Grand Mal Seizure

A tonic-clonic seizure, sometimes called a grand mal seizure, is a type of seizure that causes a person to lose consciousness and have strong muscle spasms. This is often the kind of seizure people imagine when they think about seizures.

During a seizure, there's a sudden burst of electrical activity in the brain. This unusual activity disrupts normal brain function, leading to changes in behavior and movements. These abnormal electrical surges can be localized to a specific area of the brain (focal seizures) or spread throughout the entire brain (generalized seizures).

A tonic-clonic seizure can start as a focal seizure in a small part of the brain and then spread to become a generalized seizure affecting the whole brain. This spread explains why the symptoms might change.

Focal and generalized seizures have different signs. People having generalized seizures, like tonic-clonic seizures, usually lose consciousness. However, someone experiencing a focal seizure might not lose consciousness at all, or they might only lose awareness for a short time.

In a tonic-clonic seizure, the muscles first stiffen (the "tonic" phase), causing the person to fall. This is followed by alternating periods of muscle contractions and relaxation (the "clonic" phase).

Epilepsy is the most common cause of tonic-clonic seizures. But other medical problems can also trigger them. For example, extremely low blood sugar, a high fever, or a stroke can sometimes lead to a tonic-clonic seizure.

Many people have only one tonic-clonic seizure and don't need any further treatment. However, if someone has repeated seizures (seizure disorder), they might need daily medication to control and prevent future tonic-clonic seizures. These medications are specifically designed to help regulate the unusual electrical activity in the brain.

Tonic-clonic seizures are a type of seizure with two main parts:

1. The Tonic Phase: During this part, the person loses consciousness. Their muscles suddenly tighten, causing them to fall down. This tightening usually lasts about 10 to 20 seconds.

2. The Clonic Phase: Next, the muscles start having rhythmic contractions. This means the muscles repeatedly flex and relax in a jerking motion. These convulsions typically last for 1 to 2 minutes or less.

What might happen during or after a tonic-clonic seizure?

While not everyone experiences every symptom, some people might:

• Make a noise: Some people might cry out or scream at the start of the seizure.
• Lose control of their bowels or bladder: This can happen during or after the seizure.
• Be confused or disoriented: After the seizure, the person might be confused or not know where they are. This is sometimes called postictal confusion.
• Be very tired or sleepy: Feeling tired or drowsy after a seizure is common.
• Get a headache: A headache is another possible outcome after a seizure.

When should you call for help?

Seek immediate medical attention (call 911 or your local emergency number) if:

• The seizure lasts longer than 5 minutes.
• Breathing or consciousness doesn't return after the seizure stops.
• Another seizure starts right after the first one.
• The person has a high fever.
• The person is experiencing heat exhaustion.
• The person is pregnant.
• The person has diabetes.
• The person is injured during the seizure.

When should you see a doctor?

If you or your child experience a seizure for the first time, it's important to see a healthcare professional. You should also schedule a visit if:

• You or your child are having more seizures than usual, for no apparent reason.
• You notice any new seizure symptoms.

It's crucial to remember that this information is for general knowledge and does not replace advice from a medical professional. If you have concerns about seizures, please consult a doctor or other qualified healthcare provider.

If you or someone you know has a seizure, it's important to act quickly. Call 911 or emergency medical services immediately if:

• The seizure lasts longer than five minutes. This is a serious situation. A prolonged seizure can cause harm.
• Breathing or consciousness doesn't return after the seizure stops. If breathing or alertness doesn't come back, it's a medical emergency.
• A second seizure happens right away. This is a sign of a more serious problem.
• You have a high fever. Fever can sometimes trigger seizures, especially in children.
• You're experiencing heat exhaustion or heat stroke. High body temperatures can increase the risk of seizures.
• You are pregnant. Pregnancy can sometimes put extra strain on the body, making seizures more likely.
• You have diabetes. People with diabetes may be more susceptible to seizures.
• You've injured yourself during the seizure. Falls or other injuries can happen during a seizure, and these need prompt attention.

