Do generalized tonic-clonic seizures in infancy exist?

OBJECTIVE To determine the frequency of generalized tonic-clonic seizures (GTCS) in infants (1 month to 2 years). METHODS From a total of 2,112 patients monitored in our video-EEG lab from May 2000 through January 2005, 109 distinct seizures in 77 infants were reviewed. Eight events in eight patients were excluded because of video files insufficiently reliable to determine the clinical characteristics with precision. The clinical manifestations and electrographic features of the remaining 101 seizures in 69 infants were retrospectively analyzed. RESULTS The authors did not observe a single GTCS. Four patients had icti that resembled GTCS, but careful analysis of these episodes revealed that three of them had a focal onset and that the fourth had a slightly different sequence of events. CONCLUSIONS Generalized tonic-clonic seizures are rarely, if ever, seen in infants younger than age 2 in a tertiary-care pediatric epilepsy unit. Instead, they more commonly occur in older children, particularly in the well-characterized epilepsy syndromes of childhood and adolescence.