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:

• Seizures
• Epilepsy

Alternative Names

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

Causes, incidence, and risk factors

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:

• Epilepsy
• Seizures

Signs and tests

Treatment

Support Groups

Expectations (prognosis)

Complications

Calling your health care provider

Prevention

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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.