Generalized tonic-clonic seizure

Injury	Disease	Nutrition	Poison

Symptoms	Surgery	Test	Special Topic

Central nervous system

Overview

Symptoms

Treatment

Prevention

Generalized tonic-clonic seizure

Alternative Names:

Seizure - tonic-clonic; Seizure - grand mal; Grand mal seizure; Seizure - generalized

Symptoms:

Many patients have an aura (sensory warning sign) preceding the seizure. This can include a visual, taste, smell, sensory, or other hallucination or dizziness.

The seizure itself involves:

loss of consciousness or fainting, usually lasting between 30 seconds and five minutes
general muscle contraction and rigidity (tonic posture), usually lasting 15 to 20 seconds
violent rhythmic muscle contraction and relaxation (clonic movement), usually lasting for one to two minutes
biting the cheek or tongue, clenched teeth or jaw
incontinence (loss of urine or stool control)
stopped breathing or difficulty breathing during seizure
blue skin color

Almost all people experience loss of consciousness, and most people experience both tonic and clonic muscle activity.

After the seizure:

the person usually begins breathing normally when the seizure is over
arousable but sleepy for one hour or longer
loss of memory (amnesia) regarding events surrounding the seizure episode
headache
drowsiness
confusion, temporary and mild
may be weak for 24-48 hours following seizure (Todd's paralysis)

Signs and tests:

Diagnosis of a grand mal seizure is based on the symptoms and excluding other medical problems that can look like a seizure (such as heart arrythmia). A neuromuscular examination may or may not reveal neurologic deficits (decreases in brain functions) when the person is not actively having seizures.

An EEG may show characteristic changes and in some cases may show the focus (location of the cause of the seizure). An EEG can be normal in between seizures and a normal EEG does not rule out a seizure disorder.

Tests for the cause may include various blood tests (depending on the suspected cause), including:

complete blood count
blood chemistry, blood glucose
liver function tests
kidney function tests (BUN, creatinine, etc.)
tests for infectious diseases (depending on the suspected cause)

Tests for the cause may include procedures such as:

head CT or MRI scan
lumbar puncture (spinal tap)

Disorders that may cause symptoms resembling seizures include transient ischemic attacks, rage, or panic attacks.

Review Date: 11/16/2004
Reviewed By: Luc D. Jasmin, M.D., Ph.D., Division of Neurological Surgery, University of California, San Francisco, CA. Review provided by VeriMed Healthcare Network.

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