Generalized epilepsy is a form of epilepsy in which the seizures come from the entire brain at once. There is typically no warning. There are several different types of seizures that can occur:

  1. Generalized tonic-clonic (Grand mal convulsion): The body stiffens then shakes violently, with limbs sticking out, hands fisted. The shaking gradually stops over 1-3 minutes, leaving the person in a deep sleep for up to 30 minutes. The lips may become blue, and there may be tongue-biting and loss of urine.
  2. Absence seizures can be described as “lights on, nobody home.” There may be rapid eye blinking, and the person stops activity and stares. These are usually brief (10-30 seconds), occur without warning, and the person recovers immediately after, often unaware of the seizure.
  3. Myoclonic seizures are rapid, brief muscle jerks that can involve any part of the body. They may occur as single jerks, or be repetitive. Usually the person remains conscious. They may be minimal, or may cause one to drop objects or even fall. Myoclonic seizures often occur on awakening. If they last for a long time and become progressively more violent, they may lead into a grand mal seizure.
  4. Tonic seizures consist of stiffening of the whole body. They are usually brief but may cause falls.
  5. Atonic seizures involve loss of muscle control (going limp). They are also brief and may cause falls.

The diagnosis is made by the patient’s history, EEG or video-EEG results and MRI scan. No clear cause is usually found, but these epilepsies are now thought to be genetic. They may or may not run in the family. The brain is otherwise normal (normal movement and intelligence). There are several common forms of generalized epilepsy:

Childhood absence epilepsy begins in the elementary school years and may stop by the teens or adulthood in many cases. Absence seizures are the most common seizure type. Juvenile absence epilepsy (beginning in the teens) tends to continue into adulthood.

Juvenile myoclonic epilepsy starts in the teen years. Myoclonic seizures, which begin around age 13, may not be recognized as abnormal until the first grand mal seizure occurs, usually around age 17. Absence seizures are uncommon. Once the condition starts, it usually does not go away, but is controllable with medication.

Generalized epilepsy with febrile seizures plus (GEFS+) begins with seizures with fever in the young child, with other seizure types beginning later in life. There is now a blood test to confirm this diagnosis, but it is expensive and not always necessary.

While the seizure tendency may be lifelong, the vast majority (80-90%) of people with generalized epilepsy will get full control with the correct medication, and the outlook is excellent. In uncommon cases the seizures may be resistant, and multiple medications may be required. Sometimes the vagus nerve stimulator (VNS) may be helpful. Diet therapy (ketogenic or modified Atkins diets) is also used when seizures are hard to control.

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Authored by: Eric B. Geller, MD