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Generalized Tonic-Clonic Seizure or Grand Mal Seizure

What Is Generalized Tonic-Clonic Seizure or Grand Mal Seizure?

Generalized tonic-clonic seizure is also known as grand mal seizure, this seizure occurs when there is any disturbance in the functioning of both sides of the brain. Due to this disturbance, electrical signals are transmitted to the nerves, muscles and glands resulting in loss of consciousness and severe muscle contractions, which are known as seizures. Seizures can also occur when a patient is suffering from epilepsy, has high fever, injury/trauma to the head or is hypoglycemic. Sometimes individuals can have seizures when they are going through withdrawal from alcohol or drug addiction.

Generalized Tonic-Clonic Seizure or Grand Mal Seizure

Tonic-clonic seizures are named so due to their two distinctive stages. In the tonic stage, the patient loses consciousness and can fall down. In the clonic stage, the patient has rapid contractions of the muscles, which are also known as convulsions. The clonic stage usually lasts for around two minutes or even less.

Patients suffering from epilepsy will have generalized tonic-clonic seizures during late childhood or adolescent age. Sometimes, a seizure can occur on a one time basis, which is not related to epilepsy and this could happen to a person of any age. These seizures commonly occur from a triggering event, which temporarily changes the functioning of the brain.

A generalized tonic-clonic seizures or grand mal seizure can be a medical emergency and medical treatment should be sought immediately. Tonic-Clonic Seizure Treatment comprises of antiepileptic medications, surgery and alternative therapies.

Causes of Generalized Tonic-Clonic Seizure or Grand Mal Seizure

The cause behind generalized tonic-clonic seizures is a variety of health conditions, which include:

  • Low levels of glucose, calcium, magnesium or sodium in the body.
  • Abuse or over consumption of alcohol or drugs.
  • Withdrawal from alcohol or drugs.
  • Trauma or injury to the head.
  • Certain neurological disorders or genetic conditions.
  • Brain tumor.
  • Stroke or a ruptured blood vessel in the brain.
  • Sometimes the exact cause behind the onset of seizures cannot be found.

Risk Factors For Generalized Tonic-Clonic Seizure or Grand Mal Seizure

  • Having a family history of epilepsy.
  • Having a brain injury, stroke or infection.
  • Sleep deprivation.
  • Electrolyte imbalances.
  • Drug or alcohol overuse.

Signs & Symptoms of Generalized Tonic-Clonic Seizure or Grand Mal Seizure

  • Patient may have a strange sensation or a feeling, which is also known as an aura.
  • Patient may involuntarily cry out or scream.
  • Loss of bladder and bowel control either during the seizure or after the seizure.
  • Patient may pass out and wake up feeling sleepy or confused.
  • Patient can also experience severe headache after having the seizure.
  • During the actual generalized tonic-clonic seizure, the patient becomes rigid and falls down during the tonic stage. Then the muscles of the face and limbs will convulse causing rapid and jerky movements.
  • After having generalized tonic-clonic seizure patient may feel sleepy or confused for many hours before completely recovering.

Investigations & Diagnosis of Generalized Tonic-Clonic Seizure or Grand Mal Seizures

Medical history and physical exam, where the doctor will ask about other medical conditions, seizures etc. The doctor will ask about any triggering events before the seizure.

Neurological exam is performed to check for reflexes, balance and coordination. The tone and strength of the muscles is also assessed along with how the patient holds and moves his/her body. Patient’s judgment and memory are also assessed.

  • Blood tests are done to look for other medical problems, which can trigger the seizure.
  • Medical imaging is done to monitor the brain function and these include electroencephalogram (EEG), magnetic resonance imaging (MRI) and brain scans.

Treatment for Generalized Tonic-Clonic Seizure or Grand Mal Seizure

If the patient has had one grand mal seizure, which is not repeated then it may be an isolated event and commonly does not need treatment. The patient will be monitored on a regular basis. Treatment for Generalized Tonic-Clonic Seizures or Grand Mal Seizure comprises of:

Antiepileptic Medications For Generalized Tonic-Clonic Seizure or Grand Mal Seizure

Most of the times, the seizures are managed with medications, which are started on a low dose of a single drug. The dosage is slowly increased as required. There are some patients who need more than one medication for treating their seizures. It takes time to find out the most effective type of medication and the right dosage of that medication. Medications used to treat epilepsy are: Oxcarbazepine (Trileptal), lamotrigine (Lamictal), carbamazepine (Tegretol), lorazepam (Ativan) and phenytoin (Phenytek, Dilantin).

Surgery For Generalized Tonic-Clonic Seizure or Grand Mal Seizure

If the medications are not effective in controlling the seizures, then surgery of the brain may be done. This option is effective in partial seizures which affect only a small part of the brain.

Supplemental or Alternative Treatments For Generalized Tonic-Clonic Seizure or Grand Mal Seizure

Alternative or supplemental treatment for grand mal seizures include vagus nerve stimulation where an electrical device is implanted which automatically stimulates a nerve in the neck. Also, consumption of a ketogenic diet, which is high fat and low in carbohydrates, can help some patients in controlling the seizures.

Prevention of Generalized Tonic-Clonic Seizure or Grand Mal Seizure

  • Sometimes seizures can be prevented if the triggering factors for them are identified. Certain steps can be taken in daily life to prevent seizures and these include:
  • Using safety belts, helmets and automobile airbags while driving to avoid traumatic brain injury.
  • Consumption of food, which is prepared with proper hygiene and food handling to avoid infections which cause epilepsy.
  • Trying to reduce the risk factors for stroke, such as hypertension, high cholesterol, sedentary lifestyle and smoking.
  • Adequate prenatal care should be sought by pregnant women to avoid complications which can cause a seizure disorder in the fetus. After the baby is born, it is important to immunize the child against diseases which can harm the central nervous system and cause seizure disorders.


  1. Epilepsy Foundation: “Generalized Tonic-Clonic Seizures (Grand Mal Seizures)”: https://www.epilepsy.com/learn/types-seizures/generalized-tonic-clonic-seizures
  2. Mayo Clinic: “Tonic-Clonic Seizure”: https://www.mayoclinic.org/diseases-conditions/seizure/symptoms-causes/syc-20365711
  3. MedlinePlus: “Tonic-clonic seizure”: https://medlineplus.gov/ency/article/000694.htm
Pramod Kerkar, M.D., FFARCSI, DA
Pramod Kerkar, M.D., FFARCSI, DA
Written, Edited or Reviewed By: Pramod Kerkar, M.D., FFARCSI, DA Pain Assist Inc. This article does not provide medical advice. See disclaimer
Last Modified On:August 11, 2023

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