360:(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.
335:
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,
60:
295:
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 "
313:
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.
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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
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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
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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
238:
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
312:
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
384:
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
334:
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,
252:
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
143:(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
919:
904:
159:. 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
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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).
325:
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
171:
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
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538:
818:
Michael, Glen E.; o'Connor, Robert E. (2011-02-01). "The
Diagnosis and Management of Seizures and Status Epilepticus in the Prehospital Setting".
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542:
128:. 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.
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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
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specificity in describing the onset of a seizure and being considered an archaic term, it is not typically used by medical professionals.
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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
1351:
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751:
Fisher, Robert S.; Schachter, Steven C. (2000). "The
Postictal State: A Neglected Entity in the Management of Epilepsy".
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and now referred to as focal aware seizure and focal impaired awareness seizure, respectively) can then spread to both
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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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by preventing fluid from entering the lungs. Other general actions to take as recommended by the
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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
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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
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These seizures typically initiate abruptly with either a
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Type of generalized seizure that affects the entire brain
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of focal seizures that become generalized seizures.
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265:A tonic–clonic seizure comprises three phases: the
116:muscle contractions. Tonic–clonic seizures are the
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27:"Grand mal" redirects here. For other uses, see
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199:-flashes or simple light/dark patterns, raised
696:"Electroconvulsive therapy-Electroshock (ECT)"
155:The vast majority of generalized seizures are
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537:: CS1 maint: multiple names: authors list (
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820:Emergency Medicine Clinics of North America
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1006:
729:. Epilepsy Therapy Project. Archived from
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541:) CS1 maint: numeric names: authors list (
58:
1027:
626:"2017 Revised Classification of Seizures"
1388:Citizens United for Research in Epilepsy
239:or suppressed via anticonvulsant drugs.
53:Grand mal seizure, tonic–clonic seizure
721:Ruben Kuzniecky, M.D. (16 April 2004).
183:, malnutrition, lack of sleep or rest,
14:
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356:Diagnosis can be made definitively by
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652:. Epilepsy Foundation. Archived from
1305:Dentatorubral–pallidoluysian atrophy
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108:that produces bilateral, convulsive
1352:Sudden unexpected death in epilepsy
230:, the cause is often determined by
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1282:Complex partial status epilepticus
650:"Seizure Mechanisms and Threshold"
575:10.1016/b978-1-4377-0434-1.00092-x
25:
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1367:Psychogenic non-epileptic seizure
1239:Benign familial neonatal seizures
1191:Sleep-related hypermotor epilepsy
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989:Generalized tonic–clonic seizure
569:, Elsevier, pp. 1583–1633,
94:generalized tonic–clonic seizure
45:Generalized tonic–clonic seizure
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1327:Early myoclonic encephalopathy
1300:Progressive myoclonus epilepsy
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567:Neurology in Clinical Practice
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120:most commonly associated with
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1:
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1277:Epilepsia partialis continua
507:Harrisons manual of medicine
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242:
7:
1332:Juvenile myoclonic epilepsy
1310:Unverricht–Lundborg disease
597:David Y Ko (5 April 2007).
