Materiały źródłowe

• #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. […] Generalized tonic-clonic seizures arise within and rapidly involve bilateral cortical, subcortical, and brainstem networks of the brain. […] The etiology of most of the generalized tonic-clonic seizures is underlying epilepsy from genetic causes (previously categorized as idiopathic). Besides genetic generalized epilepsy, tonic-clonic seizures can be secondary to epilepsy due to structural, infectious, metabolic, or immune-related pathologies. […] Seizures are thought to arise secondary to an imbalance between excitation and inhibition of neurons. Imbalance of excitation and inhibition can be the result of alteration in genes or from acquired etiologies. Genetic pathologies can produce dysfunction at the circuit level (e.g., abnormal synaptic connectivity) to the receptor level (imbalance between excitatory glutamate and inhibitory gamma-aminobutyric acid [GABA] receptors) to ionic channel level(example, sodium channel dysfunction in Dravet syndrome). […] Acquired cerebral insults such as trauma, strokes, or tumors can alter cerebral neuronal circuits similarly.

• #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. […] During a seizure, there’s a burst of electrical activity in the brain that causes changes in behavior and movements. […] Tonic-clonic seizures may begin as focal seizures in a small area of the brain and spread to become generalized seizures that involve the whole brain. […] 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. […] Tonic-clonic seizures occur when there’s a surge of electrical activity over the surface of the brain. Many nerve cells fire at once, much faster than usual. […] However, tonic-clonic seizures are sometimes caused by other health problems, such as severe head injuries, infections, stroke, and dementias that cause degeneration in the brain.

• #3 Generalized Tonic-Clonic Seizure – PubMed

  https://pubmed.ncbi.nlm.nih.gov/32119383/

  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. […] A generalized tonic-clonic seizure is a motor seizure and the most common type seen in patients with epilepsy. […] Generalized tonic-clonic seizures arise within and rapidly involve bilateral cortical, subcortical, and brainstem networks of the brain. […] A focal seizure-originating from either left or right hemisphere – can rapidly spread and evolve into a bilateral tonic-clonic seizure (previously known as a secondary generalized seizure), which can be difficult to differentiate from a primary generalized tonic-clonic seizure.

• #4 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. […] During a seizure, there’s a burst of electrical activity in the brain that causes changes in behavior and movements. […] Tonic-clonic seizures may begin as focal seizures in a small area of the brain and spread to become generalized seizures that involve the whole brain. […] 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. […] Tonic-clonic seizures occur when there’s a surge of electrical activity over the surface of the brain. Many nerve cells fire at once, much faster than usual. […] However, tonic-clonic seizures are sometimes caused by other health problems, such as severe head injuries, infections, stroke, and dementias that cause degeneration in the brain.

• #5 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. […] A seizure is a malfunction in how your brain cells (neurons) send and relay electrical signals. A seizure causes affected neurons to fire electrical signals uncontrollably to other nearby neurons, causing the malfunction to spread. […] Tonic-clonic seizures are generalized seizures, which means this type of seizure affects both sides of your brain. These seizures make you pass out and affect muscles throughout your body, causing convulsions, shaking and other kinds of uncontrollable muscle movements.

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

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

  Generalized epilepsy is thought to be initiated by 3 different mechanisms: […] Abnormal response of hyperexcitable cortex to initially normal thalamic input […] Primary subcortical trigger […] Abnormal cortical innervation from subcortical structures. […] Physiologically, a seizure results from a paroxysmal high-voltage electrical discharge of susceptible neurons within an epileptogenic focus. These neurons are known to be hyperexcitable and, for unknown reasons, remain in a state of partial depolarization. […] The neurons surrounding the epileptogenic focus are GABA-ergic (ie, they release gamma-aminobutyric acid) and hyperpolarized, and they inhibit the epileptogenic neurons. At times, when the epileptogenic neurons overcome the surrounding inhibitory influence, the seizure discharge spreads to neighboring cortical structures and then to subcortical and brainstem structures.

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

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

  Generalized epilepsy is thought to be initiated by 3 different mechanisms: […] Abnormal response of hyperexcitable cortex to initially normal thalamic input […] Primary subcortical trigger […] Abnormal cortical innervation from subcortical structures. […] Physiologically, a seizure results from a paroxysmal high-voltage electrical discharge of susceptible neurons within an epileptogenic focus. These neurons are known to be hyperexcitable and, for unknown reasons, remain in a state of partial depolarization. […] The neurons surrounding the epileptogenic focus are GABA-ergic (ie, they release gamma-aminobutyric acid) and hyperpolarized, and they inhibit the epileptogenic neurons. At times, when the epileptogenic neurons overcome the surrounding inhibitory influence, the seizure discharge spreads to neighboring cortical structures and then to subcortical and brainstem structures.

