Epilepsy Generalized Tonic Clonic Seizures Alone
What is epilepsy with generalized tonic-clonic seizures alone?
Epilepsy with generalized tonic-clonic seizures alone (EGTCS) is an epilepsy syndrome. Generalized tonic-clonic seizures begin between 5 and 40 years of age. In 8 out of 10 people, it starts in teens and young adults between the ages of 11 and 23 years old. This syndrome used to be called epilepsy with tonic-clonic seizures on awakening.
A family history of epilepsy is common in 2 out of 10 people. A family history of febrile seizures has been reported in 1 out of 10 people. The genetics of EGTCS is complex. In most cases, no genetic mutations are found, however, rarely, mutations or changes on a specific gene (CLCN2 gene) have been linked to this syndrome. There may be other mutations too.
People with this epilepsy syndrome have normal neurological exams. Their development and cognition are typically normal.
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Find Your Local Epilepsy FoundationWhat type of seizures are seen?
- People with EGTCS have generalized tonic-clonic seizures typically upon or within 1 to 2 hours of awakening.
- Before seizure medicines are started, seizures may be frequent.
- Seizures in people with EGTCS may be provoked by sleep deprivation, fatigue, alcohol, fever, menstrual cycle, or flashing lights (photosensitivity).
How is EGTCS diagnosed?
EGTCS is diagnosed based on the description of the seizures and when they occur. Other information is obtained from tests such as:
- EEG (electroencephalogram): People with EGTCS have normal EEG background wgeneralized spike wave or polyspike wave activity. The spike wave activity is seen in sleep in 1 out of 2 people. Specific EEG changes may be seen during photic stimulation. EEG abnormalities are more likely or increased with sleep deprivation and during sleep.
- MRI (magnetic resonance imaging) of the brain: People with EGTCS have a normal MRI of the brain.
How is EGTCS treated?
People with EGTCS should avoid sleep deprivation, alcohol, or flashing lights (due to photosensitivity).
Medication
These seizures are typically controlled with anti-seizure medications like valproic acid/divalproex, lamotrigine, levetiracetam, topiramate, and zonisamide.
Other Treatments
People with EGTCS who have long seizures may need emergency medical treatment or treatment with a rescue therapy. Talk to your health care team about what kind of rescue therapy could be used and when to use it.
When seizures last longer than usual or if a generalized seizure lasts too long (generally considered 5 minutes or longer), a child may need emergency medical care.
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Seizure EmergenciesWhat is the outlook?
Over 3 of 4 people with EGTCS will require seizure medication throughout their life. The outlook or prognosis is variable – some people can be controlled with medication, while others may have tonic-clonic seizures that become frequent and less dependent on sleep-wake cycle or other triggers.
Resources
Epilepsy Centers
Epilepsy centers provide you with a team of specialists to help you diagnose your epilepsy and explore treatment options.
Epilepsy Medication
Find in-depth information on anti-seizure medications so you know what to ask your doctor.
Epilepsy and Seizures Helpline
Call our Epilepsy and Seizures Helpline and talk with an epilepsy information specialist or submit a question online.
Tools & Resources
Get information, tips, and more to help you manage your epilepsy.
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