The goal of this review is to assess the value of treating versus not treating
benign epilepsy (of childhood) with centrotemporal spikes (
BECTS). Among 110 recommendations from 96 articles, two-thirds generally favored and one-third generally did not favor treatment with
antiepileptic drugs (AEDs). Two studies concluded that all patients should be treated, but most investigators added qualifications, for example, treating those with early onset, multiple
seizures at onset, and large numbers of
seizures, especially
generalized tonic-clonic seizures, and limiting treatment to 1 year. Other studies made treatment dependent on epileptiform discharges or amelioration of symptoms. Specific AEDs were reviewed, and in the largest number of positive studies,
valproic acid or
carbamazepine was favored. Among the studies generally opposing treatment, none opposed treatment for all patients in all circumstances. Usually, qualifications to treat were added, for example, if
generalized tonic-clonic seizures occurred or if there was a change in quality of life. One AED associated with negative effects was
carbamazepine, treatment with which can result in the development of epileptic negative
myoclonus, absence
seizures, and generalized spike-wave complexes on the EEG. Thus, if treatment is planned,
valproic acid may be considered the
drug of choice in
BECTS. Although many neurologists oppose treatment; twice as many studies concluded in favor of treatment. The typical benign aspect of this disorder may allow for nontreatment to be without serious consequences.