Generalized seizures happen when both hemispheres of the brain are involved (Lewis, Dirksen, Heitkemper, Bucher, & Harding, 2014). Typically, these patients will lose consciousness and exhibit body and limb movement during the seizure. However, there are types of generalized seizures that involve only a brief episode of altered consciousness, repetitious movements, or lack of muscle tone. Generalized seizure activity tends to be varied due to more brain involvement. These seizures are further divided into six categories: tonic-clonic, absence, myoclonic, clonic, tonic and atonic (Trinka et al., 2015). Show
A tonic-clonic seizure, formally known as a grand mal seizure, is the most common type of generalized seizures. The patient will experience a loss of consciousness, contraction of the muscle group (tonic) for a short period then jerking of the extremities (clonic). The patient may also show signs of cyanosis due to the muscles of the respiratory system contracting, incontinence, tongue biting, and excessive salivation (Lewis, Dirksen, Heitkemper, Bucher, & Harding, 2014). Seizures of this type usually last 60 to 90 seconds (Lewis, Dirksen, Heitkemper, Bucher, & Harding, 2014). The patient may be exhausted and sleep for hours afterward. They may not feel normal for several days and have no memory of the seizure (Lewis, Dirksen, Heitkemper, Bucher, & Harding, 2014). Absence seizures are non-convulsive events. These were formally referred to as petite mal seizures. These typically occur in children and rarely continue beyond adolescence. (Grossman & Porth, 2014). Absence seizures are characterized as a blank stare, motionless, and unresponsiveness. However, there can be motion in areas such as lip-smacking, eyelids, or lack of postural tone. The seizures typically last only a few seconds and then the child is able to resume normal activity (Lewis, Dirksen, Heitkemper, Bucher, & Harding, 2014). Sometimes the seizures are very subtle and may even go unnoticed. The child may complain of seeing flashes of light or may hyperventilate (Lewis, Dirksen, Heitkemper, Bucher, & Harding, 2014). They may also appear to be daydreaming. Although the seizures do not last long, if untreated, may occur up to 100 times a day (Lewis, Dirksen, Heitkemper, Bucher, & Harding, 2014). Myoclonic seizures are brief muscle contractions. They are seen as bilateral jerking of muscles typically of the face, trunk, or one or more extremities (Grossman & Porth, 2014). Sudden and excessive jerk of the body and extremities can be seen. These seizures can also happen in clusters and can progress to tonic-clonic seizures (Grossman & Porth, 2014). Clonic seizures typically begin with a loss of consciousness and sudden hypotonia. The seizure is then seen as limb jerking that may not be symmetrical (Lewis, Dirksen, Heitkemper, Bucher, & Harding, 2014). Tonic seizures are seen as sudden onset of increased tone which is held typically in extensor muscles. These seizures are often associated with falling (Lewis, Dirksen, Heitkemper, Bucher, & Harding, 2014). Atonic seizure is the sudden split-second loss of muscle tone leading to a slackening of the jaw, drooping of the eye, or falling on the ground (Lewis, Dirksen, Heitkemper, Bucher, & Harding, 2014). The seizures are also known as drop attacks. They tend to start suddenly and the patient loses consciousness. However, consciousness returns usually as a person is falling. They can resume normal activity immediately (Lewis, Dirksen, Heitkemper, Bucher, & Harding, 2014). Tonic-clonic seizures, formerly known as grand mal seizures, comprise two stages: a tonic phase and a clonic phase. These intense seizures can be frightening to experience or observe, as extreme muscle spasms may temporarily arrest breathing.
Symptoms of a Tonic-Clonic (Grand Mal) SeizureAuraThe seizure may start with a simple or complex partial seizure known as an aura. The person may experience abnormal sensations such as a particular smell, vertigo, nausea, or anxiety. If the person is familiar with having seizures, they may recognize the warning signs of a seizure about to begin. Tonic ActivityWhen the tonic-clonic seizure begins, the person loses consciousness and may fall. Strong tonic spasms of the muscles can force air out of the lungs, resulting in a cry or moan, even though the person is not aware of their surroundings. There may be saliva or foam coming from the mouth. If the person inadvertently bites their tongue or cheek, blood may be visible in the saliva. Stiffness of the chest muscles may impair breathing, the person’s face may look bluish or gray, and he or she may make gasping or gurgling sounds. Clonic ActivityJerking movements affect the face, arms and legs, becoming intense and rapid. After one to three minutes, the jerking movements slow down and the body relaxes, sometimes including the bowel or bladder. The person may let out a deep sigh and return to more normal breathing. After the Seizure (Postictal Period)After a seizure, the person may remain unconscious for several minutes as the brain recovers from the seizure activity. He or she may appear to be sleeping or snoring. Gradually the person regains awareness and may feel confused, exhausted, physically sore, sad or embarrassed for a few hours. The person may not remember having a seizure, and may have other memory loss. Occasionally, people may have abnormal or combative behavior after a tonic-clonic seizure while the brain is recovering. What to Do If Someone Has a Tonic-Clonic (Grand Mal) SeizureWitnessing a person having a tonic-clonic seizure can be upsetting, but it’s important to remember that most seizures resolve on their own after one to three minutes. To offer assistance:
Diagnosis and Treatment of Tonic-Clonic (Grand Mal) SeizuresAfter a person’s first seizure, it is important to consult with a physician. Parents or family members who observe the seizure can note the details and help create a written report that the person can take to the doctor. A video recording of the event (if available) can also aid in diagnosis. To ascertain the cause of the seizure, the doctor may prescribe magnetic resonance imaging (MRI) or other tests to look for scarred areas in the brain. Electroencephalography (EEG) can help distinguish seizure disorders from other conditions. If the doctor determines the person has a seizure disorder such as epilepsy, an individualized approach to treatment can help manage it. A range of therapies, including anti-seizure medication, nerve stimulation, dietary therapy and surgical procedures can address the seizures and, in many cases, bring them under control. What are the 4 stages of a convulsion seizure?Prodromal. Early ictal (the “aura”) Ictal. Postictal.
What are the 4 stages of most generalized seizures?Seizures take on many different forms and have a beginning (prodrome and aura), middle (ictal) and end (post-ictal) stage. These phases are described below.. Mood changes.. Anxiety.. Feeling lightheaded.. Difficulty sleeping.. Difficulty staying focused.. Behaviour changes.. What is the priority for a client experiencing a seizure?The priorities when caring for a patient who is seizing are to maintain a patent airway, protect the patient from injury, provide care during and following the seizure and documenting the event in the health record.
What are the movements of a seizure?Clonic seizures are associated with repeated or rhythmic, jerking muscle movements. These seizures usually affect the neck, face and arms on both sides of the body. Myoclonic seizures. Myoclonic seizures usually appear as sudden brief jerks or twitches of your arms and legs.
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