The generalized tonic-clonic seizure in partial versus generalized epilepsy: Semiologic differences

Purpose: To study differences in the clinical manifestations of generalized tonic-clonic seizures (GTCS) of partial versus generalized onset. Methods: We studied 10 CTCSs in nine patients with idiopathic generalized e pilepsy (IGE) and 10 GTCSs in 10 patients with temporal lobe epilepsy (TLE) . Videotaped seizures were reviewed for all clinical features, focusing on asymmetries during different phases of each seizure. Results: In the IGE group, focal features were seen before generalized moto r activity in seven seizures. The most common was adversive head rum (six s eizures). One patient had opposite direction of head turning in two recorde d seizures. The tonic phase was always symmetric. In the last generalized c lonic phase, asymmetry or asynchrony of motor activity was seen transiently in three seizures. The TLE group showed focal features before generalizati on in all seizures. Adversive head turning occurred in nine patients and wa s always contralateral to the focus. Focal clonic activity occurred before generalization in three and was always contralateral to the focus. The gene ralized tonic phase was usually asymmetric, and in the last clonic phase, m otor activity was asymmetric or asynchronous in eight seizures (p < 0.05, I GE vs. TLE). Conclusions: Brief focal features or asymmetry at onset are common in the G TCSs of IGE. However, asymmetry or asynchrony during the last clonic phase are uncommon in IGE, in contrast to TLE.