Secondarily generalized tonic-clonic seizures are 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, being the final common pathway in the ictal progression of most seizure types. Surgical therapy can be an option in the management of intractable secondary seizures. In this clinical article, clinical features suggesting lateralization along with diagnostic techniques to localize the focus are discussed. Management options, including recent advances in vagal nerve stimulation, cortical stimulation, and surgical therapy, are briefly covered.