Tonic Clonic ( Grand Mal ) Seizures / Epilepsy

[brain]

TONIC CLONIC / GRAND MAL SEIZURES - EPILEPSY


This vote and comments section applies to those
who suffers from Tonic Clonic aka Grand Mal Seizures / Epilepsy.

Here are some partial quotes:



TONIC CLONIC SEIZURES - from eMed

A seizure is an abnormal paroxysmal discharge of cerebral neurons due to cortical hyperexcitability. The International Classification of Seizures divides seizures into 2 categories: partial seizures (ie, focal or localization-related seizures) and generalized seizures.

Partial seizures result from a seizure discharge within a particular brain region or focus, and they manifest focal symptoms. Generalized seizures probably begin in the thalamus and other subcortical structures, but on scalp EEG recordings they may appear to start simultaneously in both cerebral hemispheres; therefore, they manifest symptoms bilaterally in the body and are always associated with loss of consciousness.

Partial seizures can generalize secondarily and result in tonic-clonic activity. Some partial seizures have very rapid generalization, and the partial phase of the seizure may not be readily apparent clinically or even on scalp EEG recordings. However, secondarily generalized partial seizures are not included in the category of generalized seizures, which includes only primary generalized seizures.

Generalized convulsive seizures can be classified as atonic, tonic, clonic, tonic-clonic, myoclonic, or absence on the basis of clinical symptoms and EEG abnormalities. Tonic seizure is the rigid contracture of muscles, including respiratory muscles, which is usually brief. The clonic component is the rhythmic shaking that occurs and is longer. Together, a generalized tonic-clonic seizure (GTCS) is also called a grand mal seizure and is one of the most dramatic of all medical conditions.

Several epilepsy syndromes are associated with generalized epilepsy: benign neonatal convulsions, benign myoclonic epilepsy of infancy, childhood absence epilepsy, juvenile absence epilepsy, juvenile myoclonic epilepsy, and generalized tonic-clonic seizures upon awakening.
Pathophysiology

Generalized epilepsy is thought to be initiated by 3 different mechanisms: (1) abnormal response of hyperexcitable cortex to initially normal thalamic input, (2) primary subcortical trigger, and (3) abnormal cortical innervation from subcortical structures.

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The morbidity and mortality for tonic-clonic seizure is high because these patients get no aura and thus the seizure strikes without warning. Patients can have posterior shoulder dislocations and broken bones. The incidence of sudden death is 24 times higher in persons with epilepsy than in the general population. Some of the risk factors for sudden death in epilepsy (Sudden Unexplained Death in Epilepsy) include high seizure frequency (specifically tonic-clonic type), younger age, mental retardation, and polytherapy.
Age

* Generalized convulsive seizures are uncommon in infants and rare in neonates.
* In elderly patients, GTCSs usually are due to secondary generalization of seizures emanating from localized brain lesions.


Physical

The patient may have completely nonfocal findings on neurologic examination when not having seizures. Seizures typically are divided into tonic, clonic, and postictal phases, which are described in detail in this section.

* Tonic phase

o Generalized convulsive seizures may begin with myoclonic jerks or, rarely, with absences. The tonic phase begins with flexion of the trunk and elevation and abduction of the elbows. Subsequent extension of the back and neck is followed by extension of arms and legs. This can be accompanied by apnea, which is secondary to laryngeal spasm.
o Autonomic signs are common during this phase and include increase in pulse rate and blood pressure, profuse sweating, and tracheobronchial hypersecretion.
o Although urinary bladder pressure rises, voiding does not occur because of sphincter muscle contraction.
o This stage lasts for 10-20 seconds.

* Clonic phase

o The tonic stage gives way to clonic convulsive movements, in which the tonic muscles relax intermittently, lasting for a variable period of time.
o During the clonic stage, a generalized tremor occurs at a rate of 8 tremors per second, which may slow down to about 4 tremors per second. This is because phases of atonia alternate with repeated violent flexor spasms. Each spasm is accompanied by pupillary contraction and dilation.
o The atonic periods gradually become longer until the last spasm. Voiding may occur at the end of the clonic phase as sphincter muscles relax. The atonic period lasts about 30 seconds. The patient continues to be apneic during this phase.
o The convulsion, including tonic and clonic phases, lasts for 1-2 minutes.

