Focal, generalised epilepsy or both?

A 29-year-old woman presented with a witnessed convulsion, with semiology consistent with a focal-to-bilateral tonic-clonic seizure. Routine EEG supported a syndromic diagnosis of idiopathic generalised epilepsy with photosensitivity. We discuss the clinical utility of seizure semiology, highlighting the caveat that over-reliance or sole reliance on the ictal semiology may result in an erroneous diagnosis of focal epilepsy in someone with a generalised epilepsy.
Competing Interests: Competing interests: AN and UV have no conflicts of interest. JWS reports grants and personal fees from UCB, grants from NIHR and Angelini, and personal fees from UCB and Angelini, outside the submitted work.
(© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)