Grand Mal Seizure

1 What is Grand Mal Seizure?

A grand mal seizure is also referred to as the tonic clonic seizure which is characterized by the loss of consciousness and violent muscle contractions.

It one of the most common forms of seizures people think about when people think of seizures.  This is caused by abnormal electrical activity throughout the brain. This is caused by epilepsy.

In some other cases, it is triggered by other health problems such as low blood sugar, high fever, and stroke. Many of the people that develop the grand mal seizure never develop another.

However, some people need to be provided with anti-seizure medications so as to control and prevent the future grand mal seizure. 

2 Symptoms

Symptoms of grand mal seizure vary depending on its phases.

Grand mal seizures are characterized into two phases:

  • First is the tonic phase which is characterized by the loss of consciousness and sudden contraction of the muscles which may cause someone to fall down. This phase may last for about 10-20 seconds.
  • Secondly, it is the clonic phase in which the muscles go into the rhythmic contraction characterized by alternate flexing and relaxing. These convulsions may last for less than two minute.

Some people with grand mal seizures experience a feeling of aura before a grand mal seizure. This will be different from person to person and the feeling is associated with un explained dread, which is a strange smell or feeling of numbness.

Some people may also cry out at the start of a seizure since the muscles around the vocal cords seize, forcing air out of the lungs. Loss of bowel and bladder control may also occur during or after the seizure.

Unresponsiveness/ unconsciousness may also persist for several minutes after convulsions. Confusion which is a period of disorientation may follow a grand mal seizure. This is referred to as postictal confusions.

Most people will feel fatigued after the grand mal seizure. Several headaches are common but may not be universal.

It is important to call medical help immediately after when someone has seizures and roll the person onto one side and put some soft material under his or her head. Release or loosen tight neckwear. Never place anything in the mouth.

Similarly, never restrain the victim. Locate for a medical alert bracelet which may indicate an emergency contact person and any other information. Take note of the duration of the seizure

A grand mal seizure going for more than five minutes or immediately followed by a second needs to be considered a medical emergency in most people. If the victim is also pregnant, injured or diabetic, this is also a medical emergency as soon as possible. When the number of seizure increases significantly without any reason, seek medical advice. 

3 Causes

Simply put, the cause of grand mal seizures is abnormal electric brain activity.

Grand mal seizures have been shown to occur when the electrical activity over the whole surface of the brain synchronized abnormally.

This causes the brain cells to normally communicate with each other allowing the transmission of both the chemical and electrical signals across the synapses that connect the cells. In people with seizures, the brain normal electivity is altered. The cause of this effect is unknown in more than half the cases.

Grand mal seizures may be caused by other health problems such as injury or infections that cause traumatic damage to the head. Infections such as encephalitis or meningitis or history of infections, injury can also be caused by the previous lack of oxygen.

Stroke and congenital or developmental abnormalities, malformations in the blood vessels in the brain. It has also been associated with genetic syndromes, brain tumors, metabolic disorders, very low glucose blood levels, sodium, calcium, magnesium, withdrawal syndromes from drugs including alcohol. 

4 Making a Diagnosis

Making a diagnosis of grand mal seizure is done by performing several tests.

It is important that you start by seeing your family doctor or general practitioner. You may also be referred to a doctor who specializes in nervous system disorders (neurologist).

It is important to be prepared for an appointment. One needs to get the information required so that you may also be aware of the questions to expect from the appointment.

Write down the symptoms that you are experiencing even when they are unrelated. Take notes on all the medications you have used and currently in use. Ask a family member to come with you to the doctor. They may help you remember everything you are likely to forget. They also serve as better persons to describe how you behaved during seizures than yourself.

Some of the basic questions to ask include:

  • Do I have any signs of epilepsy?
  • Are there chances of developing recurrent conditions?
  • What tests do I need to perform?
  • Is there any form of special preparation that I need?
  • What treatments are available and which is the best drug that is recommended?
  • Are there alternative treatments?
  • Is there any information booklets?

Some of the questions that one will be asked include:

  • How may seizure have you experienced?
  • How long do the seizures occur?
  • How does the seizure occur?
  • Are they the same?
  • Have you tried combinations of the medication?

The doctor may also want to understand the trigger to the seizure such as

  • intense exercise,
  • loud music,
  • flashing lights
  • or lack of sleep,

preceded by the seizure. Most of the people may not have a unique and identifiable trigger for the seizure.

Neurological exams may be needed that will determine

  • the muscle condition reflexes,
  • muscle tone,
  • muscle strength,
  • sensory function,
  • motor symptoms,
  • gait posture coordination balance.

The doctor may also ask questions to assess thinking, judgment and memory. Blood tests and brain scans can be ordered to be appropriate to check for the problems that may cause and trigger seizures.

