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A tonic-clonic seizure, previously called a grand mal seizure, is a dramatic event characterized by a sudden loss of consciousness and intense muscle contractions. It is the type most commonly associated with seizures in the public imagination. This type of seizure typically begins with a burst of electrical activity in one area of the brain, either as a focal onset that can spread and generalize throughout the brain, affecting behavior and movement globally. During the tonic phase, muscles throughout the body tense up, causing the individual to fall if standing, followed by the clonic phase where muscles begin to contract and relax rhythmically.
Tonic-clonic seizures are often associated with epilepsy, but they can also be triggered by other medical conditions such as severe hypoglycemia, high fever, or stroke. The initial tonic phase results in the stiffening of limbs, while the subsequent clonic phase leads to convulsive movements. These seizures are easily identifiable due to these pronounced physical symptoms.
Although many individuals may experience a tonic-clonic seizure at some point, it does not necessarily indicate a chronic condition. For those with recurrent seizures, ongoing management typically includes anti-seizure medications aimed at reducing the frequency and severity of future episodes. For others, a single seizure may not require further treatment unless subsequent episodes occur.
Symptoms
When most people think about seizures and epilepsy, they normally think of tonic-clonic seizures. The following phases are when the symptoms occur, and they are often more severe and noticeable:
- Tonic phase: This phase usually lasts between 10 and 20 seconds. You may pass out and all of your muscles, particularly your arms and legs, stiffen up, giving the impression that you are raising your tummy and arching your back. You could cry out as your breathing muscles try to expel air out of your lungs. Falling or clenching your teeth and biting your tongue might result in injuries.
- Clonic phase: This phase often last little more than a minute or two. Convulsions, or full-body spasms or shaking, are a characteristic of this phase. You may also froth at the mouth. Convulsions often weaken and slow throughout this period before ending. As this phase comes to an end, you may find yourself unable to control your intestines and bladder, which might result in you having to poop or urinate.
- Post-seizure recovery: This may last longer than 30 minutes or longer. Most people wake up from a seizure and feel exactly the same as they did before. You may frequently have headaches, soreness in your muscles, or confusion. In more severe situations, such as when you experienced status epilepticus, it might take you far longer to wake up.
Some tonic-clonic seizure patients, although not all, have the following signs and symptoms:
- Confusion: When a tonic-clonic seizure occurs, the patient is frequently confused. It’s known as postictal confusion.
- Fatigue: It is typical to feel sleepy following a tonic-clonic seizure.
- Headache: A tonic-clonic seizure may be followed by headaches.
- Loss control of bowel and bladder: This might occur either during or after a seizure.
- Scream: A seizure may start and some people may scream out at that point.
- Unresponsiveness: Even when the seizures stop, the patient might not wake up for a few minutes.
Seek immediate medical attention if the patient encounter seizure for the first time or they experience the following:
- Seizure last longer than five minutes.
- Patient is not breathing when the seizure stops.
- Patient stay unconscious even the seizure stops.
- There is another seizure right away.
- Having high fever.
- Heat exhaustion.
- Pregnant.
- Medical condition such as diabetes.
- Patient was injured during the onset of seizure.
Causes
Nerve cells in the brain typically communicate by sending chemical and electrical signals through the connections that bind them. Tonic-clonic seizures occur when there is a surge in electrical activity across the surface of the brain, leading to a high rate of simultaneous firing of nerve cells. The precise causes of these changes occurring frequently remain unclear.
Tonic-clonic seizures can occasionally be brought on by underlying medical issues, such as:
- Infection or injury.
- History of infections, such as encephalitis or meningitis.
- Injury caused by previous lack of oxygen.
- Stroke.
- Traumatic head injuries.
- Congenital or developmental factors
- Brain tumors.
- Genetic diseases.
- Improperly formed blood vessels in the brain.
- Metabolic issues
- Blood levels of glucose, sodium, calcium or magnesium are extremely low.
- Withdrawal syndromes
- Drugs or alcohol withdrawal.
- Drugs and alcohol (include prescription medications, recreational drugs and even caffeine).
Risk factors
The factors increase the risk for tonic-clonic seizures may include:
- People over 65 and children are more likely to get seizures.
- Having a family member with history of seizure disorders.
- History of any brain trauma, stroke, infections or other causes that may injure the brain.
- Sleep deprived individuals.
- Electrolyte imbalance caused by a medical condition.
- Use of illegal drugs.
- Heavy alcohol consumption.
Diagnosis
Healthcare providers are going to attempt to determine if a seizure was provoked or unprovoked while making a diagnosis.
- Provoked: These occur in certain situations or as the result of other medical conditions (high fevers, low blood sugar, prescription or illicit drug use, alcohol or drug withdrawal).
- Unprovoked: These seizures do not appear to be the result of an acute or chronic medical problem. Seizures occurring longer than seven days following a particular reason (such as a brain injury or stroke) are also included.
A focal point, or region of the brain where seizures frequently or always begin, is what a healthcare provider will look for when diagnosing epilepsy. Your treatment plan may change significantly if you are able to identify a focus point.
See a healthcare provider after a seizure to go over your symptoms and medical background in detail. Several tests can be required to identify the reason behind your seizure. The tests are able to determine the probability that you will experience another one.
- Neurological examination: Your behavior, motor skills, and mental function may be tested. It helps in identifying whether there is a problem with your nervous system or brain.
- Blood tests: An examination of a blood sample might reveal symptoms of infections, hereditary disorders, hyperglycemia, or electrolyte abnormalities.
- Lumbar puncture or spinal tap: To determine whether an infection was the possible cause of the seizure, you might need to have a sample of your cerebrospinal fluid taken by lumbar puncture or spinal tap.
