Generalized Tonic-Clonic Seizure (Grand Mal Seizure)

WHAT IS IT?

A generalized tonic clonic seizure (also called a grand mal seizure) refers to a diffuse type of generalized seizure that is characterized by stiffening (tonic) and movement (clonic). It is the most common for of epilepsy. It is thought to be caused by abnormal brain electrical activity.

WHY IS IT A PROBLEM?

The patient may cause harm to themselves while they are having the seizure.

WHAT MAKES US SUSPECT IT?

Seizures that are characterized by a tonic phase where the patient will fall down and a clonic phase where the patient will seize uncontrollably.

Phases of a tonic-clonic seizure (source)
Phases of a tonic-clonic seizure (source)
HOW DO WE TREAT IT?

First line medications: 

  • Phenytoin: this increases sodium channel inactivation.
  • Carbamazepineincreases sodium channel inactivation.
  • Valproic acidincreases sodium channel inactivation and increases GABA concentration by inhibition GABA transaminase

Other medications: 

  • Phenobarbital: increases GABA-A action
  • Topiramate: blocks sodium channels and increases GABA action
  • Lamotrigine: blocks voltage gated sodium channels
  • Levetiracetamunknown mechanism, thought to modulate GABA and glutamate release
OTHER HY FACTS?

Most common form of epilepsy

FURTHER READING

DynaMed

UpToDate

Page Updated: 06.03.2016