Asynchronous bilateral movements of the limbs, asymmetrical clonic contractions, pelvic thrusting and side-to-side movements of the head, often intensified by restraint

Gaze aversion, resistance to passive limb movement or eye-opening, focus on face if mirror used and eyes held open

Avoidance of the hand falling on to the face

Incontinence, tongue biting and injury rare (but can occur)

Normal or volitional pattern chest wall movements

Normal tendon reflexes, plantar responses, blink, corneal and eyelash reflexes

Absence of metabolic complications

No post-ictal confusion (drowsiness and dysarthria may be due to benzodiazepine given to treat suspected seizure)