- Electroencephalogram (EEG): This test records the electrical activity of your brain using flat metal discs called electrodes that are applied to your head. An EEG recording will display them as wavy lines. A seizure’s propensity to recur can be inferred from an EEG pattern. Excluding other disorders that could trigger a seizure may also be aided by EEG testing.
- Computerized tomography (CT) scan: A CT scan creates cross-sectional pictures of your brain using X-rays. CT scans can identify brain cysts, tumors, and bleeding that could result in seizures.
- Magnetic resonance imaging (MRI): Strong magnets and radio waves are used in an MRI to provide a detailed image of your brain. The brain’s structure is visible on an MRI. This may assist in identifying the possible seizure cause.
- Positron emission tomography (PET): A little quantity of low-dose radioactive material is injected into a vein during a PET scan. The information assists in the visualization of brain activity regions. This can assist a healthcare provider in determining the seizure’s location.
- Single-photon emission computerized tomography (SPECT): Small doses of radioactive material are injected into a vein during a SPECT examination. The test generates a comprehensive, three-dimensional picture of the blood flow activity in your brain during a seizure. You can be scheduled for a subtraction ictal SPECT coregistered to magnetic resonance imaging (SISCOM), which is a type of SPECT examination. This can contrast blood flow during a seizure with interstice blood flow.
Treatment
A variety of treatments exist for all types of seizures, including those specifically for tonic-clonic seizures often associated with epilepsy. Not all seizures necessarily occur in succession. Sometimes, treatment might be delayed until multiple seizures have occurred, as a single seizure can be a one-off event. Typically, treatment includes medication to prevent further seizures.
- Medications: Medications administered intravenously (IV) can be used to stop a seizure, though this is often limited to situations with status epilepticus. Additionally, you can reduce the frequency of seizures or perhaps avoid them altogether by taking pills every day. When epilepsy causes seizures, medications are usually the primary line of therapy.
Selecting the appropriate medication and dose might be difficult. Initially, a healthcare provider will probably just prescribe one medication at a moderate dosage. The healthcare provider may then progressively increase the dosage until your seizures are under control.
Many people with epilepsy can stop having seizures with just one medication. Others, nevertheless, require many. You might need to attempt a two-drug combination if you’ve attempted two or more single-drug regimens without results.
Take medications exactly as advised in order to attain the greatest possible control over your seizures. Always get medical advice before using additional medications. This covers over-the-counter medications, prescription drugs, and herbal treatments. Additionally, never stop taking your medication without first consulting with your healthcare provider.
Lamotrigine has occasionally been associated with a higher incidence of aseptic meningitis. An inflammation of the membranes covering the brain and spinal cord is known as aseptic meningitis. Though not brought on by germs, the illness resembles bacterial meningitis.
Inflammation and symptoms such as rash, fever, enlarged lymph nodes, and swelling of the face or eyes can be brought on by levetiracetam with clobazam. The response may cause harm to the liver, kidneys, lungs, heart, or pancreas if treatment is delayed. It may also result in death.
Always consult with a healthcare provider before stopping these medications. Seizures may reappear if the medications are abruptly stopped.
- Surgery and other therapies: In cases where anti-seizure medications are ineffective, alternative treatments might be considered:
- Surgery: When you attempt two anti- seizure medications at acceptable dosages and your seizures continue, healthcare providers usually advise screening you for epilepsy surgery. The purpose of surgery is to prevent seizures. The region of your brain where seizures occur is located and removed by surgeons. For those whose seizures consistently start in the same area of their brains, surgery is the most effective treatment.
- Vagus nerve stimulation: The vagus nerve in your neck is stimulated by a device that is inserted beneath the skin of your chest. Your brain receives messages from this that prevent seizures. You might be able to reduce the dosage of your medication using vagus nerve stimulation, but you might still need to take it.
- Deep brain stimulation: A surgeon inserts electrodes into certain brain regions in order to provide this treatment. Electrical impulses generated by the electrodes control brain function. The electrodes are attached to a device beneath your skin in your chest that resembles a pacemaker. The level of stimulation generated is adjustable using this device.
- Responsive neurostimulation: A device implanted within brain tissue or on the surface of the brain can detect seizure activity during responsive neurostimulation. To halt the seizure, the device can stimulate the identified region electrically.
- Dietary therapy: The ketogenic diet, which is low in carbs and rich in fat, has been shown to enhance seizure management. While less effective, ketogenic diet modifications can still be beneficial. These consist of the modified Atkins diet and the low glycemic index diet. They can also be helpful if surgery is not necessary or desired.
- Pregnancy and seizures: Pregnant women with a history of seizures are typically able to give birth to healthy babies. There are occasions when some medications might cause birth abnormalities.
Valproic acid in particular has been linked to neural tube abnormalities such spina bifida and cognitive impairments. The risks to the unborn child make it recommended by the healthcare providers that women refrain from using valproic acid while pregnant. If at all possible, avoid using valproic acid during the first trimester of pregnancy.
Speak with a healthcare provider about these risks. Planning ahead for conception is especially crucial for women who have experienced seizures. Not only can pregnancy increase the chance of birth abnormalities, but it can also change medication levels. Occasionally, before or during pregnancy, it could be advisable to adjust the dosage of seizure medication. Rarely, medications may need to be switched.
- Contraception and anti-seizure medications: You should be aware that certain anti-seizure medications may reduce the effectiveness of oral contraceptives, which are a kind of birth control. Additionally, the metabolism of several seizure medications may be accelerated by oral contraceptives. To find out if your medication interferes with your oral contraceptive, see a healthcare provider. Find out if you should think about using alternative kinds of contraception.
