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Generalized seizures in children

Last reviewed: 4 Sep 2023
Last updated: 22 Aug 2023



History and exam

Key diagnostic factors

  • tonic-clonic seizures
  • staring spells or inattention
  • brief, arrhythmic muscular jerking movements
  • eyes rolling back in head
  • unexplained falls
More key diagnostic factors

Other diagnostic factors

  • incontinence
  • tongue biting
  • postictal phenomena
  • seizure precipitated by fatigue or lack of sleep
  • seizure precipitated by light or noise
  • intercurrent illness
  • developmental delay
  • neurocutaneous stigmata
Other diagnostic factors

Risk factors

  • genetic predisposition or family history
  • perinatal asphyxia
  • metabolic/neurodegenerative disorders
  • head trauma
  • structural abnormalities of the central nervous system
  • autistic spectrum disorder
  • central nervous system (CNS) infection
  • neurocutaneous syndromes
  • history of febrile seizures
More risk factors

Diagnostic investigations

1st investigations to order

  • electroencephalogram (EEG)
  • blood glucose level
  • basic metabolic panel
  • CBC
  • ECG
More 1st investigations to order

Investigations to consider

  • MRI brain
  • CT brain
More investigations to consider

Treatment algorithm


generalized onset seizure in progress


epilepsy syndromes in children <1 year of age (excluding neonates)

epilepsy syndromes in early childhood

epilepsy syndromes in middle childhood

epilepsy syndromes in late childhood or adolescence

unidentified epilepsy syndrome



Leena Mewasingh, MBChB, MSc, FRCPCH

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).

Alla Nechay, MD

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 topic.


EP declares that she has no competing interests.

Peer reviewers

Adam L. Hartman, MD

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 topic.

Roger Weis, MD

Pediatric Neurologist

Kinderneurologisches Zentrum Mainz




RW declares that he has no competing interests.

John Stephenson, MA, BM, DM, FRCP, HonFRCPCH


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.

Anna Basu, BM, BCh, PhD, MA, MRCPCH

Honorary Clinical Lecturer

Paediatric Neurology

Newcastle General Hospital




AB has previously worked as part of a clinical team with Dr Ewa Posner, a previous contributor to this topic. AB declares that she has no competing interests.

  • Generalized seizures in children images
  • Differentials

    • Nonepileptic seizures or "dissociative seizures"
    • Breath-holding spells (prolonged cyanotic expiratory apnea)
    • Long QT syndrome
    More Differentials
  • Guidelines

    • Epilepsies in children, young people and adults
    • Antiseizure medication withdrawal in seizure-free patients: practice advisory update summary
    More Guidelines
  • Patient leaflets

    Epilepsy: what is it?

    Febrile seizures

    More Patient leaflets
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