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226:In the case of symptomatic
10:
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1249:Myoclonic astatic epilepsy
211:, rapid motion or flight,
29:Grand Mal (disambiguation)
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1400:Epilepsy Action Australia
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862:"General First Aid Steps"
832:10.1016/j.emc.2010.08.003
221:electroconvulsive therapy
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1362:Landau–Kleffner syndrome
1196:Panayiotopoulos syndrome
1244:Lennox–Gastaut syndrome
1126:Epilepsy and employment
753:Epilepsy & Behavior
599:"Tonic–Clonic Seizures"
399:vagus nerve stimulation
165:complex partial seizure
1176:Temporal lobe epilepsy
1096:Electroencephalography
795:"Triggers of Seizures"
765:10.1006/ebeh.2000.0023
723:"Looking at the Brain"
675:"Triggers of Seizures"
459:Electroencephalography
358:Electroencephalography
161:simple partial seizure
96:, commonly known as a
67:Generalized 3 Hz
1181:Frontal lobe epilepsy
677:. Epilepsy Foundation
439:Non-epileptic seizure
215:imbalances, anxiety,
1417:Epilepsy Research UK
1201:Vertiginous epilepsy
1121:Epilepsy and driving
1072:Epilepsy in children
372:, which can prevent
209:fluorescent lighting
126:metabolic imbalances
73:electroencephalogram
1405:Epilepsy Foundation
1372:Epilepsy in animals
1052:Aura (warning sign)
866:Epilepsy Foundation
799:Epilepsy Foundation
702:on 24 February 2021
630:Epilepsy Foundation
378:Epilepsy Foundation
106:generalized seizure
1292:Myoclonic epilepsy
1269:Status epilepticus
950:External resources
444:Tonic (physiology)
382:status epilepticus
300:biting the tongue.
195:, the presence of
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1345:Related disorders
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1186:Rolandic epilepsy
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434:Epileptic seizure
393:, diet therapy (
370:recovery position
177:seizure threshold
98:grand mal seizure
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71:discharges on an
39:Medical condition
18:Grand mal seizure
16:(Redirected from
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1422:Epilepsy Society
1411:Epilepsy Outlook
1254:Epileptic spasms
1166:Gelastic seizure
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1067:Neonatal seizure
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1161:Complex partial
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104:, is a type of
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733:on 2007-10-12
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869:. Retrieved
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826:(1): 29–39.
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802:. Retrieved
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759:(1): 52–59.
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735:. Retrieved
731:the original
727:epilepsy.com
726:
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704:. Retrieved
700:the original
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654:the original
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633:. Retrieved
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606:. Retrieved
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154:
130:
118:seizure type
101:
97:
93:
91:
36:
1211:Generalised
959:MedlinePlus
706:25 November
409:Terminology
288:Tonic phase
213:blood sugar
169:hemispheres
137:generalized
50:Other names
1234:Automatism
1081:Management
871:2018-12-14
804:2018-12-07
737:2008-03-19
681:2017-09-30
660:2015-11-13
635:2018-12-04
608:2008-03-19
465:References
364:Management
337:stimulants
332:stertorous
277:phase and
203:levels at
157:idiopathic
975:neuro/376
970:eMedicine
840:0733-8627
773:1525-5050
603:eMedicine
533:cite book
525:956960804
352:Diagnosis
280:postictal
243:Mechanism
234:or other
205:ovulation
139:onset. A
85:Neurology
80:Specialty
1460:Category
1450:Medicine
1172:Epilepsy
1152:Seizures
1033:epilepsy
1029:Seizures
848:21109100
781:12609127
418:See also
345:caffeine
248:Prodrome
228:epilepsy
201:estrogen
193:diabetes
141:prodrome
122:epilepsy
940:D004830
389:drugs,
341:alcohol
283:phase.
271:phase,
181:fatigue
1436:Portal
1040:Basics
993:Curlie
964:000695
846:
838:
779:
771:
581:
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513:
449:Clonus
274:clonic
261:Phases
197:strobe
189:stress
151:Causes
114:clonic
1145:Focal
929:345.3
914:G40.3
401:, or
330:with
297:ictal
268:tonic
163:or a
133:focal
110:tonic
1424:(UK)
1413:(UK)
1407:(US)
1396:(UK)
1390:(US)
1031:and
935:MeSH
924:9-CM
844:PMID
836:ISSN
777:PMID
769:ISSN
708:2018
579:ISBN
543:link
539:link
521:OCLC
511:ISBN
343:and
255:aura
112:and
102:GTCS
991:at
920:ICD
905:ICD
828:doi
761:doi
571:doi
397:),
232:MRI
135:or
100:or
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