**6. Prognosis**

In most cases, children with RE have a good prognosis regarding both seizures and neurodevelopment [120, 121]. The remission of seizures usually occurs before the age of 18 years [11, 98]. The cognitive and behavior problem may happen in an active period of disease which is reversible in most patients [11, 12].

Rolandic seizures occur in a period of significant brain maturation. The dysfunction of neuronal network activities such as focal discharges may be associated with neuropsychological problems, including, linguistic, cognitive, and behavioral impairment [28–30, 122]. The frequent spike discharges in sleep may boost language and attention processing problems [120, 123–125].

Mood and behavioral disorders were present in nearly a third of children (30.9%) with RE [126–128]. Retrospective studies have proposed that early age at onset pretends a more aggressive seizure course [18, 129–131].

Functional MRI study revealed CTS density caused hemodynamic changes even during wakefulness can interfere with the normal brain-language network and the bilateral insular cortex [132].

The neuropsychological tests such as Wechsler Intelligence Scale for Children-III (WISC-3rd), verbal fluency test, Wisconsin card sorting test, attention deficit diagnostic scale, and child behavior checklist scale are usually administered to measure a wide range of skills and cognitive functions of RE patients [35–38, 133].

Many researchers showed a variety of neuropsychological deficits, behavioral and emotional difficulties in a limited cohort of patients with RE range from 19 to 67% [22–40, 134, 135]. The series of reported children with uncomplicated RE were described lower average results on neuropsychological tests involving visuomotor coordination, some executive functions, sustained attention, and language issues like spelling, reading aloud, reading comprehension, memory, and learning of auditory–verbal material, delayed recall, and verbal fluency, compared with controls. However, the Full-Scale Intelligence Quotient (FSIQ ) was not significantly low in most of them.

D'Alessandro et al. investigated the neuropsychological data of 44 children with RE who did not have a seizure for more than 6 months without treatment. Attention, language, and visuomotor coordination tasks problems were more severe in children with a bilateral epileptiform discharge. However, in a follow-up assessment for 4 years, a re-examination of 11 children had revealed the normalization of cognitive functions in all [21].

Several studies reported that cognitive abnormalities and behavioral impairments are associated with a high interictal spike frequency [24, 25, 35, 120], the number of interictal abnormalities in wake or sleep [136], activation of interictal spikes during sleep [118, 137], and the presence of non-tangential dipole spikes [73].

Piccinelli et al. [138], investigated the frequency of specific learning disabilities such as reading, writing, and calculation in patients with typical RE and possible related electroclinical findings. They reported children with RE who developed seizures before age 8 years and had epileptiform discharges more than 50% of the sleep EEG recording in several tracings over more than a year were at risk of developing academic difficulties [138].

EEG may predict educational and behavioral impairments in children with RE. The presence of an intermittent slow-wave focus during wakefulness, a high number of spikes in the first hour of sleep (and during whole night sleep), and multiple asynchronous bilateral spike–wave foci in the first hour of sleep are associated with learning problems in children with RE [16, 139].
