Description

A tonic-clonic seizure, formerly known as a grand mal seizure causes a loss of consciousness and violent muscle contractions. It is the type of seizure most people picture when they think about seizures.

During a seizure, there is an explosion of electrical activity in the brain that causes changes in the behavior and movements. The seizures can be focal, that is to say, the burst of electrical activity that occurs in an area of the brain. Or seizures may be generalized, in which are the result of electrical activity in all the areas of the brain. Tonic-clonic seizures may begin as focal seizures in a small area of the brain and spread to become generalized seizures involve the whole brain.

Focal and generalized seizures have different symptoms. People who have generalized seizures tend to lose consciousness. But people who have focal seizures may or may not lose consciousness. In tonic-clonic seizures, the muscles to become rigid, causing the person to fall. Then, the muscles alternately flex and relax.

In general, a tonic-clonic seizure is caused by epilepsy. But sometimes this type of attack can be triggered by other health problems, such as high fever or damage in the brain.

Some people who have a tonic-clonic seizure does not have another and don't need treatment. But someone who has recurrent seizures may require daily treatment of anti-seizure medications to control and prevent future generalized tonic-clonic seizures. The surgery and the changes in the diet may also be options to control your seizures.

Symptoms

Tonic-clonic seizures has two phases:

  • Tonic phase. Often, someone in the tonic phase will make a sound, like a moan or a cry. The muscle suddenly becomes stiff and cause the person to fall. Loss of consciousness occurs. This phase usually lasts about 10 to 20 seconds.
  • Clonic phase. The muscles go to the rhythmic contractions. The arms and the legs are often a jerk. Alternately flex and relax. The seizures usually last 1 to 2 minutes or less.

The following symptoms are present in some but not all people with tonic-clonic seizures:

  • Loss of bowel and bladder function. This can occur during or after a seizure.
  • Does not respond after seizures. The person may not be conscious for several minutes after the seizure has ended.
  • Confusion. The person is often disoriented after a tonic-clonic seizure. This is known as the confusion poststroke.
  • Fatigue. Sleepiness is common after a tonic-clonic seizure.
  • Strong headache. Headaches may occur after a tonic-clonic seizure.

When to see a doctor

Call 911 or emergency medical help if:

  • The seizure lasts more than five minutes.
  • Of the breath or of the consciousness of no return after the seizure stops.
  • A second attack follows immediately.
  • You have a high fever.
  • You are suffering from heat exhaustion.
  • You're pregnant.
  • You have diabetes.
  • You've injured during the seizure.

If you experience a seizure for the first time, consult a health care professional.

Also consult a health professional if you or your child:

  • Experiences of a growing number of attacks for no apparent reason.
  • Notices of new symptoms of the attack.

Causes

The nerve cells in the brain normally communicate by sending electrical and chemical signals across the synapses that connect the cells. A synapse is the area between the cells that allow them to send messages. Generalized tonic-clonic seizures occur when there is an increase of the electrical activity on the surface of the brain. Many of the nerve cells fire at the same time, much faster than usual. Exactly what causes these changes are often not known.

However, tonic-clonic seizures are sometimes caused by other health problems, such as:

  • Injury or infection. Serious head injuries can cause generalized tonic-clonic seizures. Other possible causes include infections, such as encephalitis or meningitis, or having these infections in the past. Stroke and dementia that causes degeneration in the brain, such as Alzheimer's disease, can also cause generalized tonic-clonic seizures.
  • Congenital or developmental factors. These may include blood in the vessels do not form properly in the brain, and brain tumors.
  • Metabolic problems. Very low blood levels of glucose, sodium, calcium, or magnesium can cause generalized tonic-clonic seizures.
  • Withdrawal syndromes. These may include the use or the withdrawal of drugs, including alcohol.

Risk factors

The risk factors of generalized tonic-clonic seizures include:

  • A family history of seizure disorders.
  • Any injury to the brain from trauma, a stroke, previous infection, and other causes.
  • Sleep deprivation.
  • Medical problems that affect the balance of minerals in the body.
  • The use of illicit drugs.
  • The excessive use of alcohol.

