This study investigates the histories and the clinical course of 224 patients who had grand mal almost always during sleep (SGM group) and 86 patients who had grand mal on awakening (GMA group). We used 1590 patients who had grand mal and did not belong to neither of the former two groups as a control. We confirmed that the SGM group was strongly related to symptomatic localization-related epilepsy, espe cially temporal and frontal lobe epilepsy and that psychic aura as well as temporal EEG foci occurred significantly more often. In contrast, the GMA group was strongly related to idiopathic generalized epilepsy, especially juvenile myoclonic epilepsy. Absence and generalized myoclonic seizure, together with 3 c/s or faster generalized spike and wave, occurred significantly more often in the GMA group. In agreement with previous reports, the SGM group exhibited a better prognosis in comparison with symptomatic localization-related epilepsy in general.
View full abstract