* Postictal state

o The postictal state includes a variable period of unconsciousness during which the patient becomes quiet and breathing resumes.
o The patient gradually awakens, often after a period of stupor or sleep, and often is confused, with some automatic behavior.
o Headache and muscular pain are common. The patient does not recall the seizure itself.

TONIC CLONIC SEIZURES (GRAND MAL) - Epilepsy Foundation

Generalized Tonic Clonic Seizures (also called Grand Mal or a Convulsion)

'Contrary to popular folk belief, nothing should be placed in the mouth during the seizure. Severe injury could occur.'


Generalized tonic clonic seizures (grand mal seizures) are the most common and best known type of generalized seizure. They begin with stiffening of the limbs (the tonic phase), followed by jerking of the limbs and face (the clonic phase).

During the tonic phase, breathing may decrease or cease altogether, producing cyanosis (blueing) of the lips, nail beds, and face. Breathing typically returns during the clonic (jerking) phase, but it may be irregular. This clonic phase usually lasts less than a minute.

Some people experience only the tonic, or stiffening phase of the seizure; others exhibit only the clonic or jerking movements; still others may have a tonic-clonic-tonic pattern.


Generalized tonic clonic seizures (grand mal seizures) are the most common and best known type of generalized seizure. They begin with stiffening of the limbs (the tonic phase), followed by jerking of the limbs and face (the clonic phase).

During the tonic phase, breathing may decrease or cease altogether, producing cyanosis (blueing) of the lips, nail beds, and face. Breathing typically returns during the clonic (jerking) phase, but it may be irregular. This clonic phase usually lasts less than a minute.

Some people experience only the tonic, or stiffening phase of the seizure; others exhibit only the clonic or jerking movements; still others may have a tonic-clonic-tonic pattern.

Incontinence may occur as a result of the seizure. The tongue or inside of the mouth may be bitten during the episode; breathing afterwards may be noisy and appear to be labored. Contrary to popular belief, nothing should be placed in the mouth during the seizure; turning the patient on one side will help prevent choking and keep the airway clear.

Following the seizure, the patient will be lethargic, possibly confused, and want to sleep. Headache sometimes occurs. Full recovery takes minutes to hours, depending on the individual.
First Aid for Generalized Tonic-Clonic Seizures

* Prevent further injury. Place something soft under the head, loosen tight clothing, and clear the area of sharp or hard objects.
* Do not force objects into the person’s mouth.
* Do not restrain the person’s movements unless they place him or her in danger.
* Turn the person on his or her side to open the airway and allow secretions to drain.
* Stay with the person until the seizure ends.
* Do not pour any liquids into the person’s mouth or offer any food, drink, or medication until he or she is fully awake.
* If the person does not resume breathing after the seizure, start cardiopulmonary resuscitation.
* Let the person rest until he or she is fully awake.
* Be reassuring and supportive when consciousness returns.
* A convulsive seizure is usually not a medical emergency unless it lasts longer than five minutes, or a second seizure occurs soon after the first, or the person is pregnant, injured, diabetic, or not breathing easily. In these situations the person should be taken to an emergency medical facility.

TONIC CLONIC (GRAND MAL) by Epilepsy.com

A tonic-clonic seizure that lasts longer than 5 minutes probably calls for medical help. A seizure that lasts more than 30 minutes, or three seizures without a normal period in between, indicates a dangerous condition called convulsive status epilepticus. This requires emergency treatment.

* Tell me more

This type is what most people think of when they hear the word "seizure." An older term for them is "grand mal." As implied by the name, they combine the characteristics of tonic seizures and clonic seizures. The tonic phase comes first: All the muscles stiffen. Air being forced past the vocal cords causes a cry or groan. The person loses consciousness and falls to the floor. The tongue or cheek may be bitten, so bloody saliva may come from the mouth. The person may turn a bit blue in the face. After the tonic phase comes the clonic phase: The arms and usually the legs begin to jerk rapidly and rhythmically, bending and relaxing at the elbows, hips, and knees. After a few minutes, the jerking slows and stops. Bladder or bowel control sometimes is lost as the body relaxes. Consciousness returns slowly, and the person may be drowsy, confused, agitated, or depressed.

* Who gets them?

They affect both children and adults.

* What's the outlook?

