Materiały źródłowe

• #1 Tonic-Clonic (Grand Mal) Seizure: Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/22788-tonic-clonic-grand-mal-seizure

  A tonic-clonic seizure is a type of seizure that causes strong muscle movements on both sides of your body, including convulsions. These are typically the best known and easiest to recognize seizures because of these movements. […] Tonic-clonic seizures were formerly known as grand mal seizures, from the French phrase meaning great illness. The term tonic-clonic refers to the two phases of these seizures, with the initial tonic phase involving widespread tensing up of muscles in your arms and legs and then the clonic phase involving convulsions. […] Your healthcare provider, usually a neurologist, can often diagnose a tonic-clonic seizure based on the symptoms. Because you pass out during a tonic-clonic seizure, you might only recall how you felt before and after the seizure. In those cases, your healthcare provider may ask someone who was with you to describe what happened.

• #1 Tonic-Clonic (Grand Mal) Seizure | Cedars-Sinai

  https://www.cedars-sinai.org/health-library/diseases-and-conditions/t/tonic-clonic-grand-mal-seizure.html

  A detailed description of what happened during your seizure is important to making a correct diagnosis. Your doctor will likely need to speak to a witness who has seen your seizures, as people tend to go unconscious during grand mal seizures. […] The doctor will also perform a neurological exam. These examinations look at the muscles, including reflexes, muscle tone, and strength. They also look at how you walk, balance, coordination and posture. […] One of the most useful tools for diagnosis an electroencephalogram (EEG). This records electrical activity in the brain. The EEG can record unusual spikes or waves in electrical activity patterns. Different types of epilepsy can be identified with these patterns. […] Magnetic resonance imaging (MRI) and computed tomography (CT) scans may be used to look at the cause and the location within the brain. The scans can show scar tissue, tumors or structural problems in the brain.

• #1 Seizure Disorders – Neurologic Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/neurologic-disorders/seizure-disorders/seizure-disorders

  Diagnosis of Seizure Disorders […] Clinical evaluation […] For new-onset seizures, neuroimaging, laboratory testing, and usually EEG […] For known seizure disorders, usually antiseizure medication levels […] For new-onset or known seizure disorders, other testing as clinically indicated […] Evaluation must determine whether the event was a seizure versus another cause of obtundation (eg, a pseudoseizure, syncope), then identify possible causes or precipitants. Patients with new-onset seizures are evaluated in an emergency department; they can sometimes be discharged after thorough evaluation. Those with a known seizure disorder may be evaluated in a physicians office. […] History […] Patients who have had a seizure should be asked about unusual sensations, suggesting an aura and thus a seizure, and about typical seizure manifestations. Patients typically do not remember generalized-onset seizures, so a description of the seizure itself must be obtained from witnesses.

• #1 Tonic-clonic (grand mal) seizure | UM Health-Sparrow

  https://www.uofmhealthsparrow.org/departments-conditions/conditions/tonic-clonic-grand-mal-seizure

  After a seizure, see a healthcare professional to thoroughly review your symptoms and medical history. You may need several tests to determine the cause of your seizure. The tests can evaluate how likely it is that you’ll have another one. […] Tests may include: […] Neurological exam. You may have a test of your behavior, ability to move and control your muscles, and ability to think, understand and solve problems. This helps determine if there’s a health issue with your brain or other part of your nervous system. […] Blood tests. A blood sample can check for signs of infections, blood sugar levels or electrolyte imbalances. […] Electroencephalogram (EEG). In this test, flat metal discs called electrodes attached to your scalp record the electrical activity of your brain. This shows up as wavy lines on an EEG recording. The EEG may reveal a pattern that tells whether a seizure is likely to occur again. EEG testing also may help exclude other conditions that could cause a seizure.

• #1 What Is a Grand Mal Seizure?

  https://www.icliniq.com/articles/neurological-health/grand-mal-seizure

  The most apparent and recognized type of seizure is a tonic-clonic seizure, also known as a grand mal seizure. […] How to Diagnose Grand Mal Seizure? […] Making an accurate diagnosis requires a full description of what transpired during the seizure. Because people become unconscious during grand mal seizures, their doctor will most likely need to speak with a witness who was present during the seizures. […] A neurological examination will also be performed by the doctor. Muscle tone, muscle reflexes, and strength are all examined during these exams. The doctor examines your walking style, balance, coordination, and posture. […] An electroencephalogram (EEG) is one of the most important diagnostic instruments. This monitors brain electrical activity. In electrical activity patterns, the electroencephalogram (EEG) can detect odd spikes or waves. These patterns can be utilized to differentiate between different forms of epilepsy. […] Magnetic resonance imaging (MRI) and computed tomography (CT) scans can reveal scar tissue, cancers, or structural issues in the brain. It can be used to find the location and reason for the seizure inside the brain.

• #1 Seizure Disorders – Neurologic Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/neurologic-disorders/seizure-disorders/seizure-disorders

  Manifestations of other conditions, such as sudden global brain ischemia (eg, due to ventricular arrhythmia), can resemble those of a seizure, including loss of consciousness and some myoclonic jerks. […] Physical examination […] In patients who have lost consciousness, a bitten tongue, incontinence (eg, urine or feces in clothing), or prolonged confusion after loss of consciousness suggest seizure. […] In pseudoseizures, generalized muscular activity and lack of response to verbal stimuli may at first glance suggest generalized tonic-clonic seizures. However, pseudoseizures can usually be distinguished from true seizures by clinical characteristics: […] Pseudoseizures often last longer (several minutes or more). […] Postictal confusion tends to be absent. […] Typical tonic phase activity, followed by clonic phase, usually does not occur.