If it's your first seizure, or you notice any new symptoms or a change in seizure frequency, see a doctor or other healthcare provider as soon as possible. It's also important to see a doctor if you or your child are experiencing an increasing number of seizures without a clear reason. If you notice new symptoms, such as different types of movements or a change in awareness during a seizure, it's essential to seek medical attention. Regular check-ups and discussions with your doctor are crucial to monitoring any seizure activity.

The brain is made up of nerve cells that talk to each other using electrical and chemical messages. These messages travel across tiny gaps called synapses. A tonic-clonic seizure happens when there's a sudden, powerful burst of electrical activity on the surface of the brain. Many nerve cells fire extremely rapidly and out of sync, like a massive electrical storm. Scientists don't always know exactly why this happens.

However, several things can trigger these seizures. Sometimes, they're linked to underlying health problems, such as:

• Head injuries: A blow to the head can disrupt brain function and increase the risk of seizures.
• Brain infections: Infections like encephalitis or meningitis, or even a past infection, can damage brain tissue and cause seizures. Encephalitis is inflammation of the brain, and meningitis is inflammation of the membranes surrounding the brain and spinal cord.
• Lack of oxygen: If the brain doesn't get enough oxygen, it can be damaged, leading to seizures. This could be from a medical event or a birth complication.
• Stroke: A stroke happens when blood flow to a part of the brain is blocked. This can cause damage that triggers seizures.
• Brain blood vessel problems: Sometimes, blood vessels in the brain don't develop correctly, which can increase the risk of seizures.
• Genetic conditions: Some inherited conditions can make people more prone to seizures.
• Brain tumors: A tumor growing in the brain can put pressure on brain tissue and disrupt normal electrical activity, causing seizures.
• Electrolyte imbalances: Very low levels of important minerals like glucose, sodium, calcium, or magnesium in the blood can disrupt brain function and cause seizures.
• Drug use and withdrawal: Using or stopping certain drugs, including alcohol, can sometimes trigger seizures.

It's important to note that these are just some possible causes. If someone experiences seizures, it's crucial to see a doctor to find out the specific reason and get appropriate treatment.

Things that can increase your chances of having a tonic-clonic seizure (a type of seizure with muscle stiffening and jerking) include:

• Family history: If someone in your family has had seizures, you have a higher risk. This means there's a genetic link that makes you more prone to developing them.

• Brain injury: Damage to the brain from accidents, strokes, infections, or other issues can raise your risk. Even a small injury can affect brain function and increase the likelihood of seizures.

• Lack of sleep: Not getting enough sleep weakens your body and makes you more vulnerable to seizures. Chronic sleep deprivation can be especially problematic.

• Electrolyte problems: Your body needs a balance of certain minerals (like sodium and potassium) to function correctly. Imbalances in these electrolytes can trigger seizures. This might happen due to conditions like dehydration or kidney problems.

• Drug use: Using illegal drugs can significantly increase your risk of seizures. This is often because these substances disrupt normal brain function.

• Heavy drinking: Drinking too much alcohol can also lead to seizures. Regular, excessive alcohol use can cause damage to the brain over time, making seizures more likely.

Experiencing a seizure at the wrong time can be risky. Seizures can put you in harm's way, both for yourself and others. Here's why:

Falls: If you have a seizure and fall, you could hurt your head or break a bone. This is a serious risk, especially if you're not in a safe environment, like a home with a sturdy floor.

Drowning: Seizures can happen while swimming or bathing, increasing the danger of accidental drowning. If you have epilepsy, being near water without supervision is not a good idea.

Car Accidents: A seizure that causes loss of awareness or control could lead to a car accident if you're driving. It also puts you at risk if you're operating any machinery. Never drive or operate machinery if you are experiencing a seizure or know you're prone to them.

Pregnancy: Seizures during pregnancy can be dangerous for both the mother and the baby. Some anti-seizure medications can increase the risk of birth defects. If you have epilepsy and are planning to get pregnant, it's crucial to talk to your doctor. They can help adjust your medication to minimize risks and will likely monitor your pregnancy closely.

