349:(EEG), which records the electrical activity of the brain. This is typically done after a seizure episode in a clinical setting with an attempt to "capture" a seizure while it happens. According to "Harrisons Manual of Medicine," the EEG during the tonic phase will show a "progressive increase in low-voltage fast wave activity, followed by generalized high-amplitude, poly spike discharges." The clonic phase EEG will show "high amplitude activity that is typically interrupted by slow waves to create a spike-and-slow-wave pattern." Additionally, the postictal phase will show suppression of all brain activity, then slowing that gradually recovers as the patient awakens.
324:
especially with a compounding central nervous system condition or a prolonged seizure. Occasionally the patient may vomit or burst into tears from the experienced mental trauma. An additional smaller seizure can also occur several minutes after the main seizure, particularly if the patient's seizure threshold has been brought unusually low by known factors or combinations of such. Examples include: severe hangovers, sleep deprivation, elevated estrogen at ovulation, prolonged physical tiredness, and drug use or abuse (including, but not limited to,
49:
284:
from it, which will cause the patient to fall if standing or sitting. There may also be upward deviation of the eyes with the mouth open. The tonic phase is usually the shortest part of the seizure, normally lasting only 10–20 seconds. The patient may also express brief vocalizations like a loud moan upon entering the tonic stage, due to air being forcefully expelled from the lungs. This vocalization is commonly referred to as an "
302:
rapidly, causing convulsions. These may range from exaggerated twitches of the limbs to violent shaking or vibrating of the stiffened extremities. The patient may roll and stretch as the seizure spreads. Initially, these contractions may be high frequency and low amplitude, which will progress to decreased frequency and high amplitude. An eventual decrease in contraction amplitude just before seizure cessation is also typical.
1451:
402:
Generalized tonic–clonic seizures can have a focal onset (described above) that progresses into a generalized seizure or be a generalized seizure at onset. The term "Grand Mal" is nonspecific, referring to generalized tonic–clonic seizures with either a focal or generalized onset. Due to this lack of
288:
cry." Starting in the tonic phase, there may also be bluing of the skin from respiration impairment as well as pooling of saliva in the back of the throat. Increased blood pressure, pupillary size and heart rate (sympathetic response) may also be noted with clenching of the jaw possibly resulting in
283:
The tonic phase is usually the first phase and consciousness will quickly be lost (though not all generalized tonic–clonic seizures involve a full loss of consciousness), and the skeletal muscles will suddenly tense, often causing the extremities to be pulled towards the body or rigidly pushed away
227:
techniques showing that there is some degree of damage to a large number of neurons. The lesions (i.e., scar tissue) caused by the loss of these neurons can result in groups of neurons forming a seizure "focus" area with episodic abnormal firing that can cause seizures if the focus is not abolished
301:
The clonic phase is an evolution of the tonic phase and is caused by muscle relaxations superimposed on the tonic phase muscle contractions. This phase is longer than the tonic phase with the total ictal period usually lasting no longer than 1 min. Skeletal muscles will start to contract and relax
373:
and/or indication to give rescue medication and call for emergency help, moving close objects out of the way to prevent injury. It is also not recommended to hold a person down that is having a seizure, as that can lead to injury. Nor should anything be put in a person's mouth, as these items can
323:
breathing. Confusion and total amnesia upon regaining consciousness are also usually experienced and slowly wear off as the patient becomes gradually aware that a seizure occurred and remembers their identity and location. Impaired consciousness duration can last several hours after a seizure,
241:
Most generalized tonic–clonic seizures begin without warning and abruptly, but some epileptic patients describe a prodrome. The prodrome of a generalized tonic–clonic seizure is a sort of premonitory feeling hours before a seizure. This type of prodrome is distinct from stereotypic
132:(a vague sense of impending seizure) may also be present before the seizure begins. The seizure itself includes both tonic and clonic contractions, with tonic contractions usually preceding clonic contractions. After these series of contractions, there is an extended
908:
893:
148:. Some generalized seizures start as a smaller seizure that occurs solely on one side of the brain, however, and is referred to as a focal (or partial) seizure. These unilateral seizure types (formerly known as
493:
Herausgeber., Kasper, Dennis L., Herausgeber. Fauci, Anthony S., Herausgeber. Hauser, Stephen L., Herausgeber. Longo, Dan L., 1949– Herausgeber. Jameson, J. Larry, Herausgeber. Loscalzo, Joseph (2016-05-27).
314:
The postictal phase causes are multifactorial to include alteration of cerebral blood flow and effects on multiple neurotransmitters. These changes after a generalized tonic–clonic seizure cause a period of
160:
of the brain and cause a generalized tonic-clonic seizure. This type of seizure has a specific term called "focal to bilateral tonic clonic seizure." Other precipitating factors include chemical and
638:
988:
527:
807:
Michael, Glen E.; o'Connor, Robert E. (2011-02-01). "The
Diagnosis and Management of Seizures and Status Epilepticus in the Prehospital Setting".
