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Grand Mal Seizure


Disease: Grand Mal Seizure Grand Mal Seizure
Category: Neurological diseases
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Disease Definition:

Also known as a tonic-clonic seizure, a grand mal seizure includes violent muscle contractions and loss of consciousness. When people think about seizures in general, this is the one that they usually picture.


Abnormal electrical activity throughout the brain causes grand mal seizure. Sometimes a stroke, extremely low blood sugar or other health problems could cause this type of seizure. But mostly, epilepsy is the cause of grand mal seizure.


Usually, most people experience a grand mal seizure only once in their lives. However, other people may need to take daily anti-seizure medications in order to control these seizures.

Work Group:

Prepared by: Scientific Section

Symptoms, Causes


There are two stages of grand mal seizures:


Tonic phase:

In this phase, the muscles contract suddenly causing the person to fall, in addition to losing his/her consciousness. Usually, this phase lasts 10 to 20 seconds.


Clonic phase:

In this phase, the muscles go into rhythmic contractions, flexing and relaxing alternately. Usually, these convulsions last less than two minutes.


These are some of the signs and symptoms that occur in some people with grand mal seizures, but not in all:



Before a grand mal seizure, some people experience a warning feeling, called an aura. Feeling a sense of unexplained dread, a strange smell or a feeling of numbness are some of the warning signs which could vary from one person to another.



Because the muscles around the vocal cord seize and force air out at the beginning of a seizure, some people may cry out.


Unresponsiveness after convulsions:

After the convulsion has ended, unconsciousness could last for a few minutes.



A grand mal seizure is usually followed by a period of disorientation, also known as postictal confusion.


Loss of bowel and bladder control:

This situation could occur either during or after a grand mal seizure.


Severe headache:

Following a grand mal seizure, headaches are common though not universal.



After a grand mal seizure, feeling sleepy is quite common.


In case a person witness somebody having a seizure they should:


  • Call for medical help
  • Loosen tight neckwear
  • Roll the person onto one side gently, and put something soft under their head.
  • Not try to restrain the person
  • Not put anything in their mouth because the objects that are placed in the mouth could be inhaled or bitten, and the tongue cannot be swallowed.
  • Search for a medical bracelet that could indicate an emergency contact person, in addition to other information.


When a grand mal seizure is immediately followed by a second seizure, or if it lasts for more than five minutes, it could be considered a medical emergency. Someone should seek emergency care as quickly as possible in case this happens.


Someone should also seek medical advice in case:


  • New signs and symptoms of seizures appear
  • The number of experienced seizures increases significantly without explanation.


When the electrical activity over the whole surface of the brain becomes abnormally synchronized, grand mal seizures occur. Abnormal, rhythmic nerve cell (neuron) activity in the brain causes seizures in general. The nerve cells of the brain typically communicate with each other by sending electrical as well as chemical signals across the synapses that connect the cells. However, when the brain's usual electrical activity gets altered, people start having seizures.


In almost half of the cases, it is not known what exactly causes the changes to occur. But in some cases, underlying health problems could cause grand mal seizures, such as:


  • Traumatic head injuries
  • Strokes
  • Brain tumors
  • Using or withdrawing from drugs, as well as alcohol
  • Genetic syndromes
  • Injury due to a previous lack of oxygen
  • Very low blood levels of glucose, magnesium, calcium or sodium
  • Blood vessel malformations in the brain
  • Infections, including meningitis or encephalitis, or a history of such infection



Unless wearing a life preserver, people who've had grand mal seizures are mostly advised not to swim, because if a seizure occurs while they're in the water, there's a great risk of drowning. These people are also recommended to take showers instead of baths. Injuries that are associated with falling could also be caused by seizures, including head injury, fractures and joint dislocations. In some cases, the force of the seizure itself could result in an injury. In some extreme cases, especially if medication is not taken consistently or properly, seizures could be fatal.


When a person's driving a car or operating other equipment, a seizure that causes loss of awareness or control could be quite dangerous. In children, limitations on physical activities in school could be caused by seizures.


As mentioned before, some people experience seizures only once in their lives. The doctor might not start treatment until a person has had more than one seizure because a seizure could be an isolated incident. Seizures are usually treated with anti-seizure medications.



There are many medications that could treat epilepsy and seizures, including:


  • Phenobarbital
  • Lamotrigine
  • Valproic acid
  • Levetiracetam
  • Phenytoin
  • Tiagabine
  • Oxcarbazepine
  • Felbamate
  • Zonisamide
  • Pregabalin 
  • Gabapentin 
  • Carbamazepine
  • Topiramate


Finding the right medication and dosage could be a complex procedure. The patient will initially be prescribed a single drug at a relatively low dosage, and then the dosage will be increased gradually, until the seizures are well controlled. Although some people with epilepsy require more than one drug, however, many people could prevent seizures by taking only one drug. Someone may be recommended a combination of two drugs in case they've tried two or more single-drug regimens without success.


Some of the mild side effects of anti-seizure medications may include:


  • Dizziness
  • Fatigue
  • Weight gain


Some of the side effects that are more troubling and need to be brought to the doctor's attention immediately include:


  • Skin rashes
  • Speech problems
  • Mood disruption
  • Extreme fatigue
  • Loss of coordination


Medications should be taken exactly as prescribed if the patient wants to achieve the best seizure control. Before adding other prescription medications, over-the-counter drugs or herbal remedies, the doctor should be consulted. In addition to all these, a person shouldn't stop taking their medications without talking to the doctor first.



In about 90% of the cases, women who've had previous seizures have healthy pregnancies. However, in some cases, birth defects that are related to some medications may occur. These risks should be discussed with a doctor. Preconception planning is particularly important for women who've had seizures because of the birth defects and because pregnancy could alter medication levels. It could be wise to reduce seizure medications before pregnancy, and in some rare cases, these medications could be switched.



The effectiveness of birth control or contraceptive medications could be altered due to some anti-seizure medications. In case contraception is a high priority for the patient, they should check with the doctor in order to evaluate whether their medication interacts with the oral contraceptive, and if they need to consider other forms of contraception.


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