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Tonic-Clonic Seizure

Seizure Grand Mal


Presentation

  • We present a 68-year old female with an epidermoid cyst with intracystic hemorrhage who presented with a first time generalized tonic clonic seizure.[ncbi.nlm.nih.gov]
Falling
  • You might be at risk of: Falling. If you fall during a seizure, you can injure your head or break a bone. Drowning. If you have a seizure while swimming or bathing, you're at risk of accidental drowning. Car accidents.[mayoclinic.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]
  • […] which may be tactile, visual, auditory, or musical. gen·er·al·ized ton·ic-clo·nic sei·zure a generalized seizure characterized by the sudden onset of tonic contraction of the muscles often associated with a cry or moan, and frequently resulting in a fall[medical-dictionary.thefreedictionary.com]
  • He is bagging groceries when the cashier suddenly stiffens up and falls to the floor. Once on the floor, his arms and legs are jerking and bending quickly and repeatedly.[study.com]
  • 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]
Fatigue
  • Sleep deprivation, fatigue and alcohol lower threshold for seizures. Antecedent and birth history is normal, although there are patients with a previous history of childhood absence epilepsy. Neurological examination and head size is normal.[epilepsydiagnosis.org]
  • During the postictal period, the child may be sleepy, have problems with vision or speech, and may have a bad headache, fatigue, or body aches. Tonic seizures Tonic seizures usually last less than 20 seconds.[chp.edu]
  • Fatigue. Sleepiness is common after a grand mal seizure. Severe headache. Headaches may occur after a grand mal seizure.[mayoclinic.org]
  • These include: Blood clots Blood loss Heart attack Stroke Reaction to medication Additionally, there are side effects that may occur after the surgical procedures, including: Scalp numbness Fatigue Depression Headaches Difficulty speaking Loss of memory[northwell.edu]
  • The seizure threshold can be altered by: fatigue, malnutrition, lack of sleep or rest, hypertension, stress, diabetes, the presence of strobe-flashes or simple light/dark patterns, raised estrogen levels at ovulation, fluorescent lighting, rapid motion[en.wikipedia.org]
Loud Snoring
  • After these series of contractions, there is an extended postictal state where the person is unresponsive and commonly sleeping with loud snoring. There is usually pronounced confusion upon awakening.[en.wikipedia.org]
Sighing
  • Usually a deep sigh signals the end of the jerking and normal breathing resumes. The seizure is now over but the child is not awake and will not respond immediately.[doosesyndrome.org]
  • The person may let out a deep sigh and return to more normal breathing. After the Seizure (Postictal Period) After a seizure, the person may remain unconscious for several minutes as the brain recovers from the seizure activity.[hopkinsmedicine.org]
Hemoptysis
  • A 38-year-old woman presented with massive hemoptysis ( 200 mL/ 24 hours) occurring abruptly after generalized tonic clonic seizure. She experienced similar episodes of hemoptysis on three later occasions.[ncbi.nlm.nih.gov]
Suggestibility
  • It also suggests that seizure should be considered an adverse event related to taser use.[ncbi.nlm.nih.gov]
Impulsivity
  • Following this, an inhibitory impulse starts from the thalamus and interrupts the tonic phase into discontinuous bursts of electrical activity, known as the clonic phase. Etiology Most generalized epilepsies are idiopathic.[emedicine.com]
  • […] or restless; trouble sleeping (insomnia); acting aggressive; being angry, or violent; an extreme increase in activity and talking (mania); attempt to commit suicide; new or worse anxiety; panic attacks; new or worse irritability; acting on dangerous impulses[fycompa.com]
Episodic Headache
  • Headache Weakness of 1 side of the body for a few minutes to a few hours following seizure (called Todd paralysis) The doctor will perform a physical exam.[nlm.nih.gov]
  • Headache Weakness of one side of the body for a few minutes to a few hours (Todd paralysis) Causes and Risk Factors These seizures are usually caused by epilepsy.[cedars-sinai.edu]
  • Headache Weakness of 1 side of the body for a few minutes to a few hours following seizure (called Todd paralysis) Exams and Tests The doctor will perform a physical exam.[mountsinai.org]
Clonus
  • See epilepsy. atonic seizure an absence seizure characterized by sudden loss of muscle tone. focal motor seizure a simple partial seizure consisting of clonus or spasm of a muscle or muscle group, occurring either singly or in a continuous repetitive[medical-dictionary.thefreedictionary.com]
  • Focal seizure Absence seizure Epileptic seizure Non-epileptic seizure Tonic (physiology) Clonus Postictal state ictal Electroencephalography Generalized tonic–clonic seizure at Curlie[en.wikipedia.org]
Neglect
  • "The Postictal State: A Neglected Entity in the Management of Epilepsy". Epilepsy & Behavior. 1 (1): 52–59. doi : 10.1006/ebeh.2000.0023. ISSN 1525-5050. "Triggers of Seizures". Epilepsy Foundation. Retrieved 2018-12-07.[en.wikipedia.org]
Tremulousness
  • We divided GTCSs into the following phases: onset of generalization, pretonic clonic, tonic, tremulousness, and clonic. The mean GTCS duration was 62 seconds.[ncbi.nlm.nih.gov]

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.com]
Photoparoxysmal Response
  • Before seizure onset, IPS consistently induced generalized photoparoxysmal responses (PPRs).[ncbi.nlm.nih.gov]

Treatment

  • Fifty-two (24%) of the 215 patients randomized to immediate treatment and 85 (42%) of the 204 randomized to delayed treatment experienced seizure recurrence during follow-up.[ncbi.nlm.nih.gov]

Prognosis

  • Early treatment does not affect the long-term prognosis of epilepsy.[ncbi.nlm.nih.gov]
  • For further reference to treatment onset and epilepsy prognosis, see Progress in Pediatric Neurology II, PNB Publ, 1994:pp92-93.[pediatricneurologybriefs.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.com]

Etiology

  • Age, acute treatment of the seizure with benzodiazepines, remote etiologic factors, and EEG abnormalities were significant predictors of relapse.[ncbi.nlm.nih.gov]
  • […] 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]
  • Etiology Most generalized epilepsies are idiopathic. However, a definite genetic locus has been found for some of these generalized types of epilepsy.[emedicine.com]

Epidemiology

  • 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.com]
  • Recent epidemiological surveys in the United States show that the modern use of ECT is generally limited to evidence-based indications (Hermann et al., 1999).[doctorslounge.com]
Sex distribution
Age distribution

Pathophysiology

  • The condition is rare and the exact pathophysiology is unknown.[ncbi.nlm.nih.gov]
  • 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.com]

Prevention

  • Determining the risk factors associated with increased DMSO toxicity and taking preventive actions is utmost important.[ncbi.nlm.nih.gov]
  • For a person experiencing a tonic–clonic seizure, first-aid treatment includes rolling the person over into the recovery position, which can prevent asphyxiation by preventing fluid from entering the lungs.[en.wikipedia.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]
  • But someone who has recurrent seizures may need treatment with daily anti-seizure medications to control and prevent future grand mal seizures. Symptoms Grand mal seizures have two stages: Tonic phase.[mayoclinic.org]

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