• #1 Tonic-clonic (grand mal) seizure – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/grand-mal-seizure/diagnosis-treatment/drc-20364165

  EEG records the electrical activity of the brain through electrodes put on the scalp. EEG results show changes in brain activity. This may help diagnose brain conditions such as epilepsy and other seizure conditions. […] You may need several tests to determine the cause of your seizure. The tests can evaluate how likely it is that you’ll have another one. […] Tests may include: […] Electroencephalogram (EEG). In this test, flat metal discs called electrodes attached to your scalp record the electrical activity of your brain. This shows up as wavy lines on an EEG recording. The EEG may reveal a pattern that tells whether a seizure is likely to occur again. EEG testing also may help exclude other conditions that could cause a seizure. […] A healthcare professional is likely to ask you a number of questions, such as:

• #1 Phases of Tonic-Clonic Seizures and How to Manage Them

  https://www.verywellhealth.com/tonic-clonic-seizures-4132423

  A tonic-clonic seizure is often diagnosed based on the description of what happened, but tests are also key to understanding the situation. […] Diagnostic testing such as electroencephalogram (EEG) and brain imaging may also help in diagnosis and the creation of a treatment plan. […] Seizure diagnosis is based on: […] An eyewitness description or video of the seizure will help your provider identify whether you experienced a tonic-clonic seizure. […] An electroencephalogram (EEG) is a test that detects brain waves. If you’ve had a seizure or are prone to seizures, your EEG may show one or more areas of erratic electrical brain activity. […] Sometimes, an EEG does not show electrical abnormalities when you are well-rested but will show them when you’re sleep-deprived. […] Brain computed tomography (CT) and magnetic resonance imaging (MRI) scans do not show seizures, but can identify abnormalities that can cause tonic-clonic seizures, such as a brain tumor, stroke, abscess, or abnormal blood vessel in the brain.

• #1 Generalized tonic–clonic seizure – Wikipedia

  https://en.wikipedia.org/wiki/Generalized_tonic%E2%80%93clonic_seizure

  A generalized tonicclonic seizure, commonly known as a grand mal seizure or GTCS, is a type of generalized seizure that produces bilateral, convulsive tonic and clonic muscle contractions. […] Diagnosis can be made definitively by electroencephalography (EEG), which records the electrical activity of the brain. This is typically done after a seizure episode in a clinical setting with an attempt to „capture” a seizure while it happens. According to „Harrison’s Manual of Medicine,” the EEG during the tonic phase will show a „progressive increase in low-voltage fast wave activity, followed by generalized high-amplitude, poly spike discharges.” […] The clonic phase EEG will show „high amplitude activity that is typically interrupted by slow waves to create a spike-and-slow-wave pattern.” […] Additionally, the postictal phase will show suppression of all brain activity, then slowing that gradually recovers as the patient awakens.

• #1 Seizure Disorders – Neurologic Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/neurologic-disorders/seizure-disorders/seizure-disorders

  Focal epileptiform discharges in focal-to-bilateral tonic-clonic seizures […] Spikes and slow-wave discharges occurring bilaterally at a rate of 3/second and usually normal background EEG activity in typical absence seizures […] Slow spike and wave discharges usually at a rate of […] Bilateral polyspike and wave abnormality at a rate of 4- to 6-Hz in juvenile myoclonic epilepsy […] However, normal EEG cannot exclude the diagnosis of epileptic seizures, which must be made clinically. EEG is less likely to detect abnormalities if seizures are infrequent. The initial EEG may detect an epileptiform abnormality in only 30 to 55% of patients with a known epileptic seizure disorder. Serial EEG may detect epileptiform abnormalities in up to 80 to 90% of such patients. In general, serial EEG with extended recording times and with tests done after sleep deprivation greatly increases the chance of detecting epileptiform abnormalities in patients with epileptic seizures.

• #1 Tonic-clonic (grand mal) seizure | UM Health-Sparrow

  https://www.uofmhealthsparrow.org/departments-conditions/conditions/tonic-clonic-grand-mal-seizure

  CT scan. A CT scan uses X-rays to obtain cross-sectional images of your brain. CT scans can reveal tumors, bleeding and cysts in the brain that might cause a seizure. […] MRI. An MRI uses powerful magnets and radio waves to create a detailed view of your brain. An MRI shows the structure of the brain. This can help determine what may be causing the seizures. […] Positron emission tomography (PET). PET scans use a small amount of low-dose radioactive material that’s injected into a vein. The material helps visualize active areas of the brain. This can help a healthcare professional see where seizures are occurring. […] Single-photon emission computerized tomography (SPECT). A SPECT test uses a small amount of low-dose radioactive material that’s injected into a vein. The test creates a detailed, 3D map of the blood flow activity in your brain that happens during a seizure. You may have a form of a SPECT test called subtraction ictal SPECT coregistered to magnetic resonance imaging, also called SISCOM. This can compare blood flow during a seizure to blood flow in between seizures.

