Last reviewed: February 2018
Last updated: November  2017

Revised operational classification of seizure types and epilepsies by the International League Against Epilepsy

  • The classification has been revised. Seizures are divided into those of focal, generalised, unknown onset, with subcategories of motor, non-motor, with retained or impaired awareness for focal seizures. See Theory: classification.

  • Levels of classification to aid in the diagnosis include seizure type, epilepsy type (focal, generalised, combined generalised and focal, unknown) and epilepsy syndrome.

Original source of update

First-line monotherapy in children with generalised tonic-clonic seizures with or without other generalised seizure types

  • This 2017 Cochrane review supports:

  • The use of sodium valproate as the first-line treatment for children with generalised tonic-clonic seizures (with or without other generalised seizure types).

  • Lamotrigine and levetiracetam as suitable alternatives, particularly for those of childbearing potential, for whom sodium valproate may not be an appropriate therapy due to teratogenicity.

See Management: approach

Original source of update



History and exam

Key diagnostic factors

  • presence of risk factors
  • staring spells or inattention
  • tonic-clonic seizures
  • brief, arrhythmic muscular jerking movements
  • eyes rolling back in head
  • intercurrent illness
  • unexplained falls

Other diagnostic factors

  • incontinence
  • tongue biting
  • post-ictal phenomena
  • precipitated by fatigue or lack of sleep
  • precipitated by light or noise
  • developmental delay
  • neurocutaneous stigmata

Risk factors

  • genetic predisposition or FHx
  • perinatal asphyxia
  • metabolic/neurodegenerative disorders
  • head trauma
  • structural abnormalities of the CNS
  • autistic spectrum disorder
  • CNS infection
  • neurocutaneous syndromes
  • Hx of febrile seizures

Diagnostic investigations

1st investigations to order

  • electroencephalogram (EEG)
  • blood glucose level
  • basic metabolic panel
  • full blood count (FBC)
  • ECG
Full details

Treatment algorithm


Authors VIEW ALL

Consultant Paediatric Neurologist

St. Mary's Hospital

Imperial College Healthcare NHS Trust




LM has attended educational events hosted by Eisai (Perampanel/fycompa) and by Novartis (Everolimus for Tuberous Sclerosis patients).

Pediatric Neurologist

Pediatric Hospital No 1




AN declares that she has no competing interests.

Dr Leena Mewasingh and Dr Alla Nechay would like to gratefully acknowledge Dr Ewa Posner, a previous contributor to this monograph. EP declares that she has no competing interests.

Peer reviewers VIEW ALL

Assistant Professor of Neurology and Pediatrics

Johns Hopkins Hospital




AH has received research support from the National Institutes of Health that is greater than 6 figures. ALH's research is funded in part by the National Institutes of Health. He is the co-author of one review that is referenced in this monograph.

Pediatric Neurologist

Kinderneurologisches Zentrum Mainz




RW declares that he has no competing interests.


Paediatric Neurology Emeritus

Fraser of Allander Neurosciences Unit

Royal Hospital for Sick Children

Honorary Professor in Paediatric Neurology and Senior Research Fellow

Department of Child Health

Division of Developmental Medicine

University of Glasgow




JS declares that he has no competing interests.

Honorary Clinical Lecturer

Paediatric Neurology

Newcastle General Hospital




AB has previously worked as part of a clinical team with EP. AB declares that she has no competing interests.

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