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Generalized Tonic‐Clonic Seizures in Patients with Complex‐Partial Seizures: Natural History and Prognostic Relevance

Summary: Clinical course and long‐term seizure prognosis were studied in 155 patients with complex‐partial seizures during a follow‐up of 10.1 ± 1 (SD) years. In 79% of the patients generalized tonic‐clonic seizures were recorded, mostly within the first 3 years of epilepsy but occurring as late as 20 years after the onset of epilepsy. Seizure control was defined as complete absence of all seizures, including auras, for a minimum of 2 years. Seizure control occurred in 20 of 32 patients (63%) with complex‐partial seizures only and in 76 of 123 patients (62%) with complex‐partial seizures and generalized tonic‐clonic seizures. The onset of the epilepsy with generalized tonic‐clonic seizures or complex‐partial seizures did not influence the therapeutic outcome despite differences in their natural history. A family history of epilepsy and other generalized seizures (e.g., absence) were more frequent in patients with generalized tonic‐clonic seizures at the onset of epilepsy. Seizure control was significantly lower (44%) in patients with a history of a maximum frequency of one or more generalized tonic‐clonic seizures per month when compared to patients (79%) with a total of less than six generalized tonic‐clonic seizures (p < 0.05). The frequency of generalized tonic‐clonic seizures is of predictive value for the seizure prognosis of patients with complex‐partial seizures.