Neurology · Pathway 15

Generalised Tonic-Clonic Seizures

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Key points

Generalised tonic-clonic seizures — CURRENT guidance is NICE NG217 (2022, updated January 2025), which SUPERSEDES the older 'sodium valproate first-line' teaching.
First-line: offer a CHOICE of lamotrigine, levetiracetam or sodium valproate · do NOT offer sodium valproate to women or girls able to have children — offer lamotrigine or levetiracetam instead.
Sodium valproate first-line remains appropriate for boys and men, and for women unable to have children, subject to the MHRA under-55 two-specialist requirement.
Add-on options if monotherapy fails: clobazam, lamotrigine, levetiracetam, sodium valproate or topiramate.
Absence seizures* (Petit mal): NG217 offers ETHOSUXIMIDE first-line — see the Absence Seizures chapter. Myoclonic seizures**