Emotional Well-being: People who have seizures may be more prone to depression and anxiety. This can be due to dealing with the condition itself, or possibly side effects of the medications used to manage it. It's important to seek support and talk to a doctor or counselor if you're feeling down or anxious. Knowing you're not alone and getting help for these feelings is important.

Understanding Brain Activity During Seizures

An EEG (electroencephalogram) is a test that measures the electrical activity in your brain. Tiny metal discs, called electrodes, are attached to your scalp. These electrodes record the brain's electrical signals, which show up as wavy lines on a recording. Changes in these patterns can help doctors diagnose conditions like epilepsy, which causes seizures.

A high-density EEG uses many more electrodes than a standard EEG, providing a more detailed picture of brain activity. Sometimes, an elastic cap with electrodes is used instead of individual stickers.

Pinpointing the exact location of a seizure is important for treatment. One way to do this is by comparing images of blood flow in the brain during and between seizures. A SPECT (single-photon emission computed tomography) scan creates detailed images of blood flow in the brain. A special type of SPECT scan, called subtraction ictal SPECT coregistered to magnetic resonance imaging (SISCOM), compares blood flow during a seizure to normal blood flow. These images can help pinpoint the area of the brain where seizures originate.

After a seizure, it's crucial to see a doctor. They will review your symptoms and medical history. They may order several tests to find the cause of the seizure and how likely future seizures are. These tests may include:

• Neurological exam: This checks your behavior, movement, and mental abilities to see if there's a problem with your brain or nervous system.
• Blood tests: These tests look for infections, genetic conditions, blood sugar problems, or electrolyte imbalances.
• Lumbar puncture (spinal tap): If an infection is suspected, a sample of cerebrospinal fluid (the fluid around the brain and spinal cord) may be taken for testing.
• Electroencephalogram (EEG): This test records the brain's electrical activity, as described above. It can help determine if seizures are likely to happen again and rule out other possible causes.
• Computerized tomography (CT) scan: This uses X-rays to create cross-sectional images of the brain, helping to find tumors, bleeding, or cysts.
• Magnetic resonance imaging (MRI): This uses magnets and radio waves to create detailed images of the brain's structure, revealing potential causes of seizures.
• Positron emission tomography (PET) scan: This uses a small amount of radioactive material to show which parts of the brain are active. This can help pinpoint areas where seizures occur.
• Single-photon emission computed tomography (SPECT) scan: This scan shows blood flow in the brain, particularly useful in identifying areas of increased blood flow during seizures.

By combining these different tests, doctors can get a comprehensive understanding of what's happening in your brain and develop the best treatment plan for you.

Seizures and Epilepsy: Understanding Treatment and Management

Not everyone who has a seizure will have another one. If a seizure is a one-time event, treatment might not be necessary. However, if you experience more than one seizure, treatment is usually needed. The most common way to manage seizures is with medication.

Many different medications can help control epilepsy and seizures. Some examples include:

• Brivaracetam (Briviact)
• Carbamazepine (Carbatrol, Tegretol)
• Clobazam (Onfi, Sympazan)
• Felbamate (Felbatol)
• Gabapentin (Gralise, Horizant, Neurontin)
• Lacosamide (Vimpat)
• Lamotrigine (Lamictal)
• Levetiracetam (Keppra, Spritam)
• Oxcarbazepine (Oxtellar XR, Trileptal)
• Perampanel (Fycompa)
• Phenobarbital (Sezaby)
• Phenytoin (Dilantin, Phenytek)
• Topiramate (Topamax, Qudexy XR)
• Valproic acid
• Zonisamide (Zonegran, Zonisade)

Finding the right medication and dosage can take time. A healthcare professional usually starts with a low dose of a single medication. They gradually increase the dosage until the seizures are well controlled. Often, one medication is enough to manage seizures. However, some people may need more than one. If single-medication treatments don't work, a combination of medications might be necessary.

