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Generalized tonic-clonic seizure - Symptom

Alternative Names

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

Symptoms:

Many patients have an aura (sensory warning sign) preceding the seizure. This can include a visual, taste, smell, sensory, or other hallucination 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 lasts for one hour or longer
  • Loss of memory (amnesia) regarding events surrounding the seizure episode
  • Headache
  • Drowsiness
  • Confusion, temporary and mild
  • Weakness for 24-48 hours following seizure (Todd's paralysis)

Signs and tests:

Diagnosis of a grand mal seizure is based on the symptoms and excluding other medical problems that can look like a seizure (such as heart arrhythmia). A neuromuscular examination may or may not reveal neurologic deficits (decreases in brain functions) when the person is not actively having seizures.

An EEG may show characteristic changes and in some cases may show the focus (location of the cause of the seizure). An EEG can be normal in between seizures and a normal EEG does not rule out a seizure disorder.

Tests for the cause may include various blood tests (depending on the suspected cause), including:

Tests for the cause may include procedures such as:

Disorders that may cause symptoms resembling seizures include transient ischemic attacks, rage, or panic attacks.

  • Reviewed last on: 11/21/2006
  • Daniel Kantor, M.D., Director of the Comprehensive MS Center, Neuroscience Institute, University of Florida Health Science Center, Jacksonville, FL. Review provided by VeriMed Healthcare Network.

References

Goetz, CG. Textbook of Clinical Neurology. 2nd ed. St. Louis, Mo: WB Saunders; 2003.

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