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

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

  Various animal models of generalized epilepsy implicate brainstem structures in the pathogenesis of generalized seizures. […] The spread of excitability to subcortical, thalamic, brainstem, and spinal cord structures corresponds with the tonic phase of the seizure. Following this, an inhibitory impulse starts from the thalamus and interrupts the tonic phase into discontinuous bursts of electrical activity, known as the clonic phase.

• #9 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. […] Generalized tonic-clonic seizures arise within and rapidly involve bilateral cortical, subcortical, and brainstem networks of the brain. […] The etiology of most of the generalized tonic-clonic seizures is underlying epilepsy from genetic causes (previously categorized as idiopathic). Besides genetic generalized epilepsy, tonic-clonic seizures can be secondary to epilepsy due to structural, infectious, metabolic, or immune-related pathologies. […] Seizures are thought to arise secondary to an imbalance between excitation and inhibition of neurons. Imbalance of excitation and inhibition can be the result of alteration in genes or from acquired etiologies. Genetic pathologies can produce dysfunction at the circuit level (e.g., abnormal synaptic connectivity) to the receptor level (imbalance between excitatory glutamate and inhibitory gamma-aminobutyric acid [GABA] receptors) to ionic channel level(example, sodium channel dysfunction in Dravet syndrome). […] Acquired cerebral insults such as trauma, strokes, or tumors can alter cerebral neuronal circuits similarly.

• #10 Generalized Tonic-Clonic Seizure | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/28839

  Generalized tonic-clonic seizures arise within and rapidly involve bilateral cortical, subcortical, and brainstem networks of the brain. […] The etiology of most of the generalized tonic-clonic seizures is underlying epilepsy from genetic causes (previously categorized as idiopathic). Besides genetic generalized epilepsy, tonic-clonic seizures can be secondary to epilepsy due to structural, infectious, metabolic, or immune-related pathologies. […] Seizures are thought to arise secondary to an imbalance between excitation and inhibition of neurons. Imbalance of excitation and inhibition can be the result of alteration in genes or from acquired etiologies. Genetic pathologies can produce dysfunction at the circuit level (e.g., abnormal synaptic connectivity) to the receptor level (imbalance between excitatory glutamate and inhibitory gamma-aminobutyric acid [GABA] receptors) to ionic channel level (example, sodium channel dysfunction in Dravet syndrome).

• #11 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. […] Generalized tonic-clonic seizures arise within and rapidly involve bilateral cortical, subcortical, and brainstem networks of the brain. […] The etiology of most of the generalized tonic-clonic seizures is underlying epilepsy from genetic causes (previously categorized as idiopathic). Besides genetic generalized epilepsy, tonic-clonic seizures can be secondary to epilepsy due to structural, infectious, metabolic, or immune-related pathologies. […] Seizures are thought to arise secondary to an imbalance between excitation and inhibition of neurons. Imbalance of excitation and inhibition can be the result of alteration in genes or from acquired etiologies. Genetic pathologies can produce dysfunction at the circuit level (e.g., abnormal synaptic connectivity) to the receptor level (imbalance between excitatory glutamate and inhibitory gamma-aminobutyric acid [GABA] receptors) to ionic channel level(example, sodium channel dysfunction in Dravet syndrome). […] Acquired cerebral insults such as trauma, strokes, or tumors can alter cerebral neuronal circuits similarly.

• #12 Generalized Tonic-Clonic Seizure | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/28839

  Generalized tonic-clonic seizures arise within and rapidly involve bilateral cortical, subcortical, and brainstem networks of the brain. […] The etiology of most of the generalized tonic-clonic seizures is underlying epilepsy from genetic causes (previously categorized as idiopathic). Besides genetic generalized epilepsy, tonic-clonic seizures can be secondary to epilepsy due to structural, infectious, metabolic, or immune-related pathologies. […] Seizures are thought to arise secondary to an imbalance between excitation and inhibition of neurons. Imbalance of excitation and inhibition can be the result of alteration in genes or from acquired etiologies. Genetic pathologies can produce dysfunction at the circuit level (e.g., abnormal synaptic connectivity) to the receptor level (imbalance between excitatory glutamate and inhibitory gamma-aminobutyric acid [GABA] receptors) to ionic channel level (example, sodium channel dysfunction in Dravet syndrome).