1025:
531:
117:. It is a misconception that they are the sole type of seizure, as they are the main seizure type in approximately 10% of those with epilepsy.
642:
374:
become choking hazards and, depending on what is put in, can potentially break the person's teeth. Long-term therapy may include the use of
403:
specificity in describing the onset of a seizure and being considered an archaic term, it is not typically used by medical professionals.
684:
1393:
1310:
711:
466:
136:
where the person is unresponsive and commonly sleeping with loud snoring. There is usually pronounced confusion upon awakening.
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include staying with a person until a seizure is over, paying attention to length of seizure as a possible indication for
1357:
1018:
740:
Fisher, Robert S.; Schachter, Steven C. (2000). "The
Postictal State: A Neglected Entity in the Management of Epilepsy".
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503:
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and now referred to as focal aware seizure and focal impaired awareness seizure, respectively) can then spread to both
850:
1372:
1244:
1196:
994:
571:
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614:
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For a person experiencing a tonic–clonic seizure, first-aid treatment includes rolling the person over into the
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1305:
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17:
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by preventing fluid from entering the lungs. Other general actions to take as recommended by the
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61:
8:
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Abou-Khalil, Bassel W.; Gallagher, Martin J.; Macdonald, Robert L. (2012), "Epilepsies",
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and other factors. Tonic–clonic seizures can also be induced deliberately with
205:
57:
902:
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168:, both of which have been implicated. The seizure threshold can be altered by
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and seizures in general and the most common seizure associated with
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imbalances and a genetically or situationally determined
120:
These seizures typically initiate abruptly with either a
23:
Type of generalized seizure that affects the entire brain
1439:
709:
875:
246:
of focal seizures that become generalized seizures.
806:
254:A tonic–clonic seizure comprises three phases: the
105:muscle contractions. Tonic–clonic seizures are the
1463:
16:"Grand mal" redirects here. For other uses, see
739:
188:-flashes or simple light/dark patterns, raised
685:"Electroconvulsive therapy-Electroshock (ECT)"
144:The vast majority of generalized seizures are
1019:
526:: CS1 maint: multiple names: authors list (
492:
809:Emergency Medicine Clinics of North America
1026:
1012:
718:. Epilepsy Therapy Project. Archived from
585:
530:) CS1 maint: numeric names: authors list (
47:
1033:
615:"2017 Revised Classification of Seizures"
1394:Citizens United for Research in Epilepsy
228:or suppressed via anticonvulsant drugs.
42:Grand mal seizure, tonic–clonic seizure
710:Ruben Kuzniecky, M.D. (16 April 2004).
172:, malnutrition, lack of sleep or rest,
1464:
345:Diagnosis can be made definitively by
1007:
641:. Epilepsy Foundation. Archived from
1311:Dentatorubral–pallidoluysian atrophy
609:
607:
549:
547:
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543:
541:
488:
486:
484:
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480:
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476:
474:
97:that produces bilateral, convulsive
1358:Sudden unexpected death in epilepsy
219:, the cause is often determined by
13:
1288:Complex partial status epilepticus
639:"Seizure Mechanisms and Threshold"
564:10.1016/b978-1-4377-0434-1.00092-x
14:
1483:
1373:Psychogenic non-epileptic seizure
1245:Benign familial neonatal seizures
1197:Sleep-related hypermotor epilepsy
871:
604:
538:
471:
1449:
995:Generalized tonic–clonic seizure
558:, Elsevier, pp. 1583–1633,
83:generalized tonic–clonic seizure
34:Generalized tonic–clonic seizure
843:
800:
776:
733:
1333:Early myoclonic encephalopathy
1306:Progressive myoclonus epilepsy
703:
677:
656:
631:
579:
556:Neurology in Clinical Practice
460:
397:
109:most commonly associated with
1:
453:
352:
1283:Epilepsia partialis continua
496:Harrisons manual of medicine
340:
231:
7:
1338:Juvenile myoclonic epilepsy
1316:Unverricht–Lundborg disease
586:David Y Ko (5 April 2007).
406:
215:In the case of symptomatic
10:
1488:
1255:Myoclonic astatic epilepsy
200:, rapid motion or flight,
18:Grand Mal (disambiguation)
15:
1406:Epilepsy Action Australia
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1350:
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1273:
1215:
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1140:
1117:
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851:"General First Aid Steps"
821:10.1016/j.emc.2010.08.003
210:electroconvulsive therapy
139:
67:
55:
46:
38:
33:
1368:Landau–Kleffner syndrome
1202:Panayiotopoulos syndrome
1250:Lennox–Gastaut syndrome
1132:Epilepsy and employment
989:considered for deletion
742:Epilepsy & Behavior
588:"Tonic–Clonic Seizures"
388:vagus nerve stimulation
154:complex partial seizure
1182:Temporal lobe epilepsy
1102:Electroencephalography
784:"Triggers of Seizures"
754:10.1006/ebeh.2000.0023
712:"Looking at the Brain"
664:"Triggers of Seizures"
448:Electroencephalography
347:Electroencephalography
150:simple partial seizure
85:, commonly known as a
56:Generalized 3 Hz
1187:Frontal lobe epilepsy
666:. Epilepsy Foundation
428:Non-epileptic seizure
204:imbalances, anxiety,
1423:Epilepsy Research UK
1207:Vertiginous epilepsy
1127:Epilepsy and driving
1078:Epilepsy in children
361:, which can prevent
198:fluorescent lighting
115:metabolic imbalances
62:electroencephalogram
1411:Epilepsy Foundation
1378:Epilepsy in animals
1058:Aura (warning sign)
855:Epilepsy Foundation
788:Epilepsy Foundation
691:on 24 February 2021
619:Epilepsy Foundation
367:Epilepsy Foundation
95:generalized seizure
1298:Myoclonic epilepsy
1275:Status epilepticus
939:External resources
433:Tonic (physiology)
371:status epilepticus
289:biting the tongue.