For children who have had a single tonic-clonic seizure, the risk that they will have more seizures depends on many factors. Some children will outgrow their epilepsy. Often, tonic-clonic seizures can be controlled by seizure medicines. Many patients who are seizure-free for a year or two while taking seizure medicine will stay seizure-free if the medicine is gradually stopped. The risk that an individual will have more seizures depends on factors such as whether his or her EEG shows any epilepsy waves, or whether the doctor finds any abnormalities on a neurological exam. Among children with no epilepsy waves and a normal exam, about 70% of those who have had tonic-clonic seizures will stay seizure-free without medication. The comparable number is less than 30% for children with epilepsy waves and an abnormal exam. All these figures are more favorable than those for partial seizures.

* What else could it be?

Some nonepileptic (psychogenic) seizures resemble tonic-clonic seizures. The surest way to tell the difference is with video-EEG monitoring. In some cases, the same person may have both tonic-clonic and nonepileptic seizures.

People who faint sometimes develop tonic or clonic movements. These movements are rarely as intense or prolonged as a tonic-clonic seizure.

* How is the diagnosis made?

The typical appearance of a tonic-clonic seizure is usually easy to recognize. The doctor will want a detailed description of the seizures. An EEG and other tests may help to confirm the diagnosis or suggest a cause.

Topic Editor: Orrin Devinsky, M.D.

Feel free to bring about any discussion as
you wish, and you may click on the links above
to learn more in details.

[brain]

The Poll is PRIVATE and you can vote as many
options as it applies to you.

[brain]

The worst and scariest Tonic Clonic for me
was in the bathroom, just suddenly - while
the Paramedics had figured out what happened
(my <ex> hubby told me later after when we
came home from the hospital after I had been
admitted for several days); it caused me to
crash over the toilet bowl, and into the corner
of the shower tub, metal sliding railing and wall.
The result of it was a bloody mess, and because
of rust, there was a sharp broken area on the
metal railing there, had it been any closer it
would have most likely ripped or gorged my
left eye and do serious damage or I would have
been blind in that eye. I have a scar there were
they had to put sutures in.

They could not give me a Tetanus shot (seizures),
but what they did was had me admitted, on IV,
and on very strong antibiotics (which actually made
me quite sick) until I was OUT of the seizure mode,
before they administered the Tetanus shot, and
even when that was administered I was monitored.
All I can remember is that they had to give me
Ativan via IV. (I don't know if I had a seizure? They
never told me if I did, but I have very little memory
of this part here) Once my Neurologist came back
in town, he saw me, raised the Dilantin and put me
back on Klonopin at bedtime was there for overnight
and could go home in the morning if I didn't have
anymore seizures.

(The landlord removed the sliding glass door and
the railing and installed a shower curtain up, which
was no problem with him, in fact, he even replaced
the bloodied carpet that was in the bathroom himself
and cleaned up the mess.)

====================

While I've had several Tonic Clonic SE's, but the one
that follows right behind the above is the other one
that was a result of a back-to-back (not status) Tonic
Clonic which was very early 1980s, in which I was in
the Kitchen, doing dishes, washing them and putting
them in the dishwasher to dry (to heck with buying a
dish rack!) and since I ran out of room (we had company)
I towel dried the glasses, that is all I could remember.

Next thing I knew I was in the ER in the Hospital, in
"la la land" with the meds they had me to stop those
seizures. While I slept most of the time, but I sure
hurt like heck! I had bandages all over me, a couple
places I had wrapped in gauze which I had stitches
put in and my muscles ached like heck. My face on my
left side hurt and they had my head wrapped and I had
an eye pad over my left eye so I wasn't sure what all
happened to me. So naturally, even though I was
all doped up, I got up went to the bathroom and
saw my head, and unraveled the gauze off of my head
to figure out what happened to my head and I don't
like eye pads! And then I saw they had stitches lined
up there, just a couple of them, but I couldn't figure
out why the eye pad?

I kept staring at the mirror looking at my eye and it
looked fine until the Nurse came in and found me,
scolded me for taking it all off, and while I did ask, she
told me that they had it wrapped up so if I had another
seizure it wouldn't rip the stitches out (OH!). But instead
she put a band-aid on it and at least I could see and
she provided me a walker so I could walk, and she wanted
me to walk up and down the hallway, then I sat on the
lobby end for awhile to watch the boats, until the Nurse
told me my "time" was up and I had to go back into my
room. The other Nurse came and asked me questions
of what I could remember, and I told her. Then later
on my (ex) husband came after work to visit me, and
he told me what all happened, and I learned that the
Tonic Clonic had shattered 3 of the 4 crystal glasses
(hence why I was all cut up) and after when the seizure
stopped, I was still bleeding and he couldn't clean up
the mess and handle me at the same time, and I lapsed
into another Tonic Clonic again and he had to call for
the Ambulance and even in the Hospital ER, I had
several more where they had to give me meds to stop
it. It was because the Neurologist discontinued the
"anti-convulsant medications" for he felt that I didn't
need them, and it had only been like a few weeks I
think of being off of it when this all happened.

