Generalized Seizures

Generalized seizures involve networks that affect both halves of the brain at once, right from the start. In these seizures, consciousness is usually affected from the very beginning. Below, you will get to know the generalized seizure types most commonly seen in childhood.

Tonic-Clonic Seizures (Formerly "Grand Mal")

This is usually the classic "seizure" image people have in mind. It has two phases. First, the tonic phase: the child suddenly loses consciousness, all the muscles stiffen, they may fall, and sometimes give a short cry (as air is forced out through the vocal cords). Then the clonic phase: the arms and legs begin to jerk rhythmically. During this time the child's color may turn bluish, foam or saliva may come from the mouth, they may lose control of their bladder or bowels, and they may bite their tongue. The seizure usually stops on its own within 1-3 minutes; afterward the child may fall into a deep, exhausted sleep.

This seizure looks frightening — but...

Witnessing a tonic-clonic seizure is extremely distressing for a parent. This is completely natural.

But the vast majority of seizures stop on their own within a few minutes, even if you do nothing, and leave no lasting harm.

Your job is not to "stop" the seizure, but to keep the child safe. We walk through first aid step by step in Chapter 29.

Absence Seizures (Formerly "Petit Mal")

Absence seizures are common especially in school-age children and are very easily missed. The child suddenly stops what they are doing, stares blankly at a point for a few seconds, does not respond when called, and then continues from where they left off as if nothing had happened. There is usually no falling or stiffening. The seizure is so short (usually 5-15 seconds) and quiet that families and teachers may take it for "absent-mindedness" or "a lack of attention" for a long time. Sometimes it is accompanied by eye blinking or slight lip movements. These seizures can recur dozens or even hundreds of times a day and can lower school performance.

If You Notice This Kind of Zoning Out

If you notice your child frequently "zoning out" for a few seconds and then continuing from where they left off, record these moments as short videos and show them to your doctor. Video is the information that helps most with diagnosis.

Absence seizures can be brought on by rapid breathing (hyperventilation); however, this is a provocation test and is not recommended to perform at home. When needed, the hyperventilation test is evaluated much more safely under a doctor's supervision in an EEG setting.

Myoclonic Seizures

Myoclonic seizures are very brief, sudden, lightning-like muscle jerks. They usually affect the arms and shoulders. The child may suddenly fling away the cup or spoon in their hand. These jerks are especially common right after waking in the morning. Because each one is so brief, they may be dismissed as unimportant, but they are an important part of some epilepsy syndromes.

Atonic Seizures (Drop Seizures)

In atonic seizures, muscle tension is suddenly and completely lost. The child's head may drop forward, their knees may buckle, or they may collapse where they are. These seizures, also called "drop attacks," are very brief, but they carry a risk of injury (especially to the head and face) due to the sudden fall. In these children, the use of a protective helmet may come up.

Tonic Seizures

In tonic seizures, the muscles suddenly stiffen and stay contracted, but there is no clonic (thrashing) phase. They usually last a short time, often occur during sleep, and are part of some severe epilepsy syndromes.

• Seizure Type
• Typical Appearance
• Duration
• Tonic-clonic
• Stiffening + thrashing, loss of consciousness
• 1–3 minutes
• Absence
• Brief zoning out, blank stare
• 5–15 seconds
• Myoclonic
• Sudden, brief muscle jerk
• Seconds
• Atonic
• Sudden loss of tension, falling
• Seconds
• Tonic
• Sudden stiffening, staying contracted
• Seconds–1 minute