Secondarily generalized tonic-clonic seizures

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By Robert L Beach MD PhD and Rajdeep Singh MD

Secondarily generalized tonic-clonic seizures involve ictal discharges beginning in a restricted focus and spreading to involve bilateral motor outputs from the brain. Generalized tonic-clonic seizures can occur secondarily in idiopathic or symptomatic focal epilepsies and represent the final common pathway in the ictal progression of most seizure types. In this article, clinical features suggesting lateralization and diagnostic techniques to localize the focus are discussed, and management options are briefly covered.

Key Points

  • Clinically appearing generalized seizures may represent activation of specific pathways, dependent on the location of the focus, and may not be truly generalized.
  • Cardiac arrhythmias and SUDEP are associated with intractable, secondarily generalized seizures.
  • Novel therapies such as responsive intracranial stimulation hold promise for achieving more optimal seizure control.

In This Article

Historical note and nomenclature
Clinical manifestations
Differential diagnosis
Diagnostic workup
Syndromes and diseases in which the seizure type occurs
Prognosis and complications
Special considerations
References cited