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Generalized tonic-clonic seizure

• Overview
• Symptoms
• Treatment
• Prevention

Alternative Names:

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

Treatment:

EMERGENCY FIRST-AID TREATMENT

• Protect the person from injury. Clear the area of furniture or other objects that may cause injury from falls during the seizure.
• Do not attempt to force a hard object (such as a spoon or a tongue depressor, etc.) between the teeth. You can cause more damage than you can prevent.
• Do not attempt to hold the person down during the seizure.
• Turn the person to the side if vomiting occurs. Keep the person on his or her side while sleeping after the seizure is over.
• If the person having a seizure turns blue or stops breathing, try to position the head to prevent the tongue from blocking the airway. Breathing usually starts on its own once the seizure is over.
• CPR or mouth-to-mouth breathing is rarely needed after seizures and cannot be performed during the seizure.

If a person has repeated or prolonged seizures without regaining consciousness or returning to normal behavior, the body may develop a severe lack of oxygen. This an emergency situation - seek immediately medical help.

EMERGENCY TREATMENT BY MEDICAL PERSONNEL

• Measures to protect the airway may be needed, including use of tubes to keep the airway open. Breathing should be supported as needed.
• Thiamine or intravenous glucose may be given.
• Medications such as diazepam (Valium) or lorazepam, or anticonvulsant medications such as phenytoin or phenobarbital may control prolonged, repeated generalized seizures. They are usually injected into a vein.
• General anesthesia with muscle-paralyzing medications may be needed.
• After status epilepticus is controlled, the patient will be given anticonvulsants. Tests will be done to determine the cause of the condition, if it is not already known.

AFTER THE SEIZURE

Treat any injuries from bumps or falls. Record details of the seizure to report to the health care provider. Important details include:

• Date and time of the seizure
• How long it lasted
• What body parts were affected
• Type of movements or other symptoms
• Possible causes
• Behavior after the seizure

Treating the cause, if one has been identified, may stop seizures. This may include medication, surgical repair of tumors or brain lesions, or other treatments. An isolated seizure with an obvious trigger (such as fever and toxic reaction) is treated by eliminating or avoiding the precipitating factor.

An isolated seizure without an obvious trigger may not require treatment.

Anti-seizure medicines may prevent or reduce the number of future seizures. Medicines may be used alone or in combination with another drug.

Women who might get pregnant may need to take additional medications or vitamins to reduce the risk of birth defects associated with some of these medications. Such women may need to be followed in a high-risk pregnancy clinic.

Patients who continue to have seizures despite several medications may benefit from a vagal nerve stimulator (implantable device that stimulates a nerve in the neck) or from brain surgery to remove tissue responsible for causing the seizures.

Informational jewelry or cards (such as Medic-Alert bracelets) alerting others about the seizures may help a patient receive prompt medical treatment if a one occurs.

Expectations (prognosis):

Seizures can occur as a single isolated occurrence, as closely repeated seizures, or at various intervals. Seizures that recur create a condition known as epilepsy.

Seizures that occur singly or in closely associated groups are commonly caused by a condition such as brain injury. They may occur as an isolated incident or may develop into a chronic seizure disorder . Seizures within the first 2 weeks of a brain injury do not necessarily mean that a chronic seizure disorder will develop.

A seizure-free period may indicate that reduction or elimination of medications may be possible. Medications should be changed only under the supervision of the health care provider.

Death or permanent brain damage from seizures is rare. A serious injury can occur if a seizure occurs while driving or operating dangerous equipment; these activities are often restricted for people with poorly controlled seizure disorders.

Infrequent seizures may not severely restrict the patient's lifestyle. Work, school, and recreation do not necessarily need to be restricted.

Complications:

• Recurrent seizures (seizure disorder)
• Prolonged or closely occurring seizures without returning to normal behavior(status epilepticus)
• Injury from falls, bumps, and biting oneself
• Injury to oneself or others if seizure occurs during driving or operating machinery
• Inhaling fluid into the lungs, pneumonia
• Permanent brain damage (stroke or other damage)
• Side effects of medications (with or without observable symptoms)
• Learning disorders (either from seizures or medications)

Women planning to get pregnant need to tell their doctor in advance in order to adjust their medications, since many anti-epileptic medications cause birth defects.

Calling your health care provider:

Call your local emergency number (911) if this the first time a person has had a seizure or a seizure is occurring in someone without a medical ID bracelet (instructions explaining what to do). In the case of someone who has had seizures before, call the ambulance for any of these emergency situations:

• This is a longer seizure than the person normally has, or an unusual number of seizures for the person
• Repeated seizures over a few minutes
• Repeated seizures where consciousness or normal behavior is not regained between them (status epilepticus)

Call your health care provider if any new symptoms occur, including possible side effects of medications (drowsiness, restlessness, confusion, sedation, or others), nausea/vomiting, rash, loss of hair, tremors or abnormal movements, or problems with coordination.

• Review Date: 11/21/2006
• Reviewed By: 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.

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