Generalized tonic-clonic seizure
Alternative names:
grand mal seizure; seizure - generalized; seizure - grand mal; seizure - tonic-clonic
Treatment:
If a seizure occurs, give appropriate emergency first aid.
EMERGENCY FIRST-AID TREATMENT during a generalized tonic-clonic seizure:
Protect the person from injury. Do not attempt to force a hard object (such as a spoon, or a tongue depressor, etc.) between the teeth. You can cause more damage than you are trying to prevent! Clear the area of furniture or other objects that may cause injury from falls during the seizure. Do not attempt to restrain or hold the person down during the seizure.
Protect the person from aspiration (inhaling of fluid into the lungs) of vomit or mucus. Turn the person to the side if vomiting occurs. Keep the person on his or her side while sleeping after the seizure is over.
If the person having a seizure turns blue or stops breathing, try to position the head to prevent the tongue from obstructing the airway. Breathing usually starts on its own once the seizure is over. CPR or mouth-to-mouth breathing is rarely needed after seizures and cannot be performed during the seizure. Repeated or prolonged seizures (status epilepticus) may cause severe lack of oxygen in the body and are an emergency situation requiring immediate professional assistance!
MEDICAL EMERGENCY TREATMENT (status epilepticus):
Measures to protect the airway may be needed, including use of tubes to keep the airway open. Breathing should be supported as needed.
Thiamine and/or intravenous glucose may be given.
Medications such as diazepam (Valium) or lorazepam, or anticonvulsant medications such as phenytoin, phenobarbital may control prolonged, repeated generalized seizures. They are usually injected into a vein. Other medical treatment may be indicated, including the use of general anesthesia with neuromuscular blockade (muscle paralyzing medications).
After status epilepticus is controlled, oral anticonvulsants are begun and tests are performed to determine the cause of the condition.
AFTER THE SEIZURE
Treat any injuries from bumps or falls.
Record details of the seizure to report to the health care provider. Important details include the date and time of the seizure, how long it lasted, which body parts were affected, the type of movements or other symptoms, possible causes, behavior after the seizure, and other factors noted.
The treatment of causes, if the cause has been identified, may stop seizures. This may include medical treatment of disorders, surgical repair of tumors or brain lesions, or other treatments. An isolated seizure with an obvious, avoidable trigger (such as fever and toxic reactions) is treated by removal or treatment of the precipitating (trigger) factor.
An isolated seizure without obvious precipitant (the examination and EEG are normal and there are no abnormalities on other testing) may not require treatment.
Oral anticonvulsants (anti-seizure medications) may be used to prevent or reduce the number of future grand mal seizures. The response is individual, and the medication used and dosage may have to be adjusted repeatedly. The anticonvulsant medications used may include phenytoin, carbamazepine, phenobarbital, or valproic acid.
The follow-up includes review of the need for drugs at least yearly. Drugs may need to be continued indefinitely. Plasma drug-level monitoring may be advised.
Pregnancy; lack of sleep; skipping doses of medications; use of drugs, medications or alcohol; or illness may cause seizures in a person with a previously well-controlled seizure disorder.
The use of informational jewelry or cards (such as Medic-Alert or similar ones) that indicate a seizure disorder may be advised to aid in obtaining prompt medical treatment if a seizure occurs.
Expectations (prognosis):
Seizures can occur as a single isolated occurrence, as closely repeated (recurrent multiple seizures indicates), or at various intervals (episodic, paroxysmal). Seizures that recur with little or no observable cause are most commonly associated with seizure disorders (epilepsy). This is a chronic, lifelong condition.
Seizures that occur singly or in a closely associated group are commonly from an acute condition such as brain injury. They may occur as an isolated incident or may develop into a chronic seizure disorder. Seizures within the first 2 weeks of a brain injury do not necessarily mean that a chronic seizure disorder will develop.
A seizure-free period may indicate that reduction or elimination of medications may be possible. Medications should be changed only under the supervision of the health care provider.
Death or permanent brain damage from seizures is rare. A serious injury can occur if seizure occurs during driving or when operating dangerous equipment; these activities are often restricted.
Infrequent seizures may not severely restrict the patients lifestyle. Work, school, and recreation do not necessarily need to be restricted.
Complications:
- recurrent seizures (seizure disorder)
- prolonged seizures, closely occurring seizures (status epilepticus)
- injury from falls, bumps and biting yourself
- injury if seizure occurs during driving and/or operating machinery
- aspiration of fluid into the lungs, pneumonia
- permanent brain damage (stroke or other damage)
- side effects of medications (with or without observable symptoms)
Calling your health care provider:
Call your health care provider or go to the emergency room if this is the first time the person has had seizures or this is a new type of seizure for the person.
Call your health care provider if any new symptoms occur, including possible side effects of medications such as changes in mental status (drowsiness, restlessness, confusion, sedation, or others), nausea/vomiting, rash, loss of hair, tremors or abnormal movements, or problems with coordination.
Call your health care provider immediately or go the emergency room, or dial your local emergency number (911) for any of these emergency situations: repeated seizures occurring (over any amount of time), seizure lasting longer than 2 to 3 minutes, repeated seizures over a few minutes or repeated seizures where consciousness is not regained between them (status epilepticus).
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