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Generalized Clonic or Tonic-Clonic Seizures


Presentation

  • CJD typically presents with dementia, ataxia, myoclonus, and other abnormal movements; however, there is considerable clinical and pathologic overlap between FFI and CJD, and some individuals with D178N and met129 may present with a phenotype suggestive[mendelian.co]
  • The study was presented at the 2015 American Academy of Neurology Annual Meeting in Washington, D.C. “At the present time, we are practicing based on reports by our patients who often don't realize when they have seizures,” José E.[neurologyadvisor.com]
  • Read more March 15, 2017 March 15, 2017 News Epileptic children could benefit from the same drugs that are generating positive results in trials for adults, suggests a new meta-analysis to be presented April 22–28 at the 69th ...[epilepsynewstoday.com]
  • Krauss, MD Professor of Neurology The Johns Hopkins Hospital Baltimore, MD FACULTY PRESENTERS Georgia D.[cme2.medpagetoday.com]
Falling
  • 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.[epilepsynewengland.org]
  • A person undergoing a convulsion loses consciousness and falls to the ground. The fall is sometimes preceded by a shrill scream caused by forcible expiration of air as the respiratory and laryngeal muscles suddenly contract.[britannica.com]
  • Please obtain help should the individual fall and injure him/herself.[edmontonepilepsy.org]
  • Your risk of feeling dizzy and having problems walking normally may be higher if you are elderly; Sleepiness and tiredness; Increased risk of falls. Taking FYCOMPA can increase your chance of falling. These falls can cause serious injuries.[fycompa.com]
  • […] characterized by the abrupt loss of consciousness with initially tonic muscle contractions followed by clonic muscle spasms During a generalized tonic-clonic seizure, also known as a grand mal seizure, the person might have a vocal outburst, stiffen and fall[merriam-webster.com]
Nausea
  • The most common adverse events were dizziness, somnolence and nausea.[cochrane.org]
  • The person may experience abnormal sensations such as a particular smell, vertigo, nausea, or anxiety. If the person is familiar with having seizures, they may recognize the warning signs of a seizure about to begin.[hopkinsmedicine.org]
  • […] that do not go away; swelling of your face; shortness of breath; swelling of the legs; yellowing of the skin or whites of the eyes; or dark urine The most common side effects of FYCOMPA include: dizziness; sleepiness; tiredness; irritability; falls; nausea[fycompa.com]
  • Also, pseudo seizures often lack the exhaustion, confusion, and nausea that is associated with epileptic seizures. Psychogenic seizures can occur in people who also experience epileptic seizures.[epilepsy-ohio.org]
Neonatal Jaundice
  • jaundice Hyperhidrosis Degeneration of the lateral corticospinal tracts Constipation Astereognosia Drooling Resting tremor Slurred speech Infantile spasms Hypomimic face Action tremor Agraphesthesia Intellectual disability, severe Bradykinesia Arrhythmia[mendelian.co]
Hyperhidrosis
  • […] of the cerebral white matter Ophthalmoplegia Cirrhosis Bruising susceptibility Sleep disturbance Paralysis Neurofibrillary tangles Ascites Oligohydramnios Gait ataxia Psychosis Athetosis Clumsiness Dysphonia Schizophrenia Prolonged neonatal jaundice Hyperhidrosis[mendelian.co]
Hand Tremor
  • tremor Neuronal loss in central nervous system Cutaneous photosensitivity Hyperreflexia Heterogeneous Weight loss Dystonia Splenomegaly Thrombocytopenia Pneumonia Polyhydramnios Intrauterine growth retardation Jaundice Neonatal hypotonia Hepatosplenomegaly[mendelian.co]
Slurred Speech
  • speech Infantile spasms Hypomimic face Action tremor Agraphesthesia Intellectual disability, severe Bradykinesia Arrhythmia Cerebral cortical atrophy Absent speech Dyskinesia Hypsarrhythmia CNS hypomyelination Neonatal onset Apraxia Postural instability[mendelian.co]
Action Tremor
  • tremor Agraphesthesia Intellectual disability, severe Bradykinesia Arrhythmia Cerebral cortical atrophy Absent speech Dyskinesia Hypsarrhythmia CNS hypomyelination Neonatal onset Apraxia Postural instability Cerebral hypomyelination Olivopontocerebellar[mendelian.co]
Spastic Gait
  • gait EEG with burst suppression Skeletal muscle atrophy Pes cavus Progressive Lower limb muscle weakness Paraplegia Urinary incontinence Lower limb spasticity Microcephaly Postural tremor Impaired vibratory sensation Urinary urgency Lower limb hyperreflexia[mendelian.co]

Workup

  • The awake EEG of patients with generalized tonic-clonic seizure may be normal; however, certain specific interictal EEG patterns can be distinctive of generalized epilepsy syndromes (see Workup).[emedicine.medscape.com]
Spike-and-Slow-Waves
  • […] will show a "progressive increase in low-voltage fast wave activity, followed by generalized high-amplitude, poly spike discharges." [2] The clonic phase EEG will show "high amplitude activity that is typically interrrupted by slow waves to create a spike-and-slow-wave[en.wikipedia.org]
Generalized Polyspikes
  • The inclusion criteria for patient recruitment were as follows: (a) manifestation of typical clinical symptoms of GTCS; (b) presence of generalized polyspike-wave discharges on the patient’s scalp and sphenoidal electroencephalographic (including video[pubs.rsna.org]
Epileptiform Activity
  • Indices derived from processed electroencephalogram may show aberrant values during seizure activity, mostly indicating falsely high index values because of high-frequency epileptiform activity.[anesthesiology.pubs.asahq.org]
  • The cerebral cortex is the only area from which epileptiform activity arises with any frequency.[dartmouth.edu]
Neurofibrillary Tangle
  • tangles Ascites Oligohydramnios Gait ataxia Psychosis Athetosis Clumsiness Dysphonia Schizophrenia Prolonged neonatal jaundice Hyperhidrosis Degeneration of the lateral corticospinal tracts Constipation Astereognosia Drooling Resting tremor Slurred speech[mendelian.co]