I still bare scars from that, while they are faint, but
still visible!

------------------------------

TONIC CLONICS .... doesn't hurt, but it's where you
are and where you land or end up in, can be in a hazardous
situation and you can be seriously hurt, injured, or even
killed!

If you suffer from Tonic Clonics (Grand Mals), you should
always take a shower and always have someone be alerted
or nearby - never take a bath; and if you swim, never swim
alone and if your Doctor prohibits you from swimming -
HEED YOUR NEUROLOGIST / EPILEPTOLOGIST!

Yes, I was upset and mad at my Neurologist when he gave
the orders for me not to swim anymore (I'm a water baby),
but then I realized he cared enough for my own well being
to tell me this! He didn't want a report of a patient of his
being dead due to seizure in water!

[Meetz1064]

my T/C's.

As far as I know, I have never gone status, but have come close a couple times. Yes, I have stopped breathing--I do that quite often, I'm told.

I don't remember anything about mine until well after the fact--and I have to be told what has happened.

I do some weird things post-ictally, and I become 2 years old for quite a while. I really don't know much of anything. I usually break a bone or two, as well as objects around me. That's how I've ended up with so many damaged vertebrae in my back now.

Then I go back to bed, and sleep for 18 to 24 hours. I wake up, and I know I have had one, without being told because I have bitten ALL the way through my tongue. On both sides. It's typical for me.

But my T/C's are ALL based on my sleep cycle. They usually occur in the middle of it. Sometimes the beginning or end of it, but not normally. So, if I screw up my sleep cycle, and don't get my meds, I'm really screwed.

[ziggidypoo]

When I was on Triliptal I had tonic clonics and were worsening as I was dieting - I did not know Triliptal "CAN" lower your sodium in your blood and I hate salt anyway due to being used to salt-free diet for yrs.

I went status really bad Sept. 29th - all I know is I was told I had like 6 between in the facility (3) and in the Rescue Ambulance (2) and I think (3) in the ER and over the next couple of days they decreased as I had the sodium drip IV. Between the seizings, I would "look like I was dead and not breathing" I was told, and had O2 and I remember hearing one time "we are going to have to intubate" - I only remember bits and peices of it all. I did not know until "BRAIN" and later my neurologist told me people can die from such.

I am just thankful I have one super neurologist who LISTENS to me and I told her that the last 3 hospitalizations for tonic/clonic EACH time my blood-sodium levels were low.

Man, she got me off that Triliptal quick. I think I'm down to 1/2 tab 3x day now or maybe only 2x day, I don't remember.

All I know it worked on those.

Somewhere I read in these forums that adequate sleep and controlling stress were essential - I seize when I am overly stressed w/family matters out of state that I cannot help with - or if I am overly tired and in sleep-deprevation - especially if I knock my CPAP mask off during the night for sleep apnea. I have also read somewhere that lack of O2 can cause seizing???

That's my story and I'm stickin' to it!!

GET THE WORD OUT - EPILEPSY AWARENESS!!!

[skillefer]

I have grand mals....and still occasionally do. Still trying to figure out why they started up again.

[Cinnabar]

TONIC CLONIC / GRAND MAL SEIZURES - EPILEPSY


This vote and comments section applies to those
who suffers from Tonic Clonic aka Grand Mal Seizures / Epilepsy.

Here are some partial quotes:



TONIC CLONIC SEIZURES - from eMed





TONIC CLONIC SEIZURES (GRAND MAL) - Epilepsy Foundation




TONIC CLONIC (GRAND MAL) by Epilepsy.com




Feel free to bring about any discussion as
you wish, and you may click on the links above
to learn more in details.

