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Unique Clinical Phenomenology Can Help Distinguish Primary From Secondary Generalized Seizures in Children

Division of Pediatric Neurology, Department of Pediatrics, Alberta Children's Hospital, Faculty of Medicine, University of Calgary, Calgary, AB

Husam Darwish, MD, FRCPC

Division of Pediatric Neurology, Department of Pediatrics, Alberta Children's Hospital, Faculty of Medicine, University of Calgary, Calgary, AB

Elaine Wirrell, MD, FRCPC

Division of Pediatric Neurology, Department of Pediatrics, Alberta Children's Hospital, Faculty of Medicine, University of Calgary, Calgary, AB

The physical manifestations a seizure produces provide critical information. It is assumed that all generalized convulsions are ostensibly the same, regardless of whether they are primary or secondary generalized seizures. We undertook a pilot study to determine if the clinical phenomenology of secondary generalized seizures in children with epilepsy is different from classic descriptions of generalized tonic-clonic convulsions. A data capture sheet was created and applied to the video-electroencephalographic (EEG) records of 64 secondary generalized seizures from 13 children with intractable and/or refractory epilepsy. Many features of secondary generalized seizures were different from traditional descriptions of generalized convulsions. In 100% of cases, the mouth either remained open or repeatedly opened and closed rather than slamming shut. In 77% of cases, a variety of late motor activities were seen to occur after the seizure activity had ceased and the EEG record was quiet. The clinical features of a generalized convulsion in a child, especially mouth opening and late motor events, can be useful in establishing the origin as either focal or primary generalized. (J Child Neurol 2004;19:265-270).

Journal of Child Neurology, Vol. 19, No. 4, 265-270 (2004)
DOI: 10.1177/088307380401900405


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