Can anyone help with identifying this seizure type?

[LaBelleSauvage123]

DS (21) has had epilepsy since he was 14 and his seizures have progressed from complex focals to tonic clonics. His medication (Lamotrigine) was increased 11 days ago and this morning he had his first seizure since that time. It started with an absence of about 20 secs, then he started facial twitching to the left and gasping with rolling eyes. His whole body went stiff but I managed to position him so he could fall into a chair just behind, where he lay flat with arms and legs stiff and extended. The seizure continued for about 30 secs and then he was awake, speech slurred but making sense. After a few minutes he stood up and was able to go upstairs to bed with just a little support from me. He's now asleep.

I record his seizures in a diary for the epilepsy clinic but this time I don't know which type to put down. It looked focal but the stiffness suggests tonic clonic doesn't it? It was much less violent and long lasting than his usual seizures. The epilepsy clinic will take days to reply (they're great but very overloaded) so I thought I'd see if anyone had any insights here. Thanks in advance.

It sounds like my Dd when she has a breakthrough seizure. It should have been a tonic clonic but the medication has tried to prevent it.

They can all be very different. Some of her breakthroughs last seconds and only involve her face. Some sound like what happened to your son.

That does sound like it - thank you. He's on the max dose now I think - so it's a bit worrying.

Has he always been on lamotrigine? Was that given for his focal seizures? He may need different meds for the tonic clonics??
My Dd takes levetiracetam and clobazam and hers are still not reliably controlled. ☹️

I really recommend joining the Facebook group 'Parents of Children with epilepsy UK' it's so, so helpful and you will get a lot of advice on there

It sounds like a tonic seizure to me - I
have friends who have them. (Whereas I now mostly have well-controlled epilepsy, with the very VERY occasional focal seizure - it’s been over 4 years since a segue to atonic [to tonic-clonic]; I will keep my fingers crossed the same happens for your DS & Smartiepants79’s DD).

He’s tried various drugs alone and in combination- carbamazepine, Briviact and lamotrigine. None have completely controlled his seizures, though he did have almost a year seizure free when he was 16-17. He has autism with severe learning disabilities which makes everything more complex.

I will have a look. I did join an epilepsy info group on face book for a while when she was initially diagnosed. I just found it so depressing. It was just full of all these people with awful, intractable epilepsy that just completely controls their lives. I needed believe that it will be different for my DD. 🫣

I have had epilepsy since I was three and that was a while ago.
I have found that the medication and dosage can affect the presentation of your seizures.
On topamax, as a monotherapy my husband claims I had a TC which was so violent I nearly kicked in the glove box of the car (they also came on suddenly when before I had a lengthy warning period). Valproate and Lamotrigine and Valproate and Topamax cause what my husband refers to as ‘boring seizures’. I ‘go stiff and twitch a little bit’. It is still a TC but not as dramatic as the ones on TV.
Keppra/Levetivacetam we don’t talk about what happened on that drug …..ever😬
The Epilepsy Society used to have some good videos giving examples of various seizures, it may be worthwhile checking them out. Or you could, if it happens again, try to get a video for your neurologist. I know it sounds a bit cold, but that seems to be the advice if you are unsure about seizure development.
Don’t blame you for your feelings about Facebook. All the good forums linked to epilepsy charities/organisations appear to have succumbed to the horrors of social media.