I don't know if this belongs here but here I go. Weeks ago (2c) in same week, I began going into the Tonic Phase. I managed to call out to my companion in the other room. He kept my ridged, shaking shoulders stabilized with firm grip while my legs where going through unbelievable spazms.(Because he held onto me I twisted the left side of my neck -that's why they say never restrain). It seemed that his help kept me terrifingly alert throughout the Clonic Phase. I felt that if he let go I would go flying around the room out of control and land somewhere unconscious. Experiencing the Clonic was _______ I have no words to describe it. It seems I brutally lived through the Clonic Phase. After, my muscles began to relax I found myself garbling, speaking in "word salad". My neurologist and neuropsychiatrist both diagnosed this episode as being a Complex Partial Seizure with Secondary Generalization.

[RobinN]

Rebecca only has Clonic Tonic seizures.
When taking meds she experienced other symptoms, but not since they have been eliminated.
Her seizures range from 30 sec to 5 min+. She has had two status (but now that I think about it, it was during the time when she was medicated. There was also junk food infractions noted).
She is disoriented briefly, and likes to sleep / rest for about 30-60 min and then resumes her activities, though at a lower level than normal.
She is experiencing longer periods seizure free since being unmedicated and doing neurofeedback.

[danjor]

Im going to revive this topic because I mostly have Tonic Clonic. And I think i only have absences and complex partial's because of my meds.

They are uncontrolled as of now

[skillefer]

I too have tonic clonics. They had flared up the last couple of years. Now, since changing meds, I've got pretty good control. I do have breakthroughs, but I think that's due to the fact that I'm pregnant and the hormone shifts and extra stress placed on my body. If I get the right amount of sleep, I'm usually ok. It's the getting sleep that's hard. It's hard to sleep when you get up every hour and a half to go potty. :P My bladder is baby's first squeeze toy... That, and it's hard to find a comfy position to sleep in when you have what feels like a medicine ball where your stomach used to be.

[Grazianina]

I've had T/C's for all 31 years and have only recently developed Complex Partials. However, I have noticed that certain smells are responsible for triggering these. Things like bleach, patchoulli, road tar, etc..... I have noticed that my sense of smell is insanely keen an I have been able to calm myself and stop seizures from progressing to full-blown T/C's with deep breathing of things like orange, vanilla, and baked goods scents. Has anyone else had this same experience or heard of this before?

[epileric]

In the book "Epilepsy, A New Approach" the authors use a woman who sniffed jasmine to control her seizures.

Tim Betts of Birmingham University in England has documented some experiments

http://www.coping-with-epilepsy.com/...p=aromatherapy .

My only reservation is that all the experiments that I'm aware of also involved massage & I know for a fact that regular massage (without aromatherapy) does help lessen seizures.

[stilldancing_98]

Well, since I started Vimpat I have not had a G-mal seizure in about 3 months.Wow

[Meetz1064]

That's really, cool. I'm so very happy for you!! I'm glad to hear that you're find SOME control!!!

[Cinnabar]

Yeah! For you and Vimpat! I imagine you're best buddies by now
Congratulations!

[stilldancing_98]

Thank-you so very much , all of you. You have been my friends thru this all. And may I say thank-you again. A lot of people split When I went thru all of that crap. You guys are still standing by me. thank you thank-you thank-you. And I do love you. You are Awesome!

[RobinN]

Way to go SD - that is awesome. Keep up the good work

[seizingbeauty]

I have mainly T/C's also. I have had what I refer to as an awake seizure 3 times. Each time I am thankful that all my other seizures happen when I'm unconsious. I usually don't remember most of the day that I had my seizure. The only exception to that was coming round to a huge man standing over me with a MASSIVE pair of scissors. I had gone down on an escalator and my hair had gotten chaught in the mechanisim. The staff were trying to get me loose. I totally freaked and did even more damage trying to get away.
I had a 3 year period, no meds, few seizures. Then I had a really bad one and went back on the meds. The doctor just added Topamax yesterday. kinda worried...

[inesn]

how often do you have grandmals and what are you taking?

[seizingbeauty]

HI Inesn,
Welcome to CWE.
I am all over the map when it comes to my seizures. I had my first 11yrs ago, longest without was 9 mths. Worst run was 3 in 2 wks. On average I go about 3 months between seizures but they do have a tendency of clustering together. From what I understand from reading everyones stories, I have it easy. Well easier than most might be phrasing it better.
I'm on 2000mg Keppra and just added 50 mg Toppamax. I often have bad reactions to meds and have had some fun finding a mix that doesn't leave me feeling like a zombie. Keeping my fingers crossed that the Toppamax is just what I needed!
If you have have any other questions, feel free to ask. We're all here to help each other!