Generalized tonic-clonic seizures, or grand mal seizures, affect the whole body. They usually involve rigid muscles, severe muscle contractions, and loss of consciousness (fainting). People of any age can have them, as a single seizure or part of epilepsy.
Abnormal activity of brain nerve cells occurring at the same time in many parts of the brain causes these seizures. Seizures may be brought on by head injuries, strokes, brain infections, very low blood sugar, and tumors. More than half the time, the cause is unknown.
These seizures involve four phases. Often signs (auras) warn of a coming seizure. Auras include an odd feeling, strange taste or odor, and headache. Phase 2 (tonic phase) consists of rigid stiffening of the body for a minute or less, and fainting. The tonic-clonic phase (phase 3) appears as strong muscle contractions and relaxations and convulsions and can last several minutes. Loss of consciousness and loss of bladder and/or bowel control may occur. People may have trouble breathing or temporarily stop breathing. Just after a seizure is the postictal phase (phase 4). People slowly return to consciousness.
Lasting tonic-clonic seizures are an emergency called “status epilepticus.”
The health care provider will make a diagnosis from a medical history and physical examination. The health care provider will do electroencephalography (EEG), a test to check the electrical activity in the brain. Magnetic resonance imaging (MRI) or computed tomography (CT) will be done to get pictures of the brain. Blood tests will also be done to check for other causes of seizures. A doctor who specializes in disorders of the nervous system (neurologist) may be involved in your care.
The main treatment is medicine. Sometimes more than one anticonvulsant drug may be used. The health care provider may get blood samples periodically to make sure that the correct dose is being used. Often, medicine will reduce the frequency and severity of seizures, but some people may continue to have them.
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