• #1 Bilateral tonic-clonic seizure: MedlinePlus Medical EncyclopediaLock

  https://medlineplus.gov/ency/article/000695.htm

  Bilateral tonic-clonic seizure is a type of seizure that involves the entire body. It is also called grand mal seizure. The terms generalized seizure, convulsion, or epilepsy are most often associated with bilateral tonic-clonic seizures. […] Your health care provider will perform a physical exam. This will include a detailed check of the brain and nervous system. […] An electroencephalogram (EEG) will be done to check the electrical activity in the brain. People with seizures often have abnormal electrical activity seen on this test. In some cases, the test shows the area in the brain where the seizures start. The brain may appear normal after a seizure or between seizures. […] Blood and urine tests may also be ordered to check for other health problems that may be causing the seizures. […] Head CT or MRI scan may be done to find the cause and location of the problem in the brain.

• #1 Generalized Seizures (Grand Mal Seizures) – Harvard Health

  https://www.health.harvard.edu/a_to_z/generalized-seizures-grand-mal-seizures-a-to-z

  In some cases, the doctor may also order a magnetic resonance imaging (MRI) or computed tomography (CT) scan of your brain to look for evidence of a local problem, such as a brain tumor or scarring from a previous brain injury. These scans are especially important if: you are an adult with your first generalized seizure; you have an unusual pattern of symptoms; your neurological exam is abnormal; you have a history of brain damage (birth trauma, head injury, train tumor, encephalitis, meningitis).

• #1 Tonic-clonic (grand mal) seizure | Beacon Health System

  https://www.beaconhealthsystem.org/library/diseases-and-conditions/tonic-clonic-grand-mal-seizure?content_id=CON-20301698

  Tests may include: Neurological exam. […] Electroencephalogram (EEG). […] A CT scan uses X-rays to obtain cross-sectional images of your brain. […] An MRI shows the structure of the brain. […] PET scans use a small amount of low-dose radioactive material that’s injected into a vein. […] A SPECT test uses a small amount of low-dose radioactive material that’s injected into a vein.

• #1 Generalized Tonic Clonic Seizures – What You Need to Know

  https://www.drugs.com/cg/generalized-tonic-clonic-seizures.html

  A PET scan is used to see activity in areas of your brain. You are given radioactive material that helps healthcare providers see the activity better. […] A SPECT scan uses radioactive material to find where the seizure started in your brain. This scan may be done if other scans do not show where the seizure started.

• #1 Seizure Disorders – Neurologic Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/neurologic-disorders/seizure-disorders/seizure-disorders

  Syncope mimicking seizure (eg, with myoclonic jerks): ECG may detect unsuspected cardiac arrhythmias. […] Neuroimaging (typically head CT, but sometimes MRI) is usually done immediately to exclude a mass or hemorrhage. CT can be deferred and possibly avoided in children with typical febrile seizures whose neurologic status rapidly returns to normal. […] Follow-up MRI is recommended when CT is negative. It provides better resolution of brain tumors and abscesses and can detect cortical dysplasias, cerebral venous thrombosis, and herpes encephalitis. An epilepsy-protocol MRI of the head uses high-resolution coronal T1 and T2 sequences, which can detect hippocampal atrophy or sclerosis. MRI can detect some common causes of seizures, such as malformations of cortical development in young children and mesial temporal sclerosis, traumatic gliosis, and small tumors in adults.

• #1 Seizure Disorders – Neurologic Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/neurologic-disorders/seizure-disorders/seizure-disorders

  Inpatient combined video-EEG monitoring, usually for 2 to 7 days, records EEG activity and clinical behavior simultaneously. It is the most sensitive EEG testing available and is thus useful in differentiating epileptic from nonepileptic seizures. […] Ambulatory EEG can be done while patients are at home. It may be useful if seizures recur in patients who cannot be admitted to the hospital for a long time. […] If surgical resection of areas of epileptic foci is being considered, advanced imaging tests to identify such areas are available in epilepsy centers: […] Functional MRI can identify functioning cortex and guide surgical resection. […] If EEG and MRI do not clearly identify the epileptic focus, magnetoencephalography with EEG (called magnetic source imaging) may localize the lesion, avoiding the need for invasive intraoperative mapping procedures.

• #1 Generalized Tonic-Clonic Seizure – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK554496/

  A generalized tonic-clonic seizure, formerly known as grand mal seizure, is defined as a seizure that has a tonic phase followed by clonic muscle contractions. […] The disease etiology and pathophysiology are described along with the evaluation and management of generalized tonic-clonic seizures. This article covers the diagnosis and treatment of generalized tonic-clonic seizures and highlights the role of the interprofessional team in caring for patients afflicted with generalized tonic-clonic seizures. […] The diagnosis of a generalized tonic-clonic seizure is based on the patient’s history and physical examination. […] A detailed physical examination is important in these patients. […] A patient seeking care in the emergency department should have a chemistry panel done to rule out hypoglycemia, hyponatremia, uremia, and drug intoxication. Emergency neuroimaging is recommended for patients with suspected serious brain lesions, persistent neurological deficits, recent trauma, and headache.

