Generalized tonic-clonic seizure

• Alternative Names

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

• Symptoms

  Many patients have an aura (a sensory warning sign) before the seizure. This can include vision, taste, smell, or sensory changes, hallucinations, or dizziness.

  The seizure itself involves:

  • Loss of consciousness or fainting, usually lasting between 30 seconds and 5 minutes
  • General muscle contraction and rigidity (tonic posture), usually lasting 15 - 20 seconds
  • Violent rhythmic muscle contraction and relaxation (clonic movement), usually lasting for 1 -2 minutes
  • Biting the cheek or tongue, clenched teeth or jaw
  • Incontinence (loss of urine or stool control)
  • Stopped breathing or difficulty breathing during seizure
  • Blue skin color

  Almost all people lose consciousness, and most people have both tonic and clonic muscle activity.

  After the seizure, the person usually has:

  • Normal breathing
  • Sleepiness that lasts for 1 hour or longer
  • Loss of memory (amnesia) regarding events surrounding the seizure episode
  • Headache
  • Drowsiness
  • Confusion, temporary and mild
  • Weakness for up to 24 - 48 hours following seizure (This is called Todd's paralysis.)
• References

  Foldvary-Schaefer N, Wyllie E. Epilepsy. In: Goetz CG. Textbook of Clinical Neurology. 3rd ed. St. Louis, Mo: WB Saunders; 2007.

  Marx J. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 5th ed. St. Louis, Mo: Mosby; 2002.

  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(21):1996-2007.

  Spencer SS. Seizures and epilepsy. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007.

  Tomson T, Hiilesmaa V. Epilepsy in pregnancy. BMJ. 2007;335(7623):769-773.

  Sheth RD, Hardin CL. Screening for bone health in epilepsy. Epilepsia. 2007;48:39-41

Review Date: 3/28/2009

Reviewed By: Reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc., and David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine.