Tonic seizures from sleep (in slow wave sleep or on wakening) are the most characteristic seizure. These are brief (<10 seconds), and may be inconspicuous and therefore not identified. They may be predominantly truncal (with brief vocalization due to involvement of abdominal musculature) or extend to involve proximal and distal muscles (with arms elevating and flexing and legs either flexing or extending). There may be autonomic features in association. They can occur in a series. Tonic status epilepticus may occur.
CAUTION If myoclonic seizures predominate consider Dravet syndrome (especially if prolonged hemiclonic seizures).
CAUTION If myoclonic-atonic seizures predominate consider epilepsy with myoclonic-atonic seizures.