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Generalized Tonic-clonic Seizure

Alternate Names

  • grand mal seizure
  • Brain structures

Definition

Seizures are caused by sudden, spontaneous discharges of electrical impulses from brain cells that can spread to other brain cells. Generalized tonic-clonic seizures were formerly called grand mal seizures and result when these spontaneous discharges are diffuse, involving both sides of the brain.

What is going on in the body?

Neurons are the nerve cells within the brain. They coordinate movement, thinking, personality, and sensory activities. Neurons communicate with each other through electrical discharges. A seizure occurs when excitable neurons give off abnormal electrical discharges.
There are different types of seizures depending on where the excitable neurons are located and by the symptoms and signs they cause.. Epilepsy is diagnosed when an individual has a repeating pattern of seizures.
Seizures are divided into two main types: generalized and partial. Generalized seizures affect the entire brain. The person loses consciousness or awareness of the environment. Partial seizures affect only one part of the brain. Generalized tonic-clonic seizures affect the whole brain.

Risks

What are the causes and risks of the condition?

Seizures have many causes; however, the causes of generalized seizure typically include:
  • failure to take prescription anti-seizure medications as directed, in an individual with a known seizure disorder
  • generalization of a partial seizure due to the spread of the abnormal electrical discharge to both sides of the brain
  • metabolic disturbances such as hypoglycemia (low blood sugar) and electrolyte disturbances such as low sodium, calcium, or magnesium
  • alcohol or drug use or withdrawal
  • chromosomal abnormalities
  • congenital diseases or conditions
  • acute, severe high blood pressure
  • pregnancy and its complications
  • advanced liver disease
  • Alzheimer's disease or other types of dementia
  • hereditary diseases
  • infections involving the brain, including encephalitis, brain abscess, and bacterial meningitis
  • kidney failure, such as chronic renal failure
  • hypoxic/anoxic injury during birth or in the uterus
  • poisonous insect bites or stings
  • high fever, especially in young children
  • lead poisoning
  • overheating
  • thyroid disease
  • withdrawal from some medicines, including those used to treat seizures

Prevention

What can be done to prevent the injury?

For individuals with a known seizure history, adhering to the anti-seizure medication regimen prescribed by the healthcare professional is the best prevention. Proper management of conditions such as diabetes mellitus, thyroid disease, kidney disease, and liver disease can help prevent seizures related to complications from these disorders.
In addition, by reducing excessive alcohol use, a person decreases his or her risk of seizures. However, if a person with alcoholism stops drinking completely, the risk of withdrawal seizures increases in the short term. A sudden withdrawal from certain medicines, such as phenobarbital, or benzodiazepines such as diazepam (i.e., Valium), clonazepam (i.e., Klonopin), or alprazolam (i.e., Xanax) can also cause seizures. It's important to follow the healthcare provider's prescription for decreasing or stopping a medicine or alcohol.
Keeping blood pressure under control reduces a person's risk of seizures. It also helps prevent stroke, which can lead to seizures. Protection against head injury is critical for all ages. Following sports safety guidelines for children, adolescents, and adults can prevent some injuries. Many times, there is no way to prevent the onset of epilepsy.
Individuals with epilepsy can reduce their risk of further seizures by:
  • avoiding excess alcohol
  • avoiding illegal drugs, especially marijuana and cocaine
  • getting enough sleep
  • limiting intake of stimulants such as caffeine
  • recognizing and avoiding known factors that trigger their own seizures
  • seeking prompt treatment for fever and illness
  • taking all medicines as prescribed

Diagnosed

How is the condition diagnosed?

Diagnosis of seizures begins with a medical history and physical exam. The healthcare professional will ask about contributing illnesses or injuries. An electroencephalogram (r EEG) will be ordered. An EEG measures electrical activity within the brain. If a seizure occurs during the EEG, the abnormal activity can be detected. However, a normal EEG does not rule out seizures simply because it may not have been done at the time seizure activity was occurring.
Other tests that may be ordered include:
  • blood tests to look for underlying diseases or conditions
  • cranial CT scan to look for abnormalities in the brain
  • cranial MRI to provide a closer look at brain structures
  • positron emission tomography (PET) scans, to identify the abnormal brain area

Long Term Effects

What are the long-term effects of the condition?

Seizures can lead to physical injury from falling. Epilepsy may interfere with school or work.

Other Risks

What are the risks to others?

Generalized tonic-clonic seizures are not contagious and pose no risk to others.

Treatments

What are the treatments for the condition?

Medicines used to treat seizures are known as anticonvulsants. Common anticonvulsants include the following:
  • carbamazepine (i.e., Tegretol)
  • clonazepam (i.e., Frisium)
  • diazepam (i.e., Valium)
  • gabapentin (i.e., Neurontin)
  • lamotrigine (i.e., Lamictal)
  • phenobarbital (i.e., Solfoton)
  • phenytoin (i.e., Dilantin)
  • primidone (i.e., Mysoline)
  • valproate sodium (i.e., Epilim)
If a person's seizures are not controlled with medicine, a vagal nerve stimulator may be used. A small pacemaker-like box is inserted under the skin of the chest. It sends regular electrical discharges to the vagus nerve in order to disrupt the abnormal electrical charges. A vagal nerve stimulator does not involve any surgery on the brain.
People with severe, uncontrollable seizures may be candidates for brain surgery. The surgeon opens the skull with a craniotomy. He or she then removes the abnormal brain tissue.
Underlying problems, such as a brain tumor, may require further treatment. A person with epilepsy may be embarrassed or depressed. Counseling about the condition may help the individual and the family. Support groups exist for those with epilepsy.

Side Effects

What are the side effects of the treatments?

Medicines used to treat seizures may cause side effects. The side effects depend on the medication; however, drowsiness is a common side effect of anti-seizure medication.
Insertion of a vagal nerve stimulator involves a small risk for bleeding, infection, or a reaction to the anesthetic. Risks of these types from a craniotomy are somewhat larger.
Many anticonvulsants decrease the effectiveness of oral contraceptives.

After Treatment

What happens after treatment for the condition?

Many substances interfere with the action of anticonvulsants. These include over-the-counter medicines, prescription medicines, and herbal remedies. Individuals with seizures should consult their healthcare professionals before taking any new products.
Individuals with seizures may be able to drive if they can remain seizure-free. Laws governing driving vary from place to place.
People with seizures can participate in most activities of regular life. They may be advised to avoid hazardous activities. Federal law prohibits discrimination in employment. There are also laws precluding people with epilepsy from certain jobs, such as commercial trucking. A person with seizures should use an identification bracelet or card informing others of the condition.

Monitor

How is the condition monitored?

Blood is tested regularly to monitor the levels of anticonvulsants. Any new or worsening symptoms should be reported to the healthcare professional.

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