRI (magnetic resonance imaging) and other neuroimaging studies are not needed if these conditions are met:

• the child's seizures fit the classic pattern of BRE
• the child is intellectually normal
• the results of a neurological examination of the child are normal

Some more serious conditions can produce seizures and centrotemporal spikes and may resemble BRE in childhood, however. These conditions can be treated more effectively if we recognize them promptly. Some of them involve a structural abnormality of the brain that may be revealed by MRI. Therefore, study of the brain using MRI is strongly recommended if:

• the child has EEG findings that are not typical of BRE (such as generalized background slowing or disorganization or persistent focal slowing)
• the seizures cannot be well controlled by seizure medicines and if they occur during the day
• a neurological examination reveals signs that could suggest a structural abnormality in the brain.