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

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

  A generalized tonic-clonic seizure makes a persons whole body twitch, jerk, and become unconscious. Grand mal seizure is an older term for this. […] Epilepsy, a brain condition, commonly causes tonic-clonic seizures. Certain medications, some infections, and several other health conditions may also cause them. […] During a generalized tonic-clonic seizure, a person experiences rapid involuntary alternating jerking and stiffening of the body. This can involve the torso, arms, and legs on both sides of the body. The person is unaware of their surroundings and become unresponsive, sometimes losing consciousness. […] Both genetic and environmental factors can cause an imbalance. […] Some genetic factors include: abnormal neuronal connections that happen when the top layer of the brain does not form correctly, abnormal gamma-aminobutyric acid receptors that cannot properly monitor neuron activities, potassium channel mutations.

• #14 Generalized Tonic-Clonic Seizure | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/28839

  Acquired cerebral insults such as trauma, strokes, or tumors can alter cerebral neuronal circuits similarly. […] The prognosis for generalized tonic-clonic seizures is dependent on the cause of the seizure and risk factors for the patient. On average, the risk of recurrent seizures is about 40% based on observational studies. The risk of recurrent seizure is highest during the period immediately after the initial seizure and decreases with increasing time from the event. […] Patients with generalized tonic-clonic seizures are at increased risk of psychiatric disorders, cognitive impairment, sleep disorders, cardiovascular disease, bone disease, physical injuries, and even premature mortality. The most significant risk factor for sudden unexpected death in epilepsy (SUDEP) is frequent generalized tonic-clonic seizures. […] A neurologist should be consulted to evaluate, treat, and provide further workup for generalized tonic-clonic seizures.

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

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

  Generalized epilepsy is thought to be initiated by 3 different mechanisms: […] Abnormal response of hyperexcitable cortex to initially normal thalamic input […] Primary subcortical trigger […] Abnormal cortical innervation from subcortical structures. […] Physiologically, a seizure results from a paroxysmal high-voltage electrical discharge of susceptible neurons within an epileptogenic focus. These neurons are known to be hyperexcitable and, for unknown reasons, remain in a state of partial depolarization. […] The neurons surrounding the epileptogenic focus are GABA-ergic (ie, they release gamma-aminobutyric acid) and hyperpolarized, and they inhibit the epileptogenic neurons. At times, when the epileptogenic neurons overcome the surrounding inhibitory influence, the seizure discharge spreads to neighboring cortical structures and then to subcortical and brainstem structures.

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

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

  Some experimental evidence suggests that the mechanisms of ictal initiation could be different for some or even all of these subtypes of GTCS, and that there may even be more than one mechanism of initiation within each of the subtypes. […] The analysis of these theories by their main protagonists can be found in the classic book The Physiopathogenesis of the Epilepsies and in reviews. Gastaut attributed the entire GTCS to be a diffuse subcortical reticular discharge, which leads to activation of inhibitory systems and, at the end of the seizure, to a transient postictal state of cortical depression. […] Animal and human data suggest that the various types of generalized epileptic seizures involve selective networks (while sparing others) that engage in abnormally synchronous and high-frequency neuronal oscillation. The pathophysiology of absence seizures is better understood than that of any other type of generalized seizure. The pathophysiology of GTCS is different than that of absence seizures, but there may be a similar interplay of oscillations in networks intensely involving not the whole brain homogeneously but, rather, the focal bilateral regions most intensely, especially the frontal and parietal association cortex, thalamus, basal ganglia, and brain stem.

• #17 Generalized tonic–clonic seizure – Wikipedia

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

  Most generalized tonicclonic seizures begin without warning and abruptly, but some epileptic patients describe a prodrome. The prodrome of a generalized tonicclonic seizure is a sort of premonitory feeling hours before a seizure. […] A tonicclonic seizure comprises three phases: the tonic phase, clonic phase and postictal phase. The tonic phase is usually the first phase and consciousness will quickly be lost, and the skeletal muscles will suddenly tense, often causing the extremities to be pulled towards the body or rigidly pushed away from it. The clonic phase is an evolution of the tonic phase and is caused by muscle relaxations superimposed on the tonic phase muscle contractions. The postictal phase causes are multifactorial to include alteration of cerebral blood flow and effects on multiple neurotransmitters. […] 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.

