Annals of Indian Academy of Neurology
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Year : 2012  |  Volume : 15  |  Issue : 2  |  Page : 81-88

The adolescent or adult with generalized tonic-clonic seizures

1 Department of Neurology, P.D. Hinduja National Hospital, Mumbai, India
2 Department of Neurology, Sir J.J. Hospital, Mumbai, India

Correspondence Address:
Roop Gursahani
2101, Hinduja Clinic, P.D. Hinduja National Hospital, Veer Savarkar Marg, Mahim, Mumbai - 400 016
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0972-2327.94988

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Primary and secondary generalized tonic-clonic seizures (GTCs) together constitute up to 50% of adolescent and adult patients with epilepsy as diagnosed by history and EEG. Syncope and psychogenic nonepileptic seizures are major differential diagnoses and must be carefully excluded in therapy-resistant cases. Individual episodes can have up to seven phases in secondarily generalized GTCs. The distinction between primary and secondary GTCs depends mainly on history and EEG, and yield can be improved with sleep deprivation or overnight recording. Epilepsies with primary or unclassified GTCs can respond to any one of the five broad-spectrum antiepileptic drugs (AEDs): valproate, lamotrigine, levetiracetam, topiramate and zonisamide. Unless a focal onset is clearly confirmed, a sodium-channel blocking AED should not be used in the initial treatment of these conditions.

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