Generalized epilepsy means that seizures come from the entire brain at once. The term “symptomatic” means that the seizures are a symptom of some type of brain malfunction or injury. People with these epilepsies have a higher chance of intellectual disability, cerebral palsy, or other developmental problems. This form of epilepsy includes the Lennox-Gastaut syndrome.

There is commonly more than one seizure type in symptomatic generalized epilepsy (it is often called a “mixed seizure disorder”). Seizure types often include:

  • Generalized tonic-clonic (grand mal convulsion)
  • Absence (staring spells, often called “atypical absence” because they are longer or more severe than typical absences)
  • Myoclonic seizure (brief muscle jerks, often with preserved consiousness)
  • Tonic seizure (body stiffens briefly, no jerking, often causes falls)
  • Atonic seizure (body goes limp, often causes falls)

The diagnosis is made by the patient’s history, neurological examination, EEG and/or video-EEG testing, and MRI scan.

There are numerous causes of symptomatic generalized epilepsy, including genetic or congenital defects, brain injuries, or brain infection. Special testing may include blood or urine samples, skin and/or muscle biopsies, spinal fluid samples, as well as examination of other organs. Sometimes if a specific cause is found, there may be treatment with special dietary modifications or vitamin supplements. Often a specific cause is not found.

Unfortunately the outlook is often not good for those with symptomatic generalized epilepsies. The seizures are commonly resistant to medication, and often multiple medications are required. Fortunately in recent years there have been a number of medications tested and FDA-approved for this type of epilepsy. The associated conditions may require medical treatment, physical therapy and special education. Most people with these types of epilepsies do not become independent. Alternative treatments include the vagus nerve stimulator (VNS), diet therapy (ketogenic or modified Atkins), and callosotomy (a brain surgery which divides the two sides of the brain to reduce seizure spread). Selected cases may benefit from resective brain surgery. You should discuss the treatment options with your neurologist.

For more information:

Authored by: Eric B. Geller, MD