• #1 Generalized Seizures | Nationwide Children’s Hospital

  https://www.nationwidechildrens.org/conditions/seizures

  How Are Seizures Diagnosed? […] The diagnosis of a seizure is made with a physical examination and diagnostic tests. During the examination, the physician obtains a complete medical history of the child and family and asks when the seizures occurred. Seizures may be due to neurological problems and require further medical follow up. […] Diagnostic tests may include: Blood tests, Electroencephalogram (EEG) – a procedure that records the brain’s continuous, electrical activity by means of electrodes attached to the scalp, Magnetic resonance imaging (MRI) – a diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body, Computed tomography scan (Also called a CT or CAT scan.) – a diagnostic imaging procedure that uses a combination of X-rays and computer technology to produce horizontal, or axial, images (often called slices) of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general X-rays, Lumbar puncture (spinal tap) – a special needle is placed into the lower back, into the spinal canal. This is the area around the spinal cord. The pressure in the spinal canal and brain can then be measured. A small amount of cerebral spinal fluid (CSF) can be removed and sent for testing to determine if there is an infection or other problems. CSF is the fluid that bathes your child’s brain and spinal cord.

• #1 Dravet Syndrome | Children’s Hospital of Philadelphia

  https://www.chop.edu/conditions-diseases/dravet-syndrome

  The appearance of prolonged tonic-clonic or hemiclonic seizures in the first year of life in a previously well child, particularly if triggered by fever, is a strong indication of Dravet syndrome. […] Electroencephalogram (EEG) and magnetic resonance imaging (MRI) test results are often normal when seizures first appear, which can sometimes delay diagnosis. […] When Dravet syndrome is suspected, genetic testing may be done to look for a pathogenic variant in the SCN1A gene. If found, this can confirm the diagnosis, in the larger context of clinical features consistent with Dravet syndrome. […] If no pathogenic SCN1A variant is found, diagnosis may be made based purely on symptoms.

• #1 Seizure Disorders – Neurologic Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/neurologic-disorders/seizure-disorders/seizure-disorders

  If seizures are new-onset or if examination results are abnormal for the first time, neuroimaging is required. Patients with new-onset seizures or atypical manifestations also require laboratory testing, including blood tests (serum electrolytes, blood urea nitrogen (BUN), creatinine, glucose, calcium, magnesium, and phosphate levels), and liver function tests. […] Other tests may be done based on disorders that are suspected clinically: […] Meningitis or CNS infection with normal neuroimaging results: Lumbar puncture is required. […] Unreported use of illicit drugs that can cause or contribute to seizures: Drug screens may be done, although this practice is controversial because positive results do not indicate causality and test results can be inaccurate. […] Cryptogenic epilepsy: Testing for the anti-NMDA receptor antibody should be considered, especially in young women (as many as 26% may test positive); a positive result suggests anti-NMDA receptor encephalitis.

• #1 Generalized Tonic-Clonic Seizures Differential Diagnoses

  https://emedicine.medscape.com/article/1184608-differential

  The following conditions should be considered in the assessment of patients with possible generalized tonic-clonic seizures: […] Hyperventilation and electrolyte imbalances […] Prolonged QT syndrome and other arrhythmias […] Dystonias including nocturnal paroxysmal dystonias […] Paroxysmal dyskinesias […] Encephalopathies and metabolic disorders […] Pseudoepileptic seizures or nonepileptic seizures […] Nocturnal paroxysmal events (eg, sleep apnea, night terrors) […] Paroxysmal abnormalities of tone (eg, opisthotonic posturing and clonus) […] In infants, apneic syndromes including gastroesophageal reflux and jitteriness of the newborn […] In toddlers and young school-aged children, simple faints and breath-holding spells.

• #1 When Seizure Types Change: Part I | Epilepsy NYC – Epilepsy Foundation of Metropolitan New York

  http://epilepsynyc.com/2012/07/when-seizure-types-change-part-i/

  A change might have various causes and various consequences for each person. The epileptologist (epilepsy neurologist) can help make this distinction with the help of an accurate history and by using diagnostic methods, e.g. electroencephalogram (EEG) or imaging. […] It should be noted that a generalized tonic clonic seizure, also known as a grand mal; can be the result of secondary generalization of a partial (or focal ) seizure, or the manifestation of primary generalized epilepsy. […] It is advisable to use a seizure calendar at all times. […] The gold standard in characterizing the seizures is capturing an event while a person is undergoing video-EEG epilepsy monitoring. Under very controlled circumstances and close supervision epileptologists record a seizure to examine and characterize its nature in EEG and to correlate these findings with the video recordings.

• #1 Seizure Disorders – Neurologic Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/neurologic-disorders/seizure-disorders/seizure-disorders

  Single-photon emission CT (SPECT) during the ictal period may detect increased perfusion in the seizure focus and help localize the area to be surgically removed. Because injection of contrast is required at the time of seizure, patients must be admitted for continuous video-EEG monitoring when SPECT is done during the ictal period. […] Neuropsychologic testing may help identify functional deficits before and after surgery and help predict social and psychologic prognosis and capacity for rehabilitation.

