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What's a grand mal seizure?

A grand mal seizure is a seizure involving the entire body, usually characterized by muscle rigidity, violent rhythmic muscle contractions, and loss of consciousness. The condition is caused by abnormal electrical activity in the nerve cells of the brain. Grand mal seizures seizures (also called generalized tonic-clonic) are the type of seizure that most people associate with the term "seizure," convulsion, or epilepsy. They may occur in people of any age, as a single episode or as

a repeated, chronic condition (epilepsy). The majority of seizures that do occur as just a single episode are grand mal seizures rather than other types.

Generalized seizures are caused by abnormal electrical activity at multiple locations in the brain and/or over a large area of the brain. This results in loss of consciousness and body stiffening, which is followed by shaking of the arms and legs. A typical grand mal seizure starts with a loss of consciousness and falling down. This is followed by a 15- to 20-second period with muscle rigidity (tonic phase) and then a one- to two-minute period of violent, rhythmic convulsions (clonic phase). During a grand mal seizure, you may take on a dusky appearance, resulting from decreased blood oxygen levels due to impaired breathing during the seizure.

Most grand mal seizures last from one to two minutes. After the seizure, you may experience a headache and drowsiness or confusion. In most cases, seizures seem to occur randomly. But in rare cases, stimulation by light, sound, touch or reading can trigger a seizure in susceptible people. Sleep deprivation and excessive alcohol use also may trigger seizures. Abnormal electrical activity may start in one part of the brain and cause isolated symptoms (see partial seizures). Sometimes this abnormal electrical activity spreads through the brain, resulting in a generalized seizure. Seizures can be caused by a specific area of the brain that is injured or inflamed, or they can be due to stress on the brain from a more widespread systemic process, such as severely low blood sugar.

Diagnosis of a grand mal seizure is based on the symptoms and excluding other medical problems that can look like a seizure (such as heart arrythmia). A neuromuscular examination may or may not reveal neurologic deficits (decreases in brain functions) when the person is not actively having seizures. An EEG may show characteristic changes and in some cases may show the focus (location of the cause of the seizure). An EEG can be normal in between seizures and a normal EEG does not rule out a seizure disorder.

Many medications can effectively reduce or eliminate the number of seizures for some people. Finding the right medication and dosage can be complex. Medications available for the treatment of seizures include phenytoin (Dilantin), carbamazepine (Carbatrol, Tegretol), valproic acid (Depakene), divalproex (Depakote), gabapentin (Neurontin), phenobarbital, ethosuximide (Zarontin), clonazepam (Klonopin), lorazepam (Ativan), diazepam (Valium), primidone (Mysoline), oxcarbazepine (Trileptal), lamotrigine (Lamictal), topiramate (Topamax), felbamate (Felbatol) and tiagabine (Gabitril). Seizure medications are associated with birth defects.

For seizure disorders that don't respond well to medications, surgery may be an option if the seizures are localized to a particular part of the brain and that part of the brain can be removed without serious consequences. Surgery may also be effective if the cause of seizures is a tumor or malformation of the brain. In children who don't seem to have a focal point to their seizures and who regularly fall to the ground during their seizures, surgery to split the tissue that connects the brain's two hemispheres — called the corpus callosum — may dramatically reduce "drop seizures" without adversely affecting the brain's other functions.

More information on epilepsy (seizures)

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