Snapshot A 12-year-old boy had an episode during basketball practice where he fell to the floor and had 2 minutes of symmetric clonic movements. Introduction A complex (LOC), generalized (both hemispheres), tonic (contraction), clonic (rhythmic jerking) seizure Presentation Symptoms begin with sudden loss of consciousness tonic extension of back and extremities followed by 1-2 minutes of repetitive, symmetric, clonic movements followed by period of postictal confusion cyanosis and incontinence may occur Evaluation EEG is most important test in the seizure workup Rule out systemic causes through extensive workup Post-ictal lactic acidosis may be detected - generally resolves spontaneously within 60-90 minutes after cessation of seizure activity EEG, CT or MRI. Must differentiate between seizures and syncope. Treatment Treat underlying cause electrolytes, infection, toxic ingestion, trauma, azotemia, hypoxia, hypoglycemia, stroke/bleed Pharmacologic carbamazepine (unique for tonic clonic - C for Clonic) valproate phenytoin