Complications

Seizures in certain moments, it can be dangerous to you or others. You could be at risk of:

  • The fall of. If you fall during a seizure, you can injure your head or break a bone.
  • Drowning. If you have an attack while swimming or bathing, you are at risk of accidental drowning.
  • Car accidents. A seizure that causes a loss of consciousness or control can be dangerous if you are driving a car or operating other equipment.
  • Complications in pregnancy. Seizures during pregnancy pose dangers to the mother and the baby. And certain anti-epileptic drugs increase the risk of birth defects. If you have epilepsy and you plan on becoming pregnant, discuss with a health care professional. The medications may need to be adjusted. A health professional is likely that the monitor of your pregnancy.
  • Emotional health problems. People with seizures are more likely to have depression and anxiety. Children with seizures may be more likely to develop attention deficit hyperactivity disorder, also called ADHD. Emotional health problems may be a result of dealing with the disease itself or as a result of medication side effects.

Diagnosis

After a seizure, please consult a health professional to thoroughly review your medical history and symptoms. You may need several tests to determine the cause of your seizures. The tests can assess how likely it is that you are going to have another.

Tests may include:

  • Neurological examination. You can have a test of their behavior, ability to move and control of their muscles, and the ability to think, understand and solve problems. This helps to determine if there is a health problem with your brain or other parts of your nervous system.
  • Blood tests. A blood sample can detect symptoms of infections, the levels of blood sugar or electrolyte imbalances.
  • Lumbar puncture, also known as a spinal tap. You may need to take a sample of cerebrospinal fluid removed to test if an infection that could have caused the attack.
  • Electroencephalogram (EEG). In this test, flat metal discs called electrodes attached to your scalp to record the electrical activity of your brain. This shows up as wavy lines on an EEG. The EEG may reveal a pattern that indicates whether an attack is likely to occur again. EEG tests can also help rule out other conditions that could cause a seizure.
  • Computed tomography. A ct scan uses X-rays to obtain cross-sectional images of the brain. The ct scan can reveal tumors, bleeding and cysts in the brain can cause a seizure.
  • The magnetic resonance imaging. An mri uses powerful magnets and radio waves to create a detailed view of your brain. A magnetic resonance imaging shows the structure of the brain. This can help you determine what may be the cause of the seizures.
  • Positron emission tomography (PET). PET scans use a small amount of low-dose radioactive material that is injected into a vein. The material helps to visualize the active areas of the brain. This can help a health care professional to see where the attacks are occurring.
  • Single-photon emission computed tomography (SPECT). A SPECT test uses a small amount of low-dose radioactive material that is injected into a vein. The test creates a detailed 3D map of the blood flow and the activity of your brain that occurs during a seizure. You can have a form of SPECT test called the subtraction SPECT ictal coregistered to magnetic resonance imaging, also called SISCOM. This can compare the flow of blood during an attack by the flow of blood in between seizures.

Treatment

Not everyone who has a seizure the other. Because an attack may be an isolated incident, you can't start treatment until you have had more than one. Generally, treatment includes the use of anti-epileptic drugs.

Drugs

Many of the medicines used in the treatment of epilepsy and seizures. These are usually taken daily by mouth to help prevent seizures. Different medicines can be prescribed based on factors such as your specific seizure type and frequency, and their personal considerations, such as your age, and whether or not you are pregnant.

Finding the right medication and dosage can be a challenge. A healthcare provider will probably prescribe a single drug at a relatively low dosage, then the dose can be increased gradually until your seizures are well controlled.

Many people with epilepsy are able to prevent seizures with a single drug. But others need more than one. If you've tried two or more single-drug regimens without success, you may need to try a combination of medications.

For the best seizure control possible, take medicines exactly as prescribed. Ask a health professional before adding other medications or stop your medicine. This includes prescription, over-the drugs available without a prescription or herbal remedies.

Mild side effects of anticonvulsant drugs may include:

  • Fatigue.
  • The dizziness.
  • The increase of weight.

More troubling side-effects need to be brought to the attention of a health professional immediately. They include:

  • Changes of mood.
  • Rashes on the skin.
  • Loss of coordination.
  • Problems with speech.
  • The extreme fatigue.
  • Swollen lymph nodes.
  • Swelling of the face, or eyes, or painful sores in the mouth or around the eyes.
  • Difficulty swallowing or breathing, even during exercise.
  • The discoloration of the skin or eyes, such as a yellow color.
  • Bruising and bleeding that is not typical.
  • The fever and muscle pain.

