A grand mal seizure occurs when the electrical activity of the brain is temporarily out of control. Brain cells normally communicate using well-coordinated electrical signals. With a grand mal seizure, an electrical outburst causes disordered, widespread brain activity. A grand mal seizure--also called a generalized tonic-clonic seizure--is characterized by loss of consciousness and rhythmic, forceful muscles spasms. They occur with certain types of epilepsy and with illnesses that disturb normal brain metabolism. The symptoms of grand mal seizures make them easily distinguishable from other types of seizures.
Loss of Consciousness
A grand mal seizure begins with a sudden loss of consciousness and a fall to the floor. There is no warning to a true grand mal seizure. A brief interval of unconsciousness without muscular activity follows the loss of consciousness.
Tonic Muscle Rigidity
During the tonic phase of a grand mal seizure, the muscles contract and the body is stiff. The chest muscles force air from the lungs, which may cause the person having the seizure to grunt, moan or cry out. Breathing temporarily stops during this phase of the seizure. The lips, skin and nails may appear greyish or blue from lack of oxygen. Saliva may come out of the mouth because no swallowing is taking place.The arms typically flex up toward the chest. The back stiffens and may arch. The legs are rigid. The face and jaw clench. Although the tongue may be bitten as the jaw clenches, do not attempt to put anything in the mouth of the person having the seizure. The tonic phase of the seizure is short, typically lasting 15 to 20 seconds.
Clonic Muscle Contractions
Rhythmic muscular contractions characterize the clonic phase of a grand mal seizure. The arms and legs flex and extend forcefully and rapidly. Breathing resumes during the clonic phase, although it may be irregular. Within roughly a minute, the rate of the muscle contractions slows until they finally stop. As the muscles begin to relax at the end of the clonic phase, urine, stool or both may be passed. The clonic phase of a grand mal seizure generally lasts for 1 to 2 minutes.
If you are with someone having a tonic-clonic seizure, do not attempt to hold her down. You and she may both be injured. Do your best to clear the area of anything on which she may hurt herself. Otherwise, let the seizure run its course.
Confusion, Headache and Sleepiness
After the clonic phase of the seizure, the person remains unconscious but quiet for a variable period. If you are able, try to get him on his side to keep his airway clear. Slowly, he will regain consciousness. He is likely to be sleepy and may be confused; be supportive and reassuring. He may complain of a headache, but do not try to administer any medication or fluids until he is fully awake. Make him comfortable and allow him to sleep until he wakes up on his own.
References
- "Harrison's Principles of Internal Medicine, 16th Edition"; Dennis L. Kasper, M.D., et al, Editors; 2004
- Epilepsy Foundation: Generalized Tonic Clonic Seizure
- Mayo Clinic: Grand Mal Seizure, Symptoms
- Medline Plus: Generalized Tonic-Clonic Seizure
- University of Maryland Medical Center: Generalized Tonic-Clonic Seizure, Symptoms
