Numbness, and more commonly paraesthesias (tingling, prickling, freezing), are usually diffuse on one side or, exceptionally, may be highly localised even to one tooth. Motor oropharyngolaryngeal symptoms produce strange sounds, such as death rattle, gargling, grunting and guttural sounds, and combinations:
In his sleep, he was making guttural noises, with his mouth pulled to the right, ‘as if he was chewing his tongue’. We heard her making strange noises ‘like roaring’ and found her unresponsive, head raised from the pillow, eyes wide open, rivers of saliva coming out of her mouth, rigid. Arrest of speech is a form of anarthria. The child is unable to utter a single intelligible word and attempts to communicate with gestures. My mouth opened and I could not speak. I wanted to say I cannot speak. At the same time, it was as if somebody was strangling me. Hypersalivation, a prominent autonomic manifestation, is often associated with hemifacial seizures, oro-pharyngo-laryngeal symptoms and speech arrest. Hypersalivation is not just frothing:
Suddenly my mouth is full of saliva, it runs out like a river and I cannot speak. Syncope-like epileptic seizures may occur, probably as a concurrent symptom of Panayiotopoulos syndrome:
She lies there, unconscious with no movements, no convulsions, like a wax work, no life. Consciousness and recollection are fully retained in more than half (58%) of Rolandic seizures. I felt that air was forced into my mouth, I could not speak and I could not close my mouth. I could understand well everything said to me.
However, some children may present with independent autonomic seizures or seizures with mixed Rolandic-autonomic manifestations including emesis as in Panayiotopoulos syndrome.Atypical forms:  Rolandic epilepsy may present with atypical manifestations such early age at onset, developmental delay or learning difficulties at inclusion, other seizure types, atypical EEG abnormalities.These children usually have normal intelligence and development. Learning can remain unimpaired while a child is afflicted with Rolandic epilepsy. Cause
Benign epilepsy with centrotemporal spikes is thought to be a genetic disorder. An autosomal dominant inheritance with age dependency and variable penetrance has been reported, although not all studies support this theory. Linkage studies have pointed to a possible susceptibility region on chromosome 15q14, in the vicinity of the alpha-7 subunit of the acetylcholine receptor. Most studies show a slight male predominance. Because of the benign course and age-specific occurrence, it is thought to represent a hereditary impairment of brain maturation.An association with ELP4 has been identified. Diagnosis
The diagnosis can be confirmed when the characteristic centrotemporal spikes are seen on electroencephalography (EEG). Typically, high-voltage spikes followed by slow waves are seen. Given the nocturnal activity, a sleep EEG can often be helpful. Technically, the label "benign" can only be confirmed if the childs development continues to be normal during follow-up. Neuroimaging, usually with an MRI scan, is only advised for cases with atypical presentation or atypical findings on clinical examination or EEG.