Two major types of generalized seizures are the primarily generalized tonic-clonic seizures (grand mal) and the absence (petit mal) seizures. The typical primarily generalized tonic-clonic seizure is often preceded by a series of bilateral muscular jerks followed by loss of consciousness, which in turn is followed by a series of tonic and then clonic spasms. The typical absence seizure (classic petit mal) consists of a sudden brief loss of consciousness (~10 seconds), sometimes with no motor activity, although often some minor clonic motor activity exists. Based on a recent evidence-based metaanalysis of AED efficacy and effectiveness, the recommended initial monotherapy for patients with generalized seizures are CBZ, oxcarbazepine (OXC), lamotrigine, VP A, phenytoin, and topiramate (TPM), whereas children with absence seizures are best treated with lamotrigine, VPA, or ethosuximide.6,13
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