• #18 Generalized Motor Seizures Tonic Clonic | Information & Resources | Epilepsy Foundation New England

  https://epilepsynewengland.org/knowledge-center/types-of-seizures/generalized-motor-seizures-tonic-clonic

  A Generalized Onset Motor Seizure and is what most people think of when they hear the word „seizure.” An older term for this type of seizure is „grand mal.” A person loses consciousness, muscles stiffen, and jerking movements are seen. As implied by the name, they combine the characteristics of tonic seizures and clonic seizures. […] The tonic phase comes first: All the muscles stiffen. Air being forced past the vocal cords causes a cry or groan. The person loses consciousness and falls to the floor. The tongue or cheek may be bitten, so bloody saliva may come from the mouth. The person may turn a bit blue in the face. […] After the tonic phase comes the clonic phase: The arms and usually the legs begin to jerk rapidly and rhythmically, bending and relaxing at the elbows, hips, and knees. After a few minutes, the jerking slows and stops. Bladder or bowel control sometimes is lost as the body relaxes. Consciousness returns slowly, and the person may be drowsy, confused, agitated, or depressed.

• #19 Generalized tonic–clonic seizure – Wikipedia

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

  Most generalized tonicclonic seizures begin without warning and abruptly, but some epileptic patients describe a prodrome. The prodrome of a generalized tonicclonic seizure is a sort of premonitory feeling hours before a seizure. […] A tonicclonic seizure comprises three phases: the tonic phase, clonic phase and postictal phase. The tonic phase is usually the first phase and consciousness will quickly be lost, and the skeletal muscles will suddenly tense, often causing the extremities to be pulled towards the body or rigidly pushed away from it. The clonic phase is an evolution of the tonic phase and is caused by muscle relaxations superimposed on the tonic phase muscle contractions. The postictal phase causes are multifactorial to include alteration of cerebral blood flow and effects on multiple neurotransmitters. […] 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.

• #20 Generalized Motor Seizures Tonic Clonic | Information & Resources | Epilepsy Foundation New England

  https://epilepsynewengland.org/knowledge-center/types-of-seizures/generalized-motor-seizures-tonic-clonic

  A Generalized Onset Motor Seizure and is what most people think of when they hear the word „seizure.” An older term for this type of seizure is „grand mal.” A person loses consciousness, muscles stiffen, and jerking movements are seen. As implied by the name, they combine the characteristics of tonic seizures and clonic seizures. […] The tonic phase comes first: All the muscles stiffen. Air being forced past the vocal cords causes a cry or groan. The person loses consciousness and falls to the floor. The tongue or cheek may be bitten, so bloody saliva may come from the mouth. The person may turn a bit blue in the face. […] After the tonic phase comes the clonic phase: The arms and usually the legs begin to jerk rapidly and rhythmically, bending and relaxing at the elbows, hips, and knees. After a few minutes, the jerking slows and stops. Bladder or bowel control sometimes is lost as the body relaxes. Consciousness returns slowly, and the person may be drowsy, confused, agitated, or depressed.

• #21 Generalized tonic–clonic seizure – Wikipedia

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

  Most generalized tonicclonic seizures begin without warning and abruptly, but some epileptic patients describe a prodrome. The prodrome of a generalized tonicclonic seizure is a sort of premonitory feeling hours before a seizure. […] A tonicclonic seizure comprises three phases: the tonic phase, clonic phase and postictal phase. The tonic phase is usually the first phase and consciousness will quickly be lost, and the skeletal muscles will suddenly tense, often causing the extremities to be pulled towards the body or rigidly pushed away from it. The clonic phase is an evolution of the tonic phase and is caused by muscle relaxations superimposed on the tonic phase muscle contractions. The postictal phase causes are multifactorial to include alteration of cerebral blood flow and effects on multiple neurotransmitters. […] 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.

• #22 Generalized tonic–clonic seizure – Wikipedia

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

  Most generalized tonicclonic seizures begin without warning and abruptly, but some epileptic patients describe a prodrome. The prodrome of a generalized tonicclonic seizure is a sort of premonitory feeling hours before a seizure. […] A tonicclonic seizure comprises three phases: the tonic phase, clonic phase and postictal phase. The tonic phase is usually the first phase and consciousness will quickly be lost, and the skeletal muscles will suddenly tense, often causing the extremities to be pulled towards the body or rigidly pushed away from it. The clonic phase is an evolution of the tonic phase and is caused by muscle relaxations superimposed on the tonic phase muscle contractions. The postictal phase causes are multifactorial to include alteration of cerebral blood flow and effects on multiple neurotransmitters. […] 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.

