Overview Symptoms When to see a doctor Causes Complications Risk factors Diagnosis Treatment consists of anti- convulsants Medications Specialists Surgery and other therapies Pregnancy and seizures Contraception and anti-seizure medications Clinical trials Lifestyle and home remedies

1. Grand mal seizure
A grand mal seizure causes a loss of consciousness
and violent muscle contractions. It's the type
of seizure most people picture when they think
about seizures. A grand mal seizure — also known as
a generalized tonic-clonic seizure — is caused by
abnormal electrical activity throughout the brain.

2. Overview
A grand mal seizure causes a loss of consciousness and
violent muscle contractions. It's the type of seizure most
people picture when they think about seizures.
A grand mal seizure — also known as a generalized
tonic-clonic seizure — is caused by abnormal electrical
activity throughout the brain. Usually, a grand mal
seizure is caused by epilepsy. But sometimes, this type
of seizure can be triggered by other health problems,
such as extremely low blood sugar, a high fever or a
stroke.
Many people who have a grand mal seizure never have
another one and don't need treatment. But someone who
has recurrent seizures may need treatment with daily anti-
seizure medications to control and prevent future grand mal
seizures.

3. Symptoms
Grand mal seizures have two stages:
Tonic phase. Loss of consciousness occurs, and the
muscles suddenly contract and cause the person to fall
down. This phase tends to last about 10 to 20
seconds.
Clonic phase. The muscles go into rhythmic
contractions, alternately flexing and relaxing.
Convulsions usually last one to two minutes or less.
The following signs and symptoms occur in some
but not all people with grand mal seizures:
•A scream. Some people may cry out at the beginning of
a seizure.
•Loss of bowel and bladder control. This may happen
during or following a seizure.

4. •Unresponsiveness after convulsions.
•Unconsciousness may persist for several minutes after
the convulsion has ended.
•Confusion. A period of disorientation often follows
a grand mal seizure. This is referred to as postictal
confusion.
•Fatigue. Sleepiness is common after a grand mal
seizure.
•Severe headache. Headaches may occur after a
grand mal seizure.

5. When to see a doctor
Seek immediate medical help if any of the
following occurs:
•The seizure lasts more than five minutes
•Breathing or consciousness doesn't return after the seizure
stops
•A second seizure follows immediately
•You have a high fever
•You're experiencing heat exhaustion.
•You're pregnant.
•You have diabetes.
•You've injured yourself during the seizure.
•If you experience a seizure for the first time, seek medical advice.
•Additionally, seek medical advice for yourself or your child:
•If the number of seizures experienced increases significantly
without explanation
•If new seizure signs or symptoms appear

6. Causes
•Grand mal seizures occur when the electrical
activity over the whole surface of the brain
becomes abnormally synchronized. The brain's
nerve cells normally communicate with each other
by sending electrical and chemical signals across
the synapses that connect the cells.
•In people who have seizures, the brain's usual
electrical activity is altered and many nerve cells
fire at the same time. Exactly what causes the
changes to occur often remains unknown.

7. However, grand mal seizures are sometimes caused by
underlying health problems, such as:
Injury or infection
•Traumatic head injuries
•Infections, such as encephalitis or meningitis, or a history of
such infections
•Injury due to a previous lack of oxygen
•Stroke
Congenital or developmental abnormalities
•Blood vessel malformations in the brain
•Genetic syndromes
•Brain tumors
Metabolic disturbances
•Very low blood levels of glucose, sodium, calcium or
magnesium
Withdrawal syndromes
•Using or withdrawing from drugs, including alcohol

8. Risk factors
Risk factors for grand mal seizures include:
•A family history of seizure disorders
•Any injury to the brain from trauma, a
stroke, previous infection and other
causes
•Sleep deprivation
•Medical problems that affect electrolyte
balance
•Illicit drug use
•Heavy alcohol use

9. Complications
Having a seizure at certain times can lead to circumstances that are
dangerous for you or others. 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. A seizure that causes either loss of awareness or
control can be dangerous if you're driving a car or operating other
equipment.
•Pregnancy complications. Seizures during pregnancy pose
dangers to both mother and baby, and certain anti-epileptic medications
increase the risk of birth defects. If you have epilepsy and plan to become
pregnant, work with your doctor so that he or she can adjust your
medications and monitor your pregnancy, as needed.
•Emotional health issues. People with seizures are more likely to
have psychological problems, such as depression and anxiety. Problems
may be a result of difficulties dealing with the condition itself as well as
medication side effects.

