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How generalised are secondarily “generalised” tonic–clonic seizures?
  1. Kaspar Schindler,
  2. Howan Leung,
  3. Klaus Lehnertz,
  4. Christian E Elger
  1. Klinik für Epileptologie, Bonn, Germany
  1. Correspondence to:
 Dr Kaspar Schindler
 Klinik für Epileptologie, Sigmund-Freud-Str 25, D-53105 Bonn, Germany; kschindler{at}


In clinical practice, epileptic seizures with focal onset and subsequent generalised motor involvement are referred to as secondarily generalised seizures. The purpose of this study was to investigate the degree of electrophysiological generalisation in seizures that are clinically secondarily generalised. Intracranial EEG recordings of secondarily generalised tonic–clonic seizures were visually and quantitatively analysed for the presence of epileptiform activity. In 24 (26%) of 93 seizures recorded from 17 (27%) of 64 patients, intracranial EEG channels were found that never recorded epileptiform activity during secondarily generalised tonic–clonic seizures. Our results demonstrate that seizures that are secondarily generalised clinically are not always generalised electrophysiologically. This may have therapeutic implications.

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  • See Editorial Commentary, p 915

  • Published Online First 19 January 2007

  • Competing interests: None.

  • Informed consent was obtained for publication of fig 2A.

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