• #1 Tonic-Clonic Seizure: Symptoms, What to Do, and More

  https://www.healthline.com/health/generalized-tonic-clonic-seizure

  Tonic-clonic seizures, previously known as grand mal seizures, are characterized by both stiffness and jerking motions. […] A generalized tonic-clonic seizure is a disturbance in the functioning of both sides of your brain. […] A tonic-clonic seizure may be a medical emergency. This depends in part on your history of epilepsy or other health conditions. […] Tonic-clonic seizures usually last 1 to 3 minutes, according to the Epilepsy Foundation. […] There are several ways to diagnose epilepsy or the cause of a seizure. […] A doctor or other healthcare professional will ask you questions about other seizures or medical conditions you’ve had. […] A doctor may order blood tests to look for medical problems that could influence the onset of a seizure. […] Some types of brain scans can help your doctor monitor your brain function. This could include an electroencephalogram (EEG), which shows the patterns of electrical activity in your brain.

• #1 Epilepsy

  https://www.nhs.uk/conditions/epilepsy/symptoms/

  If you or your child have had a seizure you’ll need to see a specialist doctor. They’ll check what caused it and whether you might have epilepsy. […] Tests you might have include: an electroencephalogram (EEG) to check electrical activity in your brain, an electrocardiogram (ECG) to check your heart, scans such as an MRI scan or CT scan, blood tests, genetic testing. […] Having a seizure does not always mean you have epilepsy, as seizures can have other causes. You’ll usually be diagnosed with epilepsy if you’ve had more than 1 seizure, or if tests show you’re at risk of having more seizures.

• #1 Seizures | Boston Children’s Hospital

  https://www.childrenshospital.org/conditions/seizures

  If your child is having seizures, a proper diagnosis relies strongly on your observations of your child’s symptoms. […] Your medical team will first try to distinguish between true seizures and other problems that can look like seizures, such as stroke, fainting, and movement disorders. If your child is indeed having seizures, the next step is to determine where in the brain the seizures are coming from and whether the seizures represent epilepsy or some other disorder. […] Your child’s physician will use a variety of tests to evaluate seizures, including: […] Electroencephalography (EEG), a test that records electrical activity in your child’s brain using tiny wires attached to the head (EEG is highly sensitive and can pick up even small seizures that don’t lead to physical symptoms.)

• #1

  https://www.healthychildren.org/English/health-issues/conditions/seizures/Pages/Seizures-and-Epilepsy-in-Children.aspx

  Generalized tonic-clonic seizures (previously called „grand mal seizures”) involve abnormal electrical activity in the whole brain. They are the most dramatic type of seizure; they cause rhythmic and sometimes violent jerking movements in both sides of the body with loss of consciousness. These seizures usually last for 2 to 3 minutes and will almost always end on their own. […] In some instances, a focal seizure can progress to a generalized tonic-clonic seizure. […] If epilepsy is diagnosed, your child usually will be placed on an anti-seizure medication. They also may need further testing, such as EEGs, brain imaging, or genetic testing.

• #1 Tonic-clonic seizures – Epilepsy Action

  https://www.epilepsy.org.uk/info/seizures/tonic-clonic

  If a tonic-clonic seizure lasts longer than five minutes, this is called status epilepticus and you may need emergency medical treatment. […] After a tonic-clonic seizure, you might have a headache and feel sore, tired and very unwell. […] The length of time it takes to recover after a tonic-clonic seizure is different for everyone. […] A very small number of people find they have temporary weakness or cant move part of their body after theyve had a seizure. This is called Todds Paralysis or Todds paresis.

• #1 Seizure Disorders – Neurologic Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/neurologic-disorders/seizure-disorders/seizure-disorders

  The progression of muscular activity does not correspond to true seizure patterns (eg, pseudoseizure movements may include jerks moving from one side to the other and back and exaggerated pelvic thrusting). […] Intensity may wax and wane. […] Vital signs, including temperature, usually remain normal. […] Patients often actively resist passive eye opening. […] Testing […] Testing is done routinely, but normal results do not necessarily exclude a seizure disorder. Thus, the diagnosis may ultimately be clinical. Testing depends on results of the history and neurologic examination. […] If patients have a known seizure disorder but have symptoms or signs of a treatable disorder (eg. trauma, infection, metabolic disorder), additional testing is indicated. However, if examination results are normal or unchanged, little testing is required except for blood levels of antiseizure medications.

• #1 Seizure disorders: Part 1. Classification and diagnosis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC1071497/

  Tonic-clonic (grand-mal) seizures occur in 25% of all patients with seizures and are the most common type of generalized seizure in adults. […] MRI of the head is indicated after a tonic-clonic seizure. MRI will show an abnormality in 10% to 20% of patients with a generalized tonic-clonic seizure and a normal CT scan. […] In untreated patients, recurrence after a first seizure occurs in 64% at 6 months, 70% at 1 year, and 81% at 3 years.