10. After a seizure, your doctor will thoroughly review your
symptoms and medical history. Your doctor may order
several tests to determine the cause of your seizure
and evaluate how likely it is that you'll have another
one.
Diagnosis
Neurological exam.
Your doctor may test your behavior, motor abilities and
mental function to determine if you have a problem with
your brain and nervous system.

11. Blood tests. Your doctor may take a blood sample to
check for signs of infections, genetic conditions, blood
sugar levels or electrolyte imbalances.
Lumbar puncture. If your doctor suspects an infection
as the cause of a seizure, you may need to have a sample
of cerebrospinal fluid removed for testing.
Electroencephalogram (EEG). In this test, doctors
attach electrodes to your scalp with a paste-like substance.
The electrodes record the electrical activity of your brain,
which shows up as wavy lines on an EEG recording. The
EEG may reveal a pattern that tells doctors whether a
seizure is likely to occur again. EEG testing may also help
your doctor exclude other conditions that mimic epilepsy
as a reason for your seizure.

12. Computerized tomography (CT) scan. A CT scan
uses X-rays to obtain cross-sectional images of your brain. CT scans
can reveal abnormalities in your brain that might cause a seizure, such
as tumors, bleeding and cysts.
Magnetic resonance imaging (MRI). An MRI uses
powerful magnets and radio waves to create a detailed view of your
brain. Your doctor may be able to detect lesions or abnormalities in your
brain that could lead to seizures.
Positron emission tomography (PET). PET scans
use a small amount of low-dose radioactive material that's injected into a
vein to help visualize active areas of the brain and detect abnormalities.
Single-photon emission computerized
tomography (SPECT). A SPECT test uses a small amount of
low-dose radioactive material that's injected into a vein to create a
detailed, 3-D map of the blood flow activity in your brain that happens
during a seizure. Doctors may also conduct a form of a SPECT test
called subtraction ictal SPECT coregistered to magnetic resonance
imaging (SISCOM), which may provide even more-detailed results

13. Treatment consists of anti-
convulsants
Many people will have only one such seizure in their lifetime.
Others may need daily anti-seizure medication to prevent
recurrence.
Medications
•Sedative
Causes drowsiness, calmness and dulled senses.
Some types may become addictive.
•Anticonvulsant
Prevents or controls seizures, relieves pain and
treats symptoms of certain psychiatric disorders.

14. Medications
Many medications are used in the treatment of epilepsy
and seizures, including:
•Carbamazepine (Carbatrol, Tegretol, others)
•Phenytoin (Dilantin, Phenytek)
•Valproic acid (Depakene)
•Oxcarbazepine (Oxtellar, Trileptal)
•Lamotrigine (Lamictal)
•Gabapentin (Gralise, Neurontin)
•Topiramate (Topamax)
•Phenobarbital
•Zonisamide (Zonegran)
Treatment
Not everyone who has one seizure has another one.
Because a seizure can be an isolated incident, your doctor
may not start treatment until you've had more than one.
Treatment usually involves the use of anti-seizure
medications.

15. Specialists
•Neurologist
Treats nervous system disorders.
•Emergency Medicine Doctor
Treats patients in the emergency department.
•Neurosurgeon
Specialises in nervous system disorders.
•Paediatrician
Provides medical care for infants, children and
teenagers.
•Primary Care Provider (PCP)
•Prevents, diagnoses and treats diseases.

16. Many medications are used in the treatment of
epilepsy and seizures, including:
Carbamazepine (Carbatrol, Tegretol, others)
Phenytoin (Dilantin, Phenytek)
Valproic acid (Depakene)
Oxcarbazepine (Oxtellar, Trileptal)
Lamotrigine (Lamictal)
Gabapentin (Gralise, Neurontin)
Topiramate (Topamax)
Phenobarbital.
Epileptic Seizure May Turn Fatal When People Sleep On Their
Stomachs. ... Formerly known as grand mal seizures, tonic
clonic seizures carry a higher risk of dying suddenly due to the
affect they have on the entire brain compared to partial
seizures which only affect a certain area of the brain.

