Tonic-Clonic Seizure / Grand Mal Seizure
A grand mal seizure — also known as a tonic-clonic seizure — features a loss of consciousness and violent muscle contractions. It's the type of seizure most people picture when they think about seizures in general.
Grand mal seizure is caused by abnormal electrical activity throughout the brain, so signs and symptoms typically involve the entire body. In some cases, this type of seizure is triggered by other health problems, such as extremely low blood sugar or kidney failure. However, most grand mal seizures occur as a result of epilepsy.
Grand mal seizure affects all ages. This variety of seizure can occur just once or may recur throughout life. It takes at least two seizures to justify a diagnosis of epilepsy. Daily anti-seizure medications can control grand mal episodes for most people.
Grand mal seizures occur when the electrical activity in a large region of the brain becomes abnormally synchronized. The cause of seizures remains unknown in about half of cases. However, grand mal seizures are sometimes caused by underlying health problems, such as :
- Very low blood levels of glucose, sodium, calcium or magnesium
- Traumatic head injuries
- Using or withdrawing from drugs, including alcohol
- Infections such as meningitis or encephalitis
- Brain tumors
- Blood vessel malformations in the brain or strokes
Risk Factor :
Other risk factors for grand mal seizures include :
- A family history of seizure disorders
- Any injury to the brain from trauma, stroke, previous infection and other causes
- Severe medical problems that affect electrolytes
- Illicit drug use
- Heavy alcohol use
When to seek medical advice :
If you see someone having a seizure :
- Call for medical help immediately.
- Gently roll the person onto one side and put something soft under his or her head.
- Loosen tight neckwear.
- Don't put anything in the mouth — the tongue can't be swallowed.
- Don't try to restrain the person.
- Look for a medical alert bracelet, which may indicate an emergency contact person and other information.
A grand mal seizure lasting more than five minutes, or immediately followed by a second seizure, can result in brain damage or death. Get emergency care as quickly as possible.
Grand mal seizures have two stages.
- Tonic phase. Loss of consciousness occurs, and the muscles suddenly contract and cause the person to fall down. A period of rigidity follows.
- Clonic phase. The muscles go into rhythmic contractions, alternately flexing and relaxing. Convulsions usually last for less than two minutes.
The following signs and symptoms occur in some but not all people with grand mal seizures.
- Aura. Some people experience a warning feeling (aura) before a grand mal seizure.
- Loss of bowel and bladder control. This may happen during or following a seizure.
- Unresponsiveness after convulsions. Unconsciousness may persist for a few minutes.
- Confusion. A period of disorientation often follows a grand mal seizure.
- Fatigue. Sleepiness is common after a grand mal seizure.
- Severe headache. Headaches are common but not universal after grand mal seizures.
A detailed description of the seizure is crucial for diagnosis. Because people who have grand mal seizures lose consciousness and don't remember their seizures, the description needs to come from people who have witnessed the seizures.
If you've had a seizure, your doctor will usually perform a neurological exam that tests reflexes, muscle tone, muscle strength, sensory function, gait, posture, coordination and balance. He or she may also ask questions to assess your thinking, judgment and memory.
Blood tests may be ordered as appropriate to check for problems that could be causing or triggering the seizures.
Your doctor may also suggest scans or tests designed to detect abnormalities within the brain.
An EEG displays the electrical activity of your brain via electrodes affixed to your scalp. People with epilepsy often have changes in their normal pattern of brain waves, even when they're not having a seizure.
To prepare for an EEG, avoid elaborate hairstyling, metallic hair spray or greasy hair dressing. Refrain from caffeine for six hours before the test. The procedure itself is minimally uncomfortable for most and usually lasts 30 to 60 minutes. However, it can take 30 to 45 minutes to place the electrodes on your scalp.
In some cases, your doctor may recommend video-EEG monitoring. This allows your doctor to compare — second by second — the behaviors observed during a seizure with your EEG pattern from exactly that same time. This can help your doctor pinpoint what type of seizure you have and where your seizures originate, and can help make sure that the diagnosis of seizures is correct.
Video EEGs usually require hospitalization. The average hospital stay is three to five days. The hospital-based epilepsy monitoring unit is open 24 hours a day and seven days a week. During this hospital stay, you will be videotaped continuously and the EEG will be recorded the whole time, so that if you have a seizure, the data will be collected.
Magnetic resonance imaging (MRI)
An MRI machine produces detailed images of your brain. Although many people with seizures and epilepsy have normal MRIs, abnormal images can help identify the cause and location of seizure onset. Dental fillings and braces may distort the images, so be sure to tell the technician about them before the test begins.
During the test, you will lie on a padded table that slides into the MRI machine. Your head will be immobilized in a brace, to improve precision. The test is painless, but some people experience claustrophobia inside the MRI machine's close quarters. If you think you may have this problem, inform your doctor.
People with epilepsy should be supervised when they take baths or swim, because there is a real risk of drowning if a seizure occurs when you're in the water. Seizures also can produce injuries associated with falling, such as a head injury. Sometimes, the force of the seizure itself results in injury. In extreme cases, seizures can be fatal, particularly if medication is not taken consistently or properly.
A seizure that produces either loss of awareness or control can be dangerous if you're driving a car or operating other equipment. Many states have licensing restrictions related to your ability to control seizures. For children, seizure disorders may result in limitations on physical activities in school.
Sometimes, treatment will not be started until you have experienced at least two seizures. The evaluation may prompt treatment after a single seizure in some cases, however, if the risks are judged to warrant it. Not everyone who has one seizure will have another one. The most common type of one-time seizure is the grand mal variety.
There are many medications used in the treatment of epilepsy and seizures. Most of these medications are taken by mouth. Many people with epilepsy are able to prevent seizures by taking only one drug, but others require more than one.
Several standard anti-seizure drugs have been in use for decades. Newer anti-seizure drugs, most of which became available in the late 1990s, are generally no more effective in controlling seizures than are the old standbys. Some recently developed drugs may have fewer side effects.
Finding the right medication and dosage can be complex. Your doctor likely will first prescribe a single drug at a relatively low dosage, and may increase the dosage gradually until your seizures are well controlled. If you've tried two or more single-drug regimens without success, your doctor may recommend trying a combination of two drugs.
All anti-seizure medications have some side effects, which may include mild fatigue, dizziness and weight gain. More severe side effects include mood disruption, skin rashes, loss of coordination, speech problems and extreme fatigue.
To achieve the best seizure control possible, take medications exactly as prescribed. Always call your doctor before switching to a generic version of your medication or when taking other prescription medications, over-the-counter drugs or herbal remedies. And never stop taking your medication without talking to your doctor.
If anti-seizure medications don't provide satisfactory results, your doctor may suggest other treatment options — such as vagus nerve stimulation or a ketogenic diet.
Vagus nerve stimulation
A device called a vagus nerve stimulator is implanted into your chest under the collarbone. Wires from the stimulator are attached to the vagus nerve in your neck. The device turns on and off according to an adjustable program, and can be activated by the use of a magnet.
This treatment consists of a strict low-carbohydrate diet that leads to an increase in ketones, which may result in a reduction in seizures. To follow a ketogenic diet, you need the assistance of a dietitian, as well as regular urine tests at home to monitor your ketone levels. Even a tiny intake of sugar can significantly reduce the effectiveness of this treatment. In children with severe epilepsy, a third of those on the diet gain control over their seizures, and another third have fewer seizures. For the remainder, however, the diet has no effect. This approach has not been widely studied in adults.