Generalized tonic-clonic seizure

Alternative names:

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

Symptoms:

Before the seizure

• aura (sensory warning sign) preceding seizure in some people
  • visual, taste, smell, sensory, or other hallucination
  • dizziness
  • usually a similar type of aura for later seizures in the same person

Seizure:

• loss of consciousness or fainting , usually lasting 30 seconds to 5 minutes
• tonic posturing (general muscle contraction and rigidity) usually lasting15 to 20 seconds
• clonic movement (violent rhythmic muscle contraction and relaxation) usually lasting for 1 to 2 minutes
• biting of cheek or tongue, clenched teeth and/or jaw
• incontinence (loss of control) of urine and/or stool
• breathing difficulty
  • stop breathing or difficulty breathing during seizure
  • blue skin color

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

After the seizure:

• usually begin breathing normally when seizure is over
• arousable but sleepy for 1 hour or longer
• loss of memory (amnesia), partial (amnesia regarding events surrounding the seizure episode)
• a headache
• drowsiness
• confusion, temporary and mild

Signs and tests:

Diagnosis of a grand mal seizure is based on the symptoms presented. 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).

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

• a CBC
• a 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:
a head CT or MRI scan
a lumbar puncture (spinal tap)

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