17. •Finding the right medication and dosage can be
challenging. Your doctor likely will first prescribe a single
drug at a relatively low dosage, and then increase the
dosage gradually until your seizures are well-controlled.
•Many people with epilepsy are able to prevent seizures
with just one drug, but others need more than one. If you've
tried two or more single-drug regimens without success,
your doctor may recommend trying a combination of two
drugs.
•To achieve the best seizure control possible, take
medications exactly as prescribed. Always call your doctor
before adding other prescription medications, over-the-
counter drugs or herbal remedies. And never stop taking
your medication without talking to your doctor.

18. •Mild side effects of anti-seizure medications can
include:
•Fatigue
•Dizziness
•Weight gain
•More-troubling side effects that need to be
brought to your doctor's attention immediately include:
•Mood disruption
•Skin rashes
•Loss of coordination
•Speech problems
•Extreme fatigue
In addition, the drug Lamictal has been linked to an
increased risk of aseptic meningitis, an inflammation of
the protective membranes that cover the brain and spinal
cord that's similar to bacterial meningitis.

19. Surgery and other therapies
When anti-seizure medications aren't effective, other
treatments may be an option:
•Surgery. The goal of surgery is to stop seizures from
happening. Surgeons locate and remove the area of your
brain where seizures begin. Surgery works best for people
who have seizures that always originate in the same place in
their brains.
•Vagus nerve stimulation. A device implanted
underneath the skin of your chest stimulates the vagus nerve
in your neck, sending signals to your brain that inhibit
seizures. With vagus nerve stimulation, you may still need to
take medication, but you may be able to lower the dose.
•Responsive neurostimulation. During responsive
neurostimulation, a device implanted on the surface of your
brain or within brain tissue can detect seizure activity and
deliver an electrical stimulation to the detected area to stop

20. Deep brain stimulation.
Doctors implant electrodes within certain areas of your
brain to produce electrical impulses that regulate abnormal
brain activity. The electrodes attach to a pacemaker-like
device placed under the skin of your chest, which controls
the amount of stimulation produced.
Dietary therapy.
Following a diet that's high in fat and low in carbohydrates,
known as a ketogenic diet, can improve seizure control.
Variations on a high-fat, low-carbohydrate diet, such as the
low glycemic index and modified Atkins diets, though less
effective, aren't as restrictive as the ketogenic diet and may
provide benefit.

21. Pregnancy and seizures
Women who've had previous seizures usually are able to
have healthy pregnancies. Birth defects related to certain
medications can sometimes occur.
•In particular, valproic acid has been associated with
cognitive deficits and neural tube defects, such as spina
bifida. The American Academy of Neurology recommends
that women avoid using valproic acid during pregnancy
because of risks to the baby. It's especially important to
avoid valproic acid during the first trimester of pregnancy, if
possible.
•Discuss these risks with your doctor. Because of the risk of
birth defects, and because pregnancy can alter medication
levels, preconception planning is particularly important for
women who've had seizures.
•In some cases, it may be appropriate to change the dose
of seizure medication before or during pregnancy.
Medications may be switched in rare cases.

22. It's also important to know that some anti-seizure
medications can alter the effectiveness of oral
contraceptives — a form of birth control — and some
oral contraceptives can speed up the absorption of
seizure medications. If contraception is a high priority,
check with your doctor to evaluate whether your
medication interacts with your oral contraceptive, and if
other forms of contraception need to be considered.
Contraception and anti-seizure medications

23. Clinical trials
Explore Mayo Clinic studies testing new treatments,
interventions and tests as a means to prevent, detect, treat
or manage this disease.
Lifestyle and home remedies
Here are some steps you can take to help with seizure
control:
Take medication correctly. Don't adjust the dosage
before talking to your doctor. If you feel your medication
should be changed, discuss it with your doctor.
Get enough sleep. Lack of sleep can trigger seizures. Be
sure to get adequate rest every night.
Wear a medical alert bracelet. This will help emergency
personnel know how to treat you correctly if you have
another seizure.