It's vital to take your medication exactly as prescribed to get the best results. Before starting any new medication, including over-the-counter drugs or herbal remedies, always talk to your doctor. Also, never stop taking your medication without first discussing it with your healthcare provider. Stopping abruptly could lead to a return of seizures.

Common side effects of anti-seizure medications can include fatigue, dizziness, and weight gain. However, some more serious side effects need immediate attention from a doctor. These include mood changes, skin rashes, loss of coordination, speech problems, extreme fatigue, swollen lymph nodes, swelling of the face or eyes, painful sores in the mouth or around the eyes, trouble swallowing or breathing (even during exercise), skin or eye discoloration (like yellowing), unusual bruising or bleeding, and fever with muscle pain.

In rare cases, some anti-seizure medications have been linked to more serious side effects. For example, lamotrigine has been associated with aseptic meningitis, an inflammation of the membranes surrounding the brain and spinal cord. This is similar to bacterial meningitis but isn't caused by bacteria. The FDA has also warned about rare serious reactions with levetiracetam and clobazam. These medications can cause inflammation, a rash, fever, swollen lymph nodes, and swelling of the face or eyes. If left untreated, these reactions can damage organs like the liver, kidneys, lungs, heart, or pancreas, and even lead to death. Symptoms often appear 2 to 8 weeks after starting these medications, but can sometimes appear sooner or later. If you experience any of these serious symptoms, seek immediate medical attention. Always talk to your doctor before stopping these medications, as sudden discontinuation can trigger a return of seizures.

Other Treatments for Epilepsy

If medications aren't effective, other treatment options may be considered:

• Surgery: Surgery aims to stop seizures by removing the part of the brain where they begin. This works best for people whose seizures always originate in the same location.
• Vagus Nerve Stimulation: A device is implanted under the skin in the chest to stimulate the vagus nerve. This sends signals to the brain to help inhibit seizures. Medication doses may be lowered with this treatment.
• Responsive Neurostimulation: A device is implanted on the brain's surface or within the brain tissue to detect seizure activity and deliver electrical stimulation to stop it.
• Deep Brain Stimulation: Electrodes are implanted deep within the brain, and a pacemaker-like device controls the electrical stimulation to regulate brain activity.
• Dietary Therapy: A ketogenic diet, high in fat and low in carbohydrates, can sometimes help manage seizures. Variations like the low glycemic index diet and modified Atkins diet can also be helpful, but are often less effective.

Pregnancy and Epilepsy

Women with a history of seizures can usually have healthy pregnancies. However, some medications, particularly valproic acid, have been linked to birth defects, including cognitive deficits and neural tube defects like spina bifida. The American Academy of Neurology recommends avoiding valproic acid during pregnancy, especially during the first trimester. It's crucial to discuss these risks with your healthcare provider. Preconception planning is especially important for women with a history of seizures, as pregnancy can affect medication levels and dosages. Adjusting medication doses before or during pregnancy may be necessary in some cases. Also, some anti-seizure medications can reduce the effectiveness of birth control pills, and some birth control pills can speed up the metabolism of seizure medications. Consulting your healthcare provider to assess potential interactions is essential.

Living with a seizure disorder can be tough. It's normal to feel stressed, and stress can impact your mental well-being. It's crucial to talk to your doctor or another healthcare provider about how you're feeling. They can offer advice and resources to help.

At Home:

Your family is a vital source of support. Explain your seizure disorder to them. Encourage them to ask questions and share their concerns. Provide them with information about your condition, like educational materials or websites, to help them understand. Open communication is key.

At Work:

Talk to your boss about your seizure disorder and how it might affect your work. Discuss what you need if a seizure occurs while you're at work – things like time off, colleagues who can help, or adjustments to your work schedule. Consider talking to your coworkers about seizure disorders. This can build a supportive work environment and promote understanding.

You're Not Alone:

Remember that you don't have to face this alone. Reach out to friends and family. Your doctor can point you toward local support groups or online communities where you can connect with others who understand. Don't hesitate to ask for help – having a strong support network is essential for managing any health condition. Sharing your experiences and learning from others in similar situations can be incredibly valuable.