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Mandatory seizures
Tonic seizures from sleep (in slow wave sleep or on wakening) are
mandatory. These can be subtle (e.g. eye widening/rolling only) or there may be truncal (causing vocalization) and/or limb muscle contraction (e.g. arms elevating and flexing and legs either flexing or extending). The tonic contraction can be with a vibratory component. If the patient is standing, there may be a fall with risk of injury. Tonic status epilepticus can occur.
The patient must have one other seizure type, from the list below.
Non convulsive status epilepticus is common (seen in half of patients), and can be of long duration (days to weeks), during which time all seizure types may increase in frequency