Last reviewed: February 2018
Last updated: November  2017

Revised "Operational classification of seizure types by the International League Against Epilepsy"

  • The classification has been revised. Seizures are divided into those of focal, generalized, unknown onset, with subcategories of motor, nonmotor, with retained or impaired awareness for focal seizures.

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

Original source of update

First-line monotherapy in children and adults with generalized tonic-clonic seizures with or without other generalized seizure types

  • This 2017 Cochrane review supports:

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

  • The use of 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

  • focal neurologic deficits
  • focal neurologic symptoms (before or after seizure)
  • premonitory sensation or experience (fear, epigastric sensation, déjà vu, jamais vu)
  • temporary hemiparesis
  • temporary aphasia
  • fever, nuchal rigidity, altered mental status

Other diagnostic factors

  • neurocutaneous findings of neurologic disease

Risk factors

  • FHx (extended or immediate) of generalized-onset epilepsy
  • previous CNS infection
  • head trauma
  • prior seizure events or suspected seizure events
  • hx of substance use
  • premature birth
  • multiple or complicated febrile seizures

Diagnostic investigations

1st investigations to order

  • EEG
  • blood glucose
  • CBC
  • electrolyte panel
  • toxicology screen
  • head CT
  • serum prolactin
  • serum CK
Full details

Investigations to consider

  • lumbar puncture
  • MRI brain
Full details

Treatment algorithm


Authors VIEW ALL

Assistant Professor

Clinical Neurology

University of California, San Francisco

San Francisco



VRR is an author of a number of references cited in this monograph. He served as a paid consultant for NeuroPace, Inc., manufacturer of the Responsive Neurostimulation (RNS) System.

Associate Professor

Clinical Neurology

University of California, San Francisco

San Francisco



JDH has received research funding and consultancy funds from UCB Inc.

Dr Vikram R. Rao and Dr John D. Hixson would like to gratefully acknowledge Dr Daniel H. Lowenstein, a previous contributor to this monograph. DHL declares that he has no competing interests.

Peer reviewers VIEW ALL


Division of Epilepsy and Sleep

Department of Neurology

Brigham and Women's Hospital

Associate Professor of Neurology

Harvard Medical School




EBB has received speaking fees from ICR Pharma, Novartis, Abbott Laboratories, GlaxoSmithKline, and Pfizer. He has received consulting fees from ICR Pharma, Genzyme, and Spherics, and research funding from UCB Pharma. Unfortunately we have since been made aware that EBB is deceased.

Honorary Clinical Senior Lecturer

University of Glasgow

Institute of Neurological Sciences




Not disclosed.

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