Generalized seizures in children

Seizures in children may occur as a standalone event or may recur (epilepsy).

Etiology can be structural, genetic, infectious, metabolic, immune, or unknown.

An attempt should be made to identify the type(s) of epilepsy and the epilepsy syndrome by recognizing a pattern of seizure types, clinical features, etiologies, and electroencephalogram characteristics.

Detailed history is of paramount importance in the diagnosis, as key diagnostic factors lie in the history as opposed to ancillary investigations.

Treatment will vary depending on the epilepsy syndrome. Options include anticonvulsants, ketogenic diets, vagus nerve stimulation, and surgery, as well as consideration of lifestyle factors.

Generalized seizures are understood to originate at some point within the brain and rapidly engage bilaterally distributed networks. This can include both cortical and subcortical structures but does not involve the entire cortex.[1]Scheffer IE, Berkovic S, Capovilla G, et al. ILAE classification of the epilepsies: position paper of the ILAE Commission for Classification and Terminology. Epilepsia. 2017 Apr;58(4):512-21. https://onlinelibrary.wiley.com/doi/10.1111/epi.13709 http://www.ncbi.nlm.nih.gov/pubmed/28276062?tool=bestpractice.com [2]Beniczky S, Trinka E, Wirrell E, et al. Updated classification of epileptic seizures: position paper of the International League Against Epilepsy. Epilepsia. 2025 Jun;66(6):1804-23. https://onlinelibrary.wiley.com/doi/10.1111/epi.18338 http://www.ncbi.nlm.nih.gov/pubmed/40264351?tool=bestpractice.com ​​​​ The 2017 International League Against Epilepsy (ILAE) classification presents three levels at which epilepsy may be diagnosed, depending on the resources available to the clinician: 1) diagnosis of the seizure (focal, generalized, or unknown); 2) diagnosis of the epilepsy type (focal epilepsy, generalized epilepsy, combined focal and generalized epilepsy, or unknown), informed by clinical and electroencephalographic (EEG) features; and 3) diagnosis of the epilepsy syndrome, based on a characteristic cluster of clinical and test findings, which may be associated with specific etiology or comorbidities.[1]Scheffer IE, Berkovic S, Capovilla G, et al. ILAE classification of the epilepsies: position paper of the ILAE Commission for Classification and Terminology. Epilepsia. 2017 Apr;58(4):512-21. https://onlinelibrary.wiley.com/doi/10.1111/epi.13709 http://www.ncbi.nlm.nih.gov/pubmed/28276062?tool=bestpractice.com ​ A detailed ILAE classification and definition of epilepsy syndromes was published in 2022.[3]Wirrell EC, Nabbout R, Scheffer IE, et al. Methodology for classification and definition of epilepsy syndromes with list of syndromes: report of the ILAE Task Force on Nosology and Definitions. Epilepsia. 2022 Jun;63(6):1333-48. https://onlinelibrary.wiley.com/doi/10.1111/epi.17237 http://www.ncbi.nlm.nih.gov/pubmed/35503715?tool=bestpractice.com ​ Diagnosis of an epilepsy syndrome usually informs prognosis and management decisions.

Seizures may occur as a standalone event. If unprovoked seizures recur, or have a high likelihood of recurrence, the term "epilepsy" is used. This topic addresses generalized epilepsies. Previous terminology of "secondarily generalized" seizure (i.e., a focal seizure that spread to involve the rest of the body) has now changed to "focal to bilateral tonic-clonic seizure." When certain aspects of the seizure can be described but this is insufficient for clear classification, this is classed as an "unknown whether focal or generalized seizure".[2]Beniczky S, Trinka E, Wirrell E, et al. Updated classification of epileptic seizures: position paper of the International League Against Epilepsy. Epilepsia. 2025 Jun;66(6):1804-23. https://onlinelibrary.wiley.com/doi/10.1111/epi.18338 http://www.ncbi.nlm.nih.gov/pubmed/40264351?tool=bestpractice.com ​ Such seizures are further described by whether there are observable manifestations (e.g., motor or autonomic), and by the chronologic sequence of phenomena. When no information is available about the seizure (e.g., it is unwitnessed), but the clinician considers it likely to be epilepsy, this is temporarily classed as “unclassified”.[2]Beniczky S, Trinka E, Wirrell E, et al. Updated classification of epileptic seizures: position paper of the International League Against Epilepsy. Epilepsia. 2025 Jun;66(6):1804-23. https://onlinelibrary.wiley.com/doi/10.1111/epi.18338 http://www.ncbi.nlm.nih.gov/pubmed/40264351?tool=bestpractice.com

This topic does not cover seizures in neonates.

For information on febrile seizures, see the topic Febrile seizure.