Generalized tonic-clonic seizure

Definition

A generalized tonic-clonic seizure is a seizure involving the entire body. It is also called a grand mal seizure. The terms "seizure," convulsion," or "epilepsy" are most often associated with generalized tonic-clonic seizures.

For more information see:

Alternative Names

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

Causes

Generalized tonic-clonic seizures may occur in people of any age. They may occur once (single episode), or as part of a repeated, chronic condition (epilepsy).

Symptoms

Many patients with generalized tonic-clonic seizures have vision, taste, smell, or sensory changes, hallucinations, or dizziness before the seizure. This is called an aura.

The seizures usually involve muscle rigidity, followed by violent muscle contractions, and loss of alertness (consciousness).Other symptoms that occur during the seizure may include:

Biting the cheek or tongue
Clenched teeth or jaw
Loss of urine or stool control (incontinence)
Stopped breathing or difficulty breathing
Blue skin color

After the seizure, the person may have:

Normal breathing
Sleepiness that lasts for 1 hour or longer
Loss of memory (amnesia) regarding events surrounding the seizure episode
Headache
Drowsiness
Confusion
Weakness of one side of the body for a few minutes to a few hours following seizure (called Todd's paralysis)

For more information about diagnosis and treatment, see:

References

Duvivier EH, Pollack Jr CV. Seizures. In: Marx, JA, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 7th ed. Philadelphia, Pa: Mosby Elsevier; 2009: chap 100.

Kornblau DH, Conway Jr EE, Caplen SM. Neurologic Disorders. In: Marx JA, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 7th ed. Philadelphia, PA: Mosby Elsevier; 2009: chap 173.

Krumholz A, Wiebe S, Gronseth G, et al. Practice parameter: evaluating an apparent unprovoked first seizure in adults (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology and the American Epilepsy Society. Neurology. 2007;69:1991-2007.

Schachter SC. Seizure disorders. Med Clin North Am. March 2009;93(2).

Trescher WH, Lesser RP. The Epilepsies. In: Bradley WG, Daroff RB, Fenichel GM, Jakovic J, eds. Neurology in Clinical Practice. 5th ed. Philadelphia, Pa; Butterworth-Heinemann; 2008: chap 71.

Walker SP, Permezel M, Berkovic SF. The management of epilepsy in pregnancy. BJOG. 2009;116(6):758-67.

Review Date: 2/9/2012
Reviewed By: Luc Jasmin, MD, PhD, Department of Neurosurgery at Cedars-Sinai Medical Center, Los Angeles, and Department of Anatomy at UCSF, San Francisco, CA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Health Solutions, Ebix, Inc.

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