• #1 Grand Mal (Tonic-Clonic) Seizure: Causes, Treatment, and More

  https://resources.healthgrades.com/right-care/brain-and-nerves/grand-mal-seizures

  Not everyone who has had a tonic-clonic seizure will have another one in their lifetime. A 2017 study suggests that the likelihood of having another tonic-clonic seizure may be 30–50%. […] The outlook with tonic-clonic seizures can vary according to: cause of the seizure, severity and frequency of seizures, age, underlying health, EEG results, imaging test results, such as from CT or MRI scans, treatment. […] Tonic-clonic seizures and epilepsy can sometimes have significant complications, such as impaired quality of life, injury, breathing complications, such as pulmonary aspiration, status epilepticus, brain damage, increased risk of cognitive impairment, and impaired learning and development, psychiatric conditions, such as depression, sleep disorders, cardiovascular conditions, bone conditions. […] However, not everyone will experience complications. Additionally, the World Health Organization (WHO) estimates that as much as 70% of people with epilepsy could be seizure-free with effective treatment. This can reduce the risk of complications and improve quality of life.

• #1 Tonic-clonic (grand mal) seizure – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/grand-mal-seizure/diagnosis-treatment/drc-20364165

  What kinds of tests do I need? Do these tests require any special preparation? […] What treatments are available and which do you recommend? […] What types of side effects can I expect from treatment? […] Are there any alternatives to the primary approach you’re suggesting? […] Do I need to restrict any activities? […] Are there any brochures or other printed material that I can take home with me? What websites do you recommend?

• #1 Tonic-clonic (grand mal) seizure | Altru Health System

  https://www.altru.org/health-library/conditions/tonic-clonic-grand-mal-seizure

  After a seizure, see a healthcare professional to thoroughly review your symptoms and medical history. You may need several tests to determine the cause of your seizure. The tests can evaluate how likely it is that you’ll have another one. […] Tests may include: […] Electroencephalogram (EEG). In this test, flat metal discs called electrodes attached to your scalp record the electrical activity of your brain. This shows up as wavy lines on an EEG recording. The EEG may reveal a pattern that tells whether a seizure is likely to occur again. EEG testing also may help exclude other conditions that could cause a seizure. […] A healthcare professional is likely to ask you a number of questions, such as: […] What medicines have you or your child tried? What doses were used? […] Have you noticed any seizure triggers, such as sleep deprivation or illness?

• #1 Generalized Tonic-Clonic Seizure – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK554496/

  The decision to start chronic, prophylactic antiseizure medications is individualized based on numerous factors, including the chance of event being a seizure, confirmation of seizure based on history and physical examination, patient stability, and risk of recurrent seizures. […] A neurologist should be consulted to evaluate, treat, and provide further workup for generalized tonic-clonic seizures.

• #1 Managing seizures | Cornell University College of Veterinary Medicine

  https://www.vet.cornell.edu/departments-centers-and-institutes/riney-canine-health-center/canine-health-information/managing-seizures

  However, the most common cause of seizures is idiopathic epilepsy, which is a seizure condition of unknown origin. A diagnosis of idiopathic epilepsy is typically made after every other cause has been ruled out. […] A general rule is to start antiepileptic drugs if there is more than one seizure a month, Early says. Most veterinary professionals think that if a dog is seizing as much as once a month, its interfering too much with their quality of life and yours. Starting anticonvulsant therapy will likely be recommended in this case. […] Seizures in dogs can be frightening and hard to endure. Luckily, we have many tools to help diagnose and manage this tough condition. Always consult with your dogs veterinarian to be sure that you’re making the best decision for your unique dog and lifestyle.

• #1 Generalized Tonic-Clonic Seizures: Background, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/1184608-overview

  A seizure is an abnormal paroxysmal discharge of cerebral neurons due to cortical hyperexcitability. […] Patients with generalized tonic-clonic seizures and idiopathic generalized epilepsy typically have no evidence of any localized, regional, or diffuse brain abnormality on history, physical, or neurologic examination; clinical laboratory testing; or imaging studies. […] The awake EEG of patients with generalized tonic-clonic seizure may be normal; however, certain specific interictal EEG patterns can be distinctive of generalized epilepsy syndromes. […] A number of medications are used for the treatment of generalized tonic-clonic seizures. The choice of drug should be tailored to the individual patient and to the epilepsy syndrome, not only to the seizure type.

• #1 Generalized onset tonic-clonic seizures | MedLink Neurology

  https://www.medlink.com/articles/generalized-onset-tonic-clonic-seizures

  Generalized onset tonic-clonic seizures are the most dramatic, severe, and common seizures of mainly syndromes of idiopathic generalized epilepsy. […] Treatment is demanding because a significant number of currently available antiepileptic drugs may aggravate generalized seizures. […] In this updated article, the author details the clinical manifestations, pathophysiology, EEG, and neuroimaging of generalized onset tonic-clonic seizures and provides clues for correct diagnosis and optimal management of patients. […] The diagnosis is almost always based solely on the clinical history, which should be obtained in a skilled way, often requiring lengthy interrogation(s) of the patient and witnesses. […] The differential diagnosis should distinguish generalized onset tonic-clonic seizures from nonepileptic paroxysmal events and focal onset tonic-clonic seizures.

• #2 Tonic-clonic (grand mal) seizure – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/grand-mal-seizure/symptoms-causes/syc-20363458

  A tonic-clonic seizure, previously known as a grand mal seizure, causes a loss of consciousness and violent muscle contractions. […] Usually, a tonic-clonic seizure is caused by epilepsy. But sometimes this type of seizure can be triggered by other health problems, such as a high fever or damage to the brain. […] But someone who has recurrent seizures may need treatment with daily anti-seizure medicines to control and prevent future tonic-clonic seizures. […] If you experience a seizure for the first time, see a healthcare professional. […] Tonic-clonic seizures occur when there’s a surge of electrical activity over the surface of the brain. […] However, tonic-clonic seizures are sometimes caused by other health problems, such as: […] Diagnosis treatment.