The doctor can also request for scans or test that will detect abnormalities. Electroencephalogram (EEG) also provides better displays of electrical activity of your brain via electrodes affixed to your scalp. People suffering from seizure do not have normal pattern of the brain waves, even in the absence of seizures.

Video EEG monitoring also requires one to stay in hospital and allows the doctor to compare second my second the behavior observed during the seizures with disorders that one have developed. The comparison helps the doctor to point the types of the seizures disorders that one may have which helps identify the appropriate treatment options. It also guides the diagnosis of the seizures.

Brain imaging using CT and MRI are more detailed and may reveal even the tumors, cysts and structural abnormalities. In CT or MRI scan, one lies on a padded table that will be moved/slide into the machine. The head is first immobilized in a brave so as to improve the precision when the images are  taken. 

5 Treatment

Treatment of grand mal seizures depends entirely on their occurrence and frequency. You and your doctor will make a decision together.

It is known that not everyone that has seizure may have another one. This is considered an isolated incident and doctor may make a decision of when to start anti-seizure medications.

Medications used for management of seizures such as:

  • Carbamazepine (Carbatrol, tegretol, ad other),
  • Phenytoin,
  • valproic acid,
  • oxcarbazepine,
  • gabapentin,
  • Topiramate,
  • Phenobarbital,
  • Levetiracetam,
  • Felbamate,
  • Clobazam
  • Perampanel.

One needs to find the right dosage which can be challenging. The doctor normally first prescribe a single drug at a very low dose and gradually increase the dose with time until when the seizures are managed.

People with epilepsy control seizures with only one drug but for others, they may have use more than one. Take the drugs as prescribed to achieve the best management strategy.

Always consult your doctor before adding any other medication. Mild side effects of using anti-seizure drugs may also be felt such as feeling dizziness, and weight gain.

More serious side effects will however need to be shared with your doctor immediately. This may include:

  • interference with the mood,
  • skin rashes,
  • loss of coordination,
  • speech problem,
  • extreme fatigue.

Moreover, Lamictal as a drug is linked to the development of aseptic meningitis which occurs as an inflammation of the protective membranes that cover the brain and spinal cord which is similar to bacterial infections. In case of pregnancy and seizures, women that have had previous seizures may have healthy pregnancies.

Birth defects can arise as a result of certain medications such as valproic acid which is associated with cognitive deficits and neural tube defects such as spina bifida. It is therefore contraindicated for use in women with pregnancies as result of the risk to the baby.

The risks need to be discussed with the doctor. Consequently, pregnancy can alter medication levels, preconception, planning is very essential for women that have had seizures.

In some cases, the dose may also change during pregnancy. Medications may be switched though in very rare cases. Some anti-seizure medications also interfere with the use of contraceptives. If the use of the contraceptives is of high priority.

Check with your doctor on possible drug interactions with the oral contraceptive, and if other forms of contraception which need to be considered. 

6 Lifestyle and Coping

Lifestyle modifications are necessary in order to cope with grand mal seizure.

When one has a seizure disorder, one is required to wear a medical bracelet so as to help the emergency medical personnel.

The bracelet needs to indicate the number of the person that can be contacted in case of medical emergency. It also indicates on the medication that can be used and drugs to avoid as a result of the allergic reactions.

Even after seizures have been controlled, they may still be able to affect your life. Grand mal seizures can be frightening to the people around you.

Children and adults can also be embarrassed by the condition and may live in constant fear of the threat of another seizure any other time. Lack of self-esteem, depression and suicidal thinking may be the main characteristic of the people with repeated seizures.

People with such conditions are not allowed to drive until they have stayed a longer time without a seizure. It also limits the recreational activities one can be involved in such as swimming etc. locate support groups with the same condition to share information on the coping strategies. 

7 Risks and Complications

There are many risk factors that control for grand mal seizures such as family history of seizures.

Injury may develop in the brain leading to trauma, stroke, and previous infections, medical problems that may affect the electrolyte balance, illicit drug use, and heavy alcohol use.

Some activities are also restricted when suffering from seizures such as swimming. When swimming, one needs to be wearing a life saver and always walk with company.

Bathing may sometimes be risky as a result of the possibility of drowning. The force of a seizure or falling as a result of a seizure can cause injury.

Hence, it is a fatal condition when medication is not taken consistently. Some of the injuries that may occur may include joint dislocations, head injuries, bone fractures.

Repeated seizures may also induce brain damage. The longer a seizure lasts, the more it can lead to the change in the brain function and structure.

Repeated brief seizures can also lead to brain changes which sometimes cause the normal brains to become epileptic, which is a process referred to as kindling.

The seriousness of repeated seizures underscores the need for control with medication. 

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