184:, the presence of
1437:
1436:
1351:Related disorders
1346:
1345:
1192:Rolandic epilepsy
973:
972:
423:Epileptic seizure
382:, diet therapy (
359:recovery position
166:seizure threshold
87:grand mal seizure
79:
78:
60:discharges on an
28:Medical condition
1479:
1454:
1453:
1452:
1445:
1428:Epilepsy Society
1417:Epilepsy Outlook
1260:Epileptic spasms
1172:Gelastic seizure
1147:
1146:
1073:Neonatal seizure
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687:. Archived from
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380:surgical therapy
162:neurotransmitter
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1400:Epilepsy Action
1382:
1342:
1292:
1269:
1265:Febrile seizure
1230:Absence seizure
1211:
1167:Complex partial
1136:
1119:Personal issues
1113:
1098:Investigations
1094:Anticonvulsants
1082:
1068:Epileptogenesis
1063:Postictal state
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443:Postictal state
418:Absence seizure
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317:postictal sleep
308:Postictal phase
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134:postictal state
93:, is a type of
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1363:Todd's paresis
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1354:
1352:
1348:
1347:
1344:
1343:
1341:
1340:
1335:
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1326:Lafora disease
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1321:MERRF syndrome
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1235:Atonic seizure
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1162:Simple partial
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1109:Epileptologist
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880:Classification
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872:External links
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1472:Seizure types
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1053:Seizure types
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722:on 2007-10-12
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645:on 2017-08-09
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413:Focal seizure
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1225:Tonic–clonic
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858:. Retrieved
854:
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815:(1): 29–39.
812:
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791:. Retrieved
787:
778:
748:(1): 52–59.
745:
741:
735:
724:. Retrieved
720:the original
716:epilepsy.com
715:
705:
693:. Retrieved
689:the original
679:
668:. Retrieved
658:
647:. Retrieved
643:the original
633:
622:. Retrieved
618:
595:. Retrieved
591:
581:
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363:asphyxiation
356:
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295:Clonic phase
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225:neuroimaging
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174:hypertension
143:
119:
107:seizure type
90:
86:
82:
80:
25:
1217:Generalised
948:MedlinePlus
695:25 November
398:Terminology
277:Tonic phase
202:blood sugar
158:hemispheres
126:generalized
39:Other names
1240:Automatism
1087:Management
860:2018-12-14
793:2018-12-07
726:2008-03-19
670:2017-09-30
649:2015-11-13
624:2018-12-04
597:2008-03-19
454:References
353:Management
326:stimulants
321:stertorous
266:phase and
192:levels at
146:idiopathic
987:is being
964:neuro/376
959:eMedicine
829:0733-8627
762:1525-5050
592:eMedicine
522:cite book
514:956960804
341:Diagnosis
269:postictal
232:Mechanism
223:or other
194:ovulation
128:onset. A
74:Neurology
69:Specialty
1466:Category
1456:Medicine
1178:Epilepsy
1158:Seizures
1039:epilepsy
1035:Seizures
980:template
837:21109100
770:12609127
407:See also
334:caffeine
237:Prodrome
217:epilepsy
190:estrogen
182:diabetes
130:prodrome
111:epilepsy
929:D004830
378:drugs,
330:alcohol
272:phase.
260:phase,
170:fatigue
1442:Portal
1046:Basics
999:Curlie
993:
984:Curlie
953:000695
835:
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438:Clonus
263:clonic
250:Phases
186:strobe
178:stress
140:Causes
103:clonic
1151:Focal
978:‹The
918:345.3
903:G40.3
390:, or
319:with
286:ictal
257:tonic
152:or a
122:focal
99:tonic
1430:(UK)
1419:(UK)
1413:(US)
1402:(UK)
1396:(US)
1037:and
924:MeSH
913:9-CM
833:PMID
825:ISSN
766:PMID
758:ISSN
697:2018
568:ISBN
532:link
528:link
510:OCLC
500:ISBN
332:and
244:aura
101:and
91:GTCS
997:at
909:ICD
894:ICD
817:doi
750:doi
560:doi
386:),
221:MRI
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