24. •Personal safety
Seizures don't usually result in serious injury, but if you have
recurrent seizures, injury is a possibility. These steps can
help you avoid injury during a seizure:
•Take care near water. Don't swim alone or relax in a
boat without someone nearby.
•Wear a helmet for protection during activities such as
bike riding or sports participation.
•Take showers instead of baths, unless someone is near
you.
•Modify your furnishings. Pad sharp corners, buy
furniture with rounded edges and choose chairs that have
arms to keep you from falling off the chair. Consider carpet
with thick padding to protect you if you do fall.
•Display seizure first-aid tips in a place where people
can easily see them. Include any important phone numbers

25. To help someone during a seizure:
•Carefully roll the person onto one side
•Place something soft under his or her head
•Loosen tight neckwear
•Remove eyeglasses
•Avoid putting your fingers or other objects in the person's mouth
•Don't try to restrain someone having a seizure
•Clear away dangerous objects, if the person is moving
•Stay with the person until medical personnel arrive
•Observe the person closely so that you can provide details on what
happened
•Time the seizure
•Check for a medical alert bracelet or ID
•Stay calm
Seizure first aid
It's helpful to know what to do if you witness someone having a seizure.
If you're at risk of having seizures in the future, pass this information
along to family, friends and co-workers so that they know what to do if
you have a seizure.

26. •At home
Your family can provide much-needed support. Tell them what you
know about your seizure disorder. Let them know they can ask you
questions, and be open to conversations about their worries. Help
them understand your condition by sharing any educational materials
or other resources that your health care provider has given you.
•At work
Meet with your supervisor and talk about your seizure disorder and
how it affects you. Discuss what you need from your supervisor or co-
workers if a seizure happens while at work. Consider talking with your
co-workers about seizure disorders — you can widen your support
system and bring about acceptance and understanding.
Coping and support
If you're living with a seizure disorder, you may feel anxious or stressed
about what your future holds. Stress can affect your mental health, so it's
important to talk with your health care provider about your feelings and
seek ways you can find help.

27. Preparing for your appointment
In some cases, seizures need immediate medical attention, and there's
not always time to prepare for an appointment.
In other cases, your first appointment to evaluate a seizure may be with
your family doctor or a general practitioner. Or you may be referred to a
specialist, such as a doctor trained in brain and nervous system
conditions (neurologist) or a neurologist trained in epilepsy
(epileptologist).
To prepare for your appointment, consider what you can do to get ready
and understand what to expect from your doctor.
You're not alone
Remember, you don't have to go it alone. Reach out to family and friends.
Ask your health care provider about local support groups or join an online
support community. Don't be afraid to ask for help. Having a strong
support system is important to living with any medical condition.

28. What you can do
•Record information about the seizure. Include the time,
location, symptoms you experienced and how long it lasted, if you know
these details. Seek input from anyone who may have seen the seizure,
such as a family member, friend or co-worker, so that you can record
information you may not know.
•Write down any symptoms you or your child has
experienced, including any that may seem unrelated to the reason for
which you scheduled the appointment.
•Make a list of all medications, vitamins and supplements you're
taking and the dosages used. Also, write down the reasons you stopped
taking any medications, whether this was because of side effects or lack of
effectiveness.
•Ask a family member to come with you to the
doctor, because it's not always easy to remember everything you've
been told during your appointment. Also, since memory loss can happen
during seizures, many times an observer is able to better describe the
seizure than is the person who's had the seizure.

29. Preparing a list of questions will help you make the most of your
time with your doctor. For a grand mal seizure, some basic
questions to ask your doctor include:
•Do I have epilepsy?
•Will I have more seizures?
•What kinds of tests do I need? Do these tests require any
special preparation?
•What treatments are available and which do you
recommend?
•What types of side effects can I expect from treatment?
•Are there any alternatives to the primary approach you're
suggesting?
•Is there a generic alternative to the medicine you're
prescribing?
•Do I need to restrict any activities?
•Are there any brochures or other printed material that I can
Write down questions to ask your doctor.

30. What to expect from your doctor
Your doctor is likely to ask you a number of questions, such as:
•When did you or your child begin experiencing
symptoms?
•How many seizures have you or your child had?
•How often do the seizures occur? How long do they last?
•Can you describe a typical seizure?
•Do the seizures occur in clusters?
•Do they all look the same, or are there different seizure
behaviors you or others have noticed?
•What medications have you or your child tried? What
doses were used?
•Have you tried combinations of medications?
•Have you noticed any seizure triggers, such as sleep
deprivation or illness?