Treatment

  • It does not provide medical advice, diagnosis or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment.[dravetsyndromenews.com]
  • The study will have 3 periods: prerandomization, when a baseline seizure frequency is established; treatment; and follow-up.[neurologylive.com]
  • Program Highlights ILAE classification of seizure types AAN Practice Guideline on SUDEP Updates in treatment-refractory generalized tonic-...[myana.org]
  • Data collection and analysis: Outcome measures were: proportion of people (1) with 50% or greater reduction in frequency; (2) with cessation of seizures; (3) who had treatment withdrawn; (4) with adverse effects ; and (5) cognitive effects; (6) quality[cochrane.org]
  • Epilepsy with GTCS alone on awakening is probably lifelong with high (83%) incidence of relapse on withdrawal of treatment. Avoidance of seizure precipitants.[pennsw.com.au]

Prognosis

  • Abstract Clinical course and long-term seizure prognosis were studied in 155 patients with complex-partial seizures during a follow-up of 10.1 /- 1 (SD) years.[ncbi.nlm.nih.gov]
  • The outlook or prognosis is variable – some people can be controlled with medication, while others may have tonic-clonic seizures that become frequent and less dependent on sleep-wake cycle or other triggers.[epilepsy.com]
  • ., thiopental , propofol , or midazolam Nonbenzodiazepine therapy (to prevent recurrence) : fosphenytoin or valproate Prognosis Status epilepticus is a life‑threatening event![amboss.com]
  • Complications Complications in FTD/MND can include the following: Prognosis Progressive dementia with symptoms of executive dysfunction, personality change, and […] Background Sleep disorders are among the most common clinical problems encountered in[nvneurocare.com]
  • Prognosis The morbidity for tonic-clonic seizure can be high because these patients experience no aura and thus the seizure strikes without warning; minor injuries are frequent. Patients can have posterior shoulder dislocations and broken bones.[emedicine.medscape.com]

Etiology

  • Etiology Epilepsy Although these seizures are referred to as unprovoked, they may be triggered by certain provocative factors![amboss.com]
  • This finding reflects the vasogenic and cytotoxic edema induced by seizure and can help exclude etiologic lesions such as tumors, inflammation and demyelinating disease that induce epilepsy.[synapse.koreamed.org]
  • […] repeated, chronic condition–epilepsy, and are caused by abnormal electrical activity at multiple locations in the brain, or over most of the brain, which may be accompanied by changes in mental status–alertness, awareness and/or focal neurologic Sx Etiology[medical-dictionary.thefreedictionary.com]
  • In addition, a variety of environmental and behavioral factors may precipitate migraine attacks in persons with a predisposition to migraine (see Etiology).[nvneurocare.com]
  • Etiology Most generalized epilepsies are idiopathic. However, a definite genetic locus has been found for some of these generalized types of epilepsy.[emedicine.medscape.com]

Epidemiology

  • Definition References: [1] [2] [3] [4] [5] Epidemiology References: [6] Epidemiological data refers to the US, unless otherwise specified.[amboss.com]
  • Approximately 75% of all persons who experience migraines are women (see Epidemiology). The term migraine is derived from the Greek word hemikrania. This term was corrupted into low Latin as hemigranea, the French translation of which was migraine.[nvneurocare.com]
  • Epidemiology The age-adjusted incidence of epilepsy (ie, recurrent unprovoked seizures) ranges from 24-53 per 100,000 population per year. Approximately 20-25% of cases are classified as generalized seizures.[emedicine.medscape.com]
Sex distribution
Age distribution

Pathophysiology

  • Currently, however, the neurovascular theory describes migraine as primarily a neurogenic process with secondary changes in cerebral perfusion associated with a sterile neurogenic inflammation (see Pathophysiology).[nvneurocare.com]
  • Although substantial efforts have been made in the past decade, the pathophysiological mechanisms of GTCS remain largely unclear.[frontiersin.org]
  • The presence of both anatomic and functional changes suggested that the bilateral ACC is important in the pathophysiology of IGE.[pubs.rsna.org]
  • Pathophysiology Generalized epilepsy is thought to be initiated by 3 different mechanisms: Abnormal response of hyperexcitable cortex to initially normal thalamic input Primary subcortical trigger Abnormal cortical innervation from subcortical structures[emedicine.medscape.com]
  • In this updated article, the author details the clinical manifestations, pathophysiology, EEG , and neuroimaging of generalized onset tonic-clonic seizures and provides clues for correct diagnosis and optimal management of patients.[medlink.com]

Prevention

  • 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.[epilepsynw.org]
  • Do - prevent crowds gathering round. Do - place a cushion or some clothing under the person's head to prevent injury. Do not - try to restrain the person.[patient.info]
  • Treatment and Prevention Tonic clonic seizure treatment is primarily focused on prevention, and it is rare that a tonic clonic seizure needs to be treated while it is occurring.[verywellhealth.com]

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