In rare cases, the medicine lamotrigine has been linked to an increased risk of aseptic meningitis. Aseptic meningitis is an inflammation of the protective membranes that cover the brain and spinal cord. The disease is similar to bacterial meningitis, but is not caused by bacteria.

The Food and Drug Administration has warned that two anti-epileptic drugs can cause a severe reaction, although it happens on rare occasions. Levetiracetam and clobazam may cause inflammation and symptoms that include a rash, fever, swollen lymph nodes, and swelling of the face or the eyes. Without quick treatment, the reaction may cause damage to the organs, including the liver, kidneys, lungs, heart, or pancreas. It can also lead to death.

These symptoms can begin within 2 to 8 weeks after starting levetiracetam or clobazam, but symptoms can also occur before or after. Get emergency medical help if you take these medications and experience a reaction, or any of these severe symptoms.

Talk with your health care professional before you stop taking these medicines. You suddenly stop taking the medication may cause seizures to return.

Surgery and other treatments

When the anti-epileptic drugs are not effective, other treatments may be an option:

  • Surgery. The goal of surgery is to stop the seizures from occurring. May be an option if you have tried two different medications and do not prevent seizures. Surgeons locate and remove the area of your brain where seizures begin. The surgery works better for people who have seizures that originate in the same place in their brains.
  • Stimulation of the vagus nerve. A device that is placed under the skin of your chest stimulates the vagus nerve in the neck. This sends signals to the brain to stop seizures. With the stimulation of the vagus nerve, you may need to take medications, but you may be able to reduce the dose.
  • Responsive neurostimulation. During responsive neurostimulation, a device implanted in the surface of the brain or in the brain tissue can detect seizure activity. The device can deliver an electrical stimulation to the detected area to stop the attack.
  • The deep brain stimulation. For this therapy, a surgeon implants electrodes within certain areas of the brain. The electrodes produce electrical impulses that regulate the activity of the brain. The electrodes attach to a pacemaker-like device that is placed under the skin of your chest. This device controls the amount of stimulation it produces.
  • Diet therapy. A diet that is high in fat and protein and low in carbohydrates, known as a ketogenic diet, it can improve the control of seizures. The variations of the ketogenic diet are less effective, but may provide benefit. They include low-glycemic index of the diet and the modified Atkins Diet.

Pregnancy and seizures

Women who have had seizures usually are able to have healthy pregnancies. Birth defects associated with certain medications can sometimes occur.

In particular, valproic acid has been associated with cognitive deficits and neural tube defects, such as spina bifida. The American Academy of Neurology recommends that women do not use valproic acid during pregnancy due to the risks to your baby.

You can talk about these risks with a health care professional. Planning before pregnancy, it is particularly important for women who have had seizures. In addition to the risk of birth defects, pregnancy can alter the medicine of the levels.

In some cases, it may be desirable to change the doses of anti-seizure medication before or during pregnancy. In rare cases, your health care professional may consider the ability to change your medications.

Contraceptives and anti-seizure medications

It is also important to know that some anti-seizure medicines can make oral contraceptives — a form of birth control less effective. Also, some oral contraceptives may accelerate the metabolism of the anti-epileptic drugs. Consult with a health care professional to assess whether your medication interacts with your oral contraceptive. Ask if other forms of contraception should be considered.

Lifestyle and home remedies

Here are some steps you can take to help control attacks:

  • Take the medication correctly. Do not adjust the dose before you talk with a health care professional. Tell your health care professional if you feel that your medication needs to be changed.
  • Get enough sleep. Lack of sleep can trigger seizures. Make sure you get enough rest each night.
  • Wear a medical alert bracelet. This helps emergency personnel know how to properly treat if you have another attack.

Personal safety

The seizures do not usually result in serious injury. But the injury is possible if you have recurrent seizures. These steps can help you stay safe during an attack:

  • Be careful near the water. Do not swim alone or ride in a boat without someone nearby.
  • Wear a helmet for protection during activities such as riding a bike, or participate in sports.
  • Take showers instead of baths, unless someone is close to you.
  • Modify your furniture. The pad corners, buy furniture with rounded edges and choose the chairs that have arms to prevent the fall of the chair. Consider the carpet with thick padding to protect you if you fall.
  • Show the seizure first aid tips in a place where people can easily see. Include any of the important phone numbers, as well.