• #2 Grand mal (tonic-clonic) seizures: Causes, symptoms, and more

  https://www.medicalnewstoday.com/articles/grand-mal-seizure

  A doctor will diagnose a persons tonic-clonic seizure by evaluating their medical history and recollection of the seizure. They will also perform a physical examination and check for signs of a seizure, such as tongue bites. […] Additionally, they will ask about environmental factors high fevers, drug or alcohol use, drug or alcohol withdrawal, stress, and flashing lights to determine the cause of the seizure. […] Having a tonic-clonic seizure does not necessarily mean a person has epilepsy. However, a doctor may think a persons seizure is the result of epilepsy if: they have had at least two seizures, the seizures were at least 24 hours apart, there is no evidence to suggest that other factors caused the seizures. […] If this is the case, the doctor will perform a number of tests. These may include: a neurological exam, an electroencephalogram (EEG) test, an imaging test, such as a CT or MRI scan.

• #2 Tonic-clonic (grand mal) seizure | Health Library | Memorial Health System

  https://www.mhsystem.org/health-library/con-20301698/

  A tonic-clonic seizure, previously known as a grand mal seizure, causes a loss of consciousness and violent muscle contractions. […] Usually, a tonic-clonic seizure is caused by epilepsy. But sometimes this type of seizure can be triggered by other health problems, such as a high fever or damage to the brain. […] After a seizure, see a healthcare professional to thoroughly review your symptoms and medical history. You may need several tests to determine the cause of your seizure. The tests can evaluate how likely it is that you’ll have another one. […] Tests may include: […] An EEG records the electrical activity of the brain through electrodes put on the scalp. EEG results show changes in brain activity. This may help diagnose brain conditions such as epilepsy and other seizure conditions. […] A healthcare professional is likely to ask you a number of questions, such as: […] What treatments are available and which do you recommend? […] Do I have epilepsy? […] What kinds of tests do I need? Do these tests require any special preparation?

• #2 Epilepsy with generalized tonic-clonic seizures alone | MedLink Neurology

  https://www.medlink.com/articles/epilepsy-with-generalized-tonic-clonic-seizures-alone

  Epilepsy with generalized tonic-clonic seizures (GTCS) alone is likely a syndrome of idiopathic/genetic generalized epilepsy of uncertain boundaries. […] Differential diagnosis is demanding for the exclusion of nonepileptic attacks and focal onset tonic-clonic seizures. […] Prognosis is markedly variable, from excellent in mild cases to severe with continuing GTCS becoming more frequent and less dependent on sleep-waking cycle and precipitating factors. […] Prophylactic treatment, mainly with sodium valproate, levetiracetam, or lamotrigine, is effective. […] Differential diagnosis is often difficult without appropriately performed and assessed video-EEG. […] The EEG background is normal. […] Generalized spike-and-wave or polyspike-and-wave is seen in the interictal EEG. […] The first routine EEG may be normal in approximately 12% of patients, but the yield of abnormalities increases with repeat EEG and partial sleep deprivation EEG with recordings during both sleep and awakening states.

• #2 Seizure Disorders – Neurologic Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/neurologic-disorders/seizure-disorders/seizure-disorders

  Syncope mimicking seizure (eg, with myoclonic jerks): ECG may detect unsuspected cardiac arrhythmias. […] Neuroimaging (typically head CT, but sometimes MRI) is usually done immediately to exclude a mass or hemorrhage. CT can be deferred and possibly avoided in children with typical febrile seizures whose neurologic status rapidly returns to normal. […] Follow-up MRI is recommended when CT is negative. It provides better resolution of brain tumors and abscesses and can detect cortical dysplasias, cerebral venous thrombosis, and herpes encephalitis. An epilepsy-protocol MRI of the head uses high-resolution coronal T1 and T2 sequences, which can detect hippocampal atrophy or sclerosis. MRI can detect some common causes of seizures, such as malformations of cortical development in young children and mesial temporal sclerosis, traumatic gliosis, and small tumors in adults.

• #2 Seizure Disorders – Neurologic Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/neurologic-disorders/seizure-disorders/seizure-disorders

  Single-photon emission CT (SPECT) during the ictal period may detect increased perfusion in the seizure focus and help localize the area to be surgically removed. Because injection of contrast is required at the time of seizure, patients must be admitted for continuous video-EEG monitoring when SPECT is done during the ictal period. […] Neuropsychologic testing may help identify functional deficits before and after surgery and help predict social and psychologic prognosis and capacity for rehabilitation.

