Case history
Case history #1
A 10-year-old girl presents after having had a generalised tonic-clonic seizure while at school the previous day. It lasted approximately 2 minutes and she was incontinent of urine during the episode. Afterwards she complained of headache and feeling tired. She had been well prior to this episode and there is no family history of epilepsy. General physical examination including neurological assessment on the day after the seizure were both normal. An ECG was done, which was normal and showed a normal QTc interval.
Case history #2
A 15-year-old boy presents with a history of having had two seizures. He is healthy and has no relevant past medical history. There is no family history of epilepsy. Both episodes happened early in the morning and were self-limiting. Jerking of the whole body and all four limbs lasted <5 minutes, and he was sleepy for several hours after the episodes. His general examinations, including blood pressure, a random blood sugar, and an ECG, were normal.
Other presentations
While generalised tonic-clonic seizures are easily recognisable, in some instances a generalised seizure is not obvious. Tonic-clonic seizures that occur exclusively at night may only come to light when the patient shares a bedroom or if the accompanying noise wakes up a family member. Absence seizures are characterised by a sudden interruption in the child's activities, often with a blank stare or inattention. Atonic seizures are characterised by a brief loss of muscle tone causing what used to be referred to as 'drop attacks', whereby the patient suddenly and limply falls to the ground. Myoclonic seizures are characterised by brief, arrhythmic muscular jerking movements. Clonic seizures consist of rhythmic, muscular jerking movements with or without impaired consciousness. Tonic seizures consist of tonic extension or flexion of the extremities.
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