• #23 Tonic-Clonic Seizures – Epilepsy Ontario

  https://epilepsyontario.org/about-epilepsy/types-of-seizures/tonic-clonic-seizures/

  During a generalized tonic-clonic (formerly grand mal) seizure, electric discharges instantaneously involve the entire brain. The person loses consciousness right from the beginning of the seizure. […] A tonic-clonic seizure usually lasts one to three minutes, but may last up to five minutes. If seizures last more than five minutes, or occur one after another without recovery between seizures, the individual may be experiencing a life-threatening medical emergency and requires immediate medical help. […] The period after the seizure is referred to as the post-ictal state. During this time, the person will need to rest. It may be difficult to wake him/her or get any response from him/her during this time. After a seizure, the person may feel fatigue, confusion and disorientation, which may last from five minutes to several hours or even days. Rarely, this disorientation may last up to two weeks. […] There is no evidence that tonic-clonic seizures cause brain damage.

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

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

  Some experimental evidence suggests that the mechanisms of ictal initiation could be different for some or even all of these subtypes of GTCS, and that there may even be more than one mechanism of initiation within each of the subtypes. […] The analysis of these theories by their main protagonists can be found in the classic book The Physiopathogenesis of the Epilepsies and in reviews. Gastaut attributed the entire GTCS to be a diffuse subcortical reticular discharge, which leads to activation of inhibitory systems and, at the end of the seizure, to a transient postictal state of cortical depression. […] Animal and human data suggest that the various types of generalized epileptic seizures involve selective networks (while sparing others) that engage in abnormally synchronous and high-frequency neuronal oscillation. The pathophysiology of absence seizures is better understood than that of any other type of generalized seizure. The pathophysiology of GTCS is different than that of absence seizures, but there may be a similar interplay of oscillations in networks intensely involving not the whole brain homogeneously but, rather, the focal bilateral regions most intensely, especially the frontal and parietal association cortex, thalamus, basal ganglia, and brain stem.

• #25 Pathophysiology of Generalized Tonic-Clonic Seizures | SpringerLink

  https://link.springer.com/10.1007%2F978-1-84882-128-6_32

  The clinical features of generalized tonic clonic seizures (GTCS) were described in previous Chapters (Epilepsy with Generalized Tonic-Clonic Seizures Only; Generalized Tonic-Clonic Seizures). GTCS are a common and dangerous type of seizure, which can be primarily or secondarily generalized. Primary GTCS begin with tonic stiffening, followed by a clonic pattern of rhythmic jerking, followed by a post-ictal phase of altered mental state. The EEG shows generalized spike-wave discharges and high-amplitude polyspikes at all the scalp electrodes. These findings indicate wide cerebral cortical involvement during GTCS. There is highly suggestive clinical evidence for brainstem involvement in GTCS. Thus, brainstem and/or spinal cord generators can cause various types of convulsive muscular activity, such as the opisthotonos of strychnine poisoning, the tonic stiffening in extension of decerebrate posturing. […] Mechanisms of human inherited epilepsies.

• #26 Pathophysiology of Generalized Tonic-Clonic Seizures | SpringerLink

  https://link.springer.com/10.1007%2F978-1-84882-128-6_32

  The clinical features of generalized tonic clonic seizures (GTCS) were described in previous Chapters (Epilepsy with Generalized Tonic-Clonic Seizures Only; Generalized Tonic-Clonic Seizures). GTCS are a common and dangerous type of seizure, which can be primarily or secondarily generalized. Primary GTCS begin with tonic stiffening, followed by a clonic pattern of rhythmic jerking, followed by a post-ictal phase of altered mental state. The EEG shows generalized spike-wave discharges and high-amplitude polyspikes at all the scalp electrodes. These findings indicate wide cerebral cortical involvement during GTCS. There is highly suggestive clinical evidence for brainstem involvement in GTCS. Thus, brainstem and/or spinal cord generators can cause various types of convulsive muscular activity, such as the opisthotonos of strychnine poisoning, the tonic stiffening in extension of decerebrate posturing. […] Mechanisms of human inherited epilepsies.

• #27 Generalized Tonic-Clonic Seizure – PubMed

  https://pubmed.ncbi.nlm.nih.gov/32119383/

  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. […] A generalized tonic-clonic seizure is a motor seizure and the most