• #2 Seizure Disorders – Neurologic Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/neurologic-disorders/seizure-disorders/seizure-disorders

  If seizures are new-onset or if examination results are abnormal for the first time, neuroimaging is required. Patients with new-onset seizures or atypical manifestations also require laboratory testing, including blood tests (serum electrolytes, blood urea nitrogen (BUN), creatinine, glucose, calcium, magnesium, and phosphate levels), and liver function tests. […] Other tests may be done based on disorders that are suspected clinically: […] Meningitis or CNS infection with normal neuroimaging results: Lumbar puncture is required. […] Unreported use of illicit drugs that can cause or contribute to seizures: Drug screens may be done, although this practice is controversial because positive results do not indicate causality and test results can be inaccurate. […] Cryptogenic epilepsy: Testing for the anti-NMDA receptor antibody should be considered, especially in young women (as many as 26% may test positive); a positive result suggests anti-NMDA receptor encephalitis.

• #2 Epilepsy

  https://www.nhs.uk/conditions/epilepsy/symptoms/

  If you or your child have had a seizure you’ll need to see a specialist doctor. They’ll check what caused it and whether you might have epilepsy. […] Tests you might have include: an electroencephalogram (EEG) to check electrical activity in your brain, an electrocardiogram (ECG) to check your heart, scans such as an MRI scan or CT scan, blood tests, genetic testing. […] Having a seizure does not always mean you have epilepsy, as seizures can have other causes. You’ll usually be diagnosed with epilepsy if you’ve had more than 1 seizure, or if tests show you’re at risk of having more seizures.

• #2 When Seizure Types Change: Part I | Epilepsy NYC – Epilepsy Foundation of Metropolitan New York

  http://epilepsynyc.com/2012/07/when-seizure-types-change-part-i/

  A change might have various causes and various consequences for each person. The epileptologist (epilepsy neurologist) can help make this distinction with the help of an accurate history and by using diagnostic methods, e.g. electroencephalogram (EEG) or imaging. […] It should be noted that a generalized tonic clonic seizure, also known as a grand mal; can be the result of secondary generalization of a partial (or focal ) seizure, or the manifestation of primary generalized epilepsy. […] It is advisable to use a seizure calendar at all times. […] The gold standard in characterizing the seizures is capturing an event while a person is undergoing video-EEG epilepsy monitoring. Under very controlled circumstances and close supervision epileptologists record a seizure to examine and characterize its nature in EEG and to correlate these findings with the video recordings.

• #2 Generalized Tonic-Clonic Seizure – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK554496/

  The decision to start chronic, prophylactic antiseizure medications is individualized based on numerous factors, including the chance of event being a seizure, confirmation of seizure based on history and physical examination, patient stability, and risk of recurrent seizures. […] A neurologist should be consulted to evaluate, treat, and provide further workup for generalized tonic-clonic seizures.

• #2 Epilepsy: What It Is, Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/17636-epilepsy

  Technically, if you experience two or more seizures that werent caused by a known medical condition for example, from alcohol withdrawal or low blood sugar youre considered to have epilepsy. […] Before making a diagnosis, your healthcare provider (or epilepsy specialist) will perform a physical exam, take your medical history and may order blood work (to rule out other causes). […] They may ask about your symptoms during the seizure and conduct other tests, as well. […] Tests include: […] Electroencephalography (EEG): This test measures the electrical activity in your brain. Certain abnormal electrical patterns are related to seizures. […] Brain scans: Magnetic resonance imaging (MRI) to look for such things as tumors, infections or blood vessel abnormalities.

• #2 Managing seizures | Cornell University College of Veterinary Medicine

  https://www.vet.cornell.edu/departments-centers-and-institutes/riney-canine-health-center/canine-health-information/managing-seizures

  The big, bad grand mal seizure is a generalized, convulsive seizure with widespread, excessive, abnormal electrical activity occurring in both sides of the brain. Also known as tonic-clonic, this type of seizure is the one where a dog suddenly falls over with violent, jerking spasms affecting all four limbs, paddling, frothing at the mouth, possible loss of bladder and bowel control, and loss of consciousness. […] Timing the seizure is important because of a life-threatening condition called status epilepticus. […] Status epilepticus is an ongoing seizure that doesnt self-resolve, typically considered more than five minutes, says Dr. Peter Early, visiting clinical professor of neurology in the Department of Clinical Sciences. […] If a dog is in status epilepticus for too long, they could die.

• #2 Mayo Clinic Health Library – Tonic-clonic (grand mal) seizure | Swiss Medical Network

  https://www.swissmedical.net/en/healtcare-library/con-20301698

  During a high-density EEG, flat metal discs called electrodes are attached to the scalp. The electrodes are connected to the EEG machine with wires. […] A healthcare professional is likely to ask you a number of questions, such as: […] What kinds of tests do I need? Do these tests require any special preparation? […] What treatments are available and which do you recommend? […] What types of side effects can I expect from treatment? […] Are there any alternatives to the primary approach you’re suggesting? […] Do I need to restrict any activities? […] Are there any brochures or other printed material that I can take home with me? What websites do you recommend?

• #2 Generalized onset tonic-clonic seizures | MedLink Neurology

  https://www.medlink.com/articles/generalized-onset-tonic-clonic-seizures

  No antiseizure drugs reach the highest levels of evidence (levels A and B) for efficacy/effectiveness for adults with GTCS. […] In deciding the first monotherapy option for patients with PGTCS, it should be remembered that antiseizure drug prophylactic therapy is often lifelong in most idiopathic generalized epilepsies, and, therefore, adverse effects from chronic use should be considered.

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