Generalized Tonic Clonic Seizures (also called Grand Mal or a Convulsion)

'Contrary to popular folk belief, nothing should be placed in the mouth during the seizure. Severe injury could occur.'

Generalized tonic clonic seizures (grand mal seizures) are the most common and best known type of generalized seizure. They begin with stiffening of the limbs (the tonic phase), followed by jerking of the limbs and face (the clonic phase).

During the tonic phase, breathing may decrease or cease altogether, producing cyanosis (blueing) of the lips, nail beds, and face. Breathing typically returns during the clonic (jerking) phase, but it may be irregular. This clonic phase usually lasts less than a minute.

Some people experience only the tonic, or stiffening phase of the seizure; others exhibit only the clonic or jerking movements; still others may have a tonic-clonic-tonic pattern.

Figure at right: A generalized tonic clonic seizure. Here the whole brain is affecting from the beginning. In (a) there is a cry and loss of consciousness, arms flex up then extend in (b) and remain rigid (the tonic phase) for a few seconds. A series of jerking movements take place (the clonic phase) as muscles contract and relax together. In (c) the jerking is slowing down and will eventually stop. In (d) the man has been placed on his side to aid breathing and to keep the airway clear.

Generalized tonic clonic seizures (grand mal seizures) are the most common and best known type of generalized seizure. They begin with stiffening of the limbs (the tonic phase), followed by jerking of the limbs and face (the clonic phase).

During the tonic phase, breathing may decrease or cease altogether, producing cyanosis (blueing) of the lips, nail beds, and face. Breathing typically returns during the clonic (jerking) phase, but it may be irregular. This clonic phase usually lasts less than a minute.

Some people experience only the tonic, or stiffening phase of the seizure; others exhibit only the clonic or jerking movements; still others may have a tonic-clonic-tonic pattern.

Incontinence may occur as a result of the seizure. The tongue or inside of the mouth may be bitten during the episode; breathing afterwards may be noisy and appear to be labored. Contrary to popular belief, nothing should be placed in the mouth during the seizure; turning the patient on one side will help prevent choking and keep the airway clear.

Following the seizure, the patient will be lethargic, possibly confused, and want to sleep. Headache sometimes occurs. Full recovery takes minutes to hours, depending on the individual.

First Aid for Generalized Tonic-Clonic Seizures

• Prevent further injury. Place something soft under the head, loosen tight clothing, and clear the area of sharp or hard objects.
• Do not force objects into the person’s mouth.
• Do not restrain the person’s movements unless they place him or her in danger.
• Turn the person on his or her side to open the airway and allow secretions to drain.
• Stay with the person until the seizure ends.
• Do not pour any liquids into the person’s mouth or offer any food, drink, or medication until he or she is fully awake.
• If the person does not resume breathing after the seizure, start cardiopulmonary resuscitation.
• Let the person rest until he or she is fully awake.
• Be reassuring and supportive when consciousness returns.
• A convulsive seizure is usually not a medical emergency unless it lasts longer than five minutes, or a second seizure occurs soon after the first, or the person is pregnant, injured, diabetic, or not breathing easily. In these situations the person should be taken to an emergency medical facility.