Tonic-Clonic Seizures

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Tonic-clonic seizures, previously known as terrific mal seizures, involve two phases: both a tonic and clonic phase. Extreme muscle spasms can cause these severe seizures to temporarily stop breathing, which can be terrifying to witness or experience.

Both tonic (stiffening) and clonic (twitching or jerking) phases of muscle activity are involved in tonic-clonic seizures. A simple partial seizure or aura may be the first sign of a tonic-clonic seizure. Prior to the tonic-clonic seizure, the individual may have experienced changes in sensation, state of mind, or emotion.


Symptoms of a Tonic-Clonic (Grand Mal) Seizure


Aura: A simple or complex partial seizure known as an aura may begin the seizure. Anxiety, vertigo, nausea, and other unusual sensations may be experienced by the individual. The person may be able to recognize the signs of a coming seizure if they are used to them.


Tonic Activity: The person may lose consciousness and fall during the tonic-clonic seizure. Even if the person is not aware of their surroundings, strong tonic spasms of the muscles can force air out of the lungs, resulting in a cry or moan. The mouth may be producing foam or saliva. The saliva may contain blood if the person bites their tongue or cheek inadvertently.


The person may make gasping or gurgling sounds, have bluish or gray faces, and have stiff chest muscles that can make breathing difficult.


Clonic Activity: The face, arms, and legs are affected by jerking movements, which become rapid and intense. The jerking movements slow down after one to three minutes, and the body relaxes, sometimes including the bowel or bladder. The individual might let out a deep sigh before resuming their normal breathing.


After the Seizure (Postictal Period)

As the brain recovers from the activity of the seizure, the person may remain unconscious for several minutes after a seizure. It's possible that he or she is snoring or sleeping.


The individual gradually regains consciousness and may experience confusion, exhaustion, physical soreness, sadness, or embarrassment for a few hours. The individual may not remember having a seizure and may also have memory loss in other ways. During the time that the brain is recovering from a tonic-clonic seizure, some people may exhibit abnormal or combative behavior.


What to Do If Someone Has a Tonic-Clonic (Grand Mal) Seizure


Witnessing a person having a tonic-clonic seizure can be upsetting, but it’s important to remember that most seizures resolve on their own after one to three minutes. To offer assistance:


  • Protect the person from injury by helping them to the floor and clearing away furniture or other items. Do not attempt to hold the person still.

  • Do not put anything in the person’s mouth. It is physically impossible to swallow one’s tongue, and putting things in the mouth may lead to injury.

  • Time the seizure.

  • A seizure lasting more than 5 minutes is an emergency. 

  • Calm reassurance can be helpful to a person who is recovering from a seizure.




Diagnosis and Treatment of Tonic-Clonic (Grand Mal) Seizures


When a person has their first seizure, it's important to talk to a doctor. When a child has a seizure, their parents or other family members can take notes on the specifics and assist in writing a report that the child can take to the doctor. If possible, a video recording of the event can also be used to aid in diagnosis.


The doctor may recommend magnetic resonance imaging (MRI) or other tests to look for scarred brain regions to determine the cause of the seizure. Electroencephalography, or EEG, can help differentiate between other conditions and seizures.


An individualized treatment plan can assist in managing a seizure disorder, such as epilepsy, if the patient is diagnosed by a doctor. Seizures can be treated with a variety of treatments, including anti-seizure medication, nerve stimulation, dietary therapy, and surgical procedures.


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