Case history
Case history #1
A 10-year-old girl presents after having had a generalized tonic-clonic seizure while at school the previous day. It lasted approximately 2 minutes and she was incontinent of urine during the episode. Afterward 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 exam including neurologic 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-limited. Jerking of the whole body and all four limbs lasted <5 minutes, and he was sleepy for several hours after the episodes. His general exams, including blood pressure, a random blood sugar, and an ECG, were normal.
Other presentations
While generalized tonic-clonic seizures are easily recognizable, in some instances a generalized 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 characterized by a sudden interruption in the child's activities, often with a blank stare or inattention. Atonic seizures are characterized 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 characterized 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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