Symptoms & signs: rigid (tonic phase), trunk and extremities extended, rhythmic (clonic) jerking of the trunk and extremities, apneic, maybe cyanotic, urinate, vomit. Deep, rapid breathing. Typical attacks last from 60-90s. Postictal confusion, myalgias, and fatigue may persist for several hours.
Key diagnostic factors: focal neurological deficits, focal neurological symptoms (before or after seizure), premonitory sensation or experience (fear, epigastric sensation, déjà vu, jamais vu), temporary hemiparesis, temporary aphasia, fever, nuchal rigidity, altered mental status. Raised serum prolactin, lactate. CT/MRI Brain. Obtain radiographs of the cervical spine if there is suspicion of head or neck trauma. Biting tongue, eyes open.
Strong risk factors: FHx (extended or immediate) of idiopathic generalised epilepsy, previous CNS infection, head trauma, prior seizure events or suspected seizure events,
Weak risk factors: Hx of substance use, premature birth, multiple or complicated febrile seizures