Generalized onset seizures with focal evolution (GOFE) – a largely unknown ictal variation in genetic generalized epilepsies

The operational seizure classification by the ILAE in 2017 divides seizures into those with focal, generalized, or unknown onset [1]. Correct classification of seizures is the prerequisite to make the correct diagnosis of the epilepsy type. The ILAE defines focal seizures as “originating within networks limited to one hemisphere” whereas generalized seizures “engage bilateral networks from onset” [1]. In genetic generalized epilepsies (GGEs), however, up to one in four myoclonic seizures is asymmetrical [2,3], and at onset, every other generalized tonic–clonic seizure is characterized by an aversive head turn [4].

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