Seizure first aid

It is useful to know what to do if you witness someone having a seizure. If you are at risk of having a seizure in the future, pass this information along to your family, friends and work colleagues so that they know what to do.

To help someone during a seizure:

  • Carefully roll the person onto one side.
  • Place something soft under the person's head.
  • Loosen tight clothing around the neck.
  • Remove contact lenses.
  • Do not put fingers or other objects into the mouth of the person.
  • Do not try to hold on to someone who is having a seizure.
  • Clear away dangerous objects if the person is in motion.
  • Stay with the person until medical personnel.
  • Observe with attention to the person who can give details about what happened.
  • The duration of the attack.
  • Verification of a medical alert bracelet or ID.
  • Keep calm.

Coping and support

It can be stressful to live with a seizure disorder. Stress can affect your mental health, so it is important to talk with a health professional about their feelings, which may suggest ways in which you can find help.

Home

Your family can provide the necessary support. Tell them what you know about your seizure disorder. Let them know they can ask questions, and be open to conversations about your concerns. To help them understand their condition by sharing educational materials, or other resources.

On the job

Meet with your supervisor and talk about his seizure disorder and how it affects you. Discuss what you need from your supervisor or coworkers if the attack occurs on the job. Consider talking with your colleagues about seizure disorders. This can help you to expand your support system. You may also bring about acceptance and understanding.

You are not alone

Remember, you don't have to do it alone. Reach out to family and friends. Ask your health care professional about local support groups, or join an online support community. Don't be afraid to ask for help. Having a strong support system is important for those living with any medical condition.

Preparing for your appointment

Sometimes seizures need immediate medical attention, and there is time to prepare for an appointment.

If the seizure was not an emergency, please make an appointment with a health care professional. You may be referred to a specialist, such as a doctor trained in brain and nervous system conditions, known as a neurologist. Or you may be referred to a neurologist trained in epilepsy, known as an epileptologist.

To prepare for your appointment, consider what you can do to prepare and understand what to expect.

What you can do

  • Record the information about the seizure. It includes the time, location, symptoms experienced, and how long it lasted, if you know these details. Search for the entry of any person who has seen the seizure, such as a family member, friend or work colleague. Record of the information provided.
  • Write down any symptoms you or your child has experienced. Include any of the symptoms that may seem unrelated to the reason for which you scheduled the appointment.
  • Make a list of all the medicines, vitamins, and supplements you are taking. Include the doses used for each one. Also write down the reasons why you stopped taking any medication. Note if you have stopped taking the drug due to side effects or lack of efficacy.
  • Ask a member of the family with you. It can be difficult to remember everything that I have said to you during your appointment. And since the loss of memory can occur during seizures, an observer may be able to better describe the crisis.
  • Write down your questions.

Prepare a list of questions that help make the most of your time to your appointment. For seizures, some basic questions to ask include:

  • I have epilepsy?
  • I'm going to have more attacks?
  • What kinds of tests do I need? Do these tests require any special preparation?
  • What treatments are available and which do you recommend?
  • What types of side effects can I expect from treatment?
  • Are there any alternatives to the primary approach you're suggesting?
  • Is there a generic alternative to the medicine you're prescribing?
  • What do I need to restrict the activities?
  • Are there brochures or other printed material that I can take my house? What sites do you recommend?

Do not hesitate to ask any questions that occur to you.

What to expect from your doctor

A health professional is likely to ask a series of questions, such as:

  • When you or your child begin to experience the symptoms?
  • How many attacks have had your child?
  • How is the frequency of the attacks occur? How long does it last?
  • Can you describe a typical seizure?
  • Do seizures occur in clusters?
  • Not all look the same, or are there different seizure of the behaviors that you or other people have noticed?
  • What are the medicines that you or your child you tried? What dose is used?
  • Have you tried combinations of drugs?
  • Have you noticed any seizure triggers such as sleep deprivation or disease?
The symptoms and the treatment of generalized Tonic-clonic seizures (grand mal) seizure