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What Is a Tonic-Clonic aka Grand Mal Seizure?

Learn about the generalized seizure tonic-clonic aka grand mal seizure from Steve Wolf, MD and Patty McGoldrick, NP in this Howcast video.


Dr. Steve Wolf: So I've heard the term tonic, clonic and grand mal seizures. Grand mal is sort of an older term, but they are the same type of seizures. It's when the whole body falls to the ground, and tonic is when you're stiff, and clonic is when you jerk forward, so tonic clonic obviously is jerking forward, back, and forth.

Patty McGoldrick: So generalized tonic clonic seizures is the correct nomenclature for what used to be called grand mal seizures, and these are seizures that arise from the whole brain, so the whole brain lights up with electricity all at once. It's just one of a number of different types of generalized seizures. This is the one most people think of when they hear seizures or convulsions.

Dr. Wolf: The thing though is, even though these seizures the whole brain turns on at once, we know that these could be the end results of seizures that started in one area of the brain, and then spread, or what's called the secondary generalization.

Patty: And it's also important to remember during this, that the patient is not awake. That patient is absolutely out of it. They're not feeling anything. They don't know what's going on.

Dr. Wolf: And very commonly after generalized tonic clonic seizures, they're wiped out, they're tired . . .

Patty: Tired.

Dr. Wolf: . . . exhausted, will have a headache, and those patients will need some time to sleep it off.

Patty: And they sleep for a while often afterwards. That's called the postictal, so the -ictal is during the seizure, and post- is what happens afterwards, which is the tiredness and the sleepiness.

Dr. Wolf: In generalized tonic clonic seizures or grand mal seizures are really the same thing. These are the bigger seizures where your whole body is jerking and twitching back and forth. They can last anywhere from a few minutes to multiple minutes. If they last longer than five minutes, those should be treated with medications to stop the seizures.

And they are important to recognize, and make that patient safe when they're having them. Again by putting a pillow underneath their heads, putting them on their sides, and of course, if they go on for a long time, call 911.

Discuss with your doctors what should be done when the seizures last too long. That would be an important thing to know, in how to take care of these patients.

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