Diseases & Conditions

Grand mal seizure

A grand mal seizure — also known as a tonic-clonic seizure — features a loss of consciousness and violent muscle contractions. It's the type of seizure most people picture when they think about seizures in general.

Grand mal seizure is caused by abnormal electrical activity throughout the brain. In some cases, this type of seizure is triggered by other health problems, such as extremely low blood sugar or a stroke. However, most of the time grand mal seizure is caused by epilepsy.

Many people who have a grand mal seizure will never have another one. However in some people, daily anti-seizure medications are needed to control grand mal seizure.

A detailed description of the seizure is crucial for diagnosis. Because people who have grand mal seizures lose consciousness and don't remember their seizures, the description needs to come from people who have witnessed the seizures.

If you've had a seizure, your doctor will usually perform a neurological exam that tests reflexes, muscle tone, muscle strength, sensory function, gait, posture, coordination and balance. He or she may also ask questions to assess your thinking, judgment and memory.

Blood tests may be ordered as appropriate to check for problems that could be causing or triggering the seizures.

Your doctor may also suggest scans or tests designed to detect abnormalities within the brain.

Electroencephalogram (EEG)
An EEG displays the electrical activity of your brain via electrodes affixed to your scalp. People with epilepsy often have changes in their normal pattern of brain waves, even when they're not having a seizure.

In some cases, your doctor may recommend video-EEG monitoring, which may require a hospital stay. This allows your doctor to compare — second by second — the behaviors observed during a seizure with your EEG pattern from exactly that same time. This can help your doctor pinpoint the type of seizure disorder you have, which helps to identify the most appropriate treatment options, and can help make sure that the diagnosis of seizures is correct.

Magnetic resonance imaging (MRI)
An MRI machine produces detailed images of your brain. Although many people with seizures and epilepsy have normal MRIs, certain MRI abnormalities may provide a clue as to the cause of seizures in some cases.

During the test, you will lie on a padded table that slides into the MRI machine. Your head will be immobilized in a brace, to improve precision. The test is painless, but some people experience claustrophobia inside the MRI machine's close quarters. If you think you may have this problem, inform your doctor.

People who've had grand mal seizures are advised not to swim unless wearing a life preserver because there is a real risk of drowning if a seizure occurs when you're in the water. It's recommended that people who've had seizures take showers instead of baths for the same reason. Seizures also can produce injuries associated with falling, such as joint dislocations, head injury and fractures. Sometimes, the force of the seizure itself results in injury. In extreme cases, seizures can be fatal, particularly if medication is not taken consistently or properly.

A seizure that produces either loss of awareness or control can be dangerous if you're driving a car or operating other equipment. Most states have licensing restrictions for driving for people with a history of seizures. For children, seizure disorders may result in limitations on physical activities in school.

Not everyone who has one seizure will have another one, and because a seizure can be an isolated incident, your doctor may decide to not start treatment until you've had more than one. Treatment usually involves the use of anti-seizure medications.

Medications
Many medications are used in the treatment of epilepsy and seizures, such as:

• Carbamazepine (Tegretol)
• Phenytoin (Dilantin)
• Valproic acid (Depakene)
• Oxcarbazepine (Trileptal)
• Lamotrigine (Lamictal)
• Gabapentin (Neurontin)
• Topiramate (Topamax)
• Phenobarbital
• Zonisamide (Zonegran)
• Levetiracetam (Keppra)
• Tiagabine (Gabitril)
• Pregabalin (Lyrica)
• Felbamate (Felbatol)

Finding the right medication and dosage can be complex. 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 by taking only one drug, but others require 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.

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

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.

Pregnancy and seizures
Women who've had previous seizures will have healthy pregnancies in over 90 percent of cases. Birth defects related to certain medications can sometimes occur. 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 reduce seizure medication prior to pregnancy, and medications may be switched in rare cases. The American Academy of Neurology recommends that women avoid using valproate during pregnancy because of risks to the baby. If your seizures can't be well controlled with any other medication, discuss the potential risks with your doctor.

Contraception and anti-seizure medications
It's also important to know that some anti-seizure medications can alter the effectiveness of oral contraceptive (birth control) medication. 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.

If you have a seizure disorder, wear a medical bracelet to help emergency medical personnel. The bracelet should state whom to contact in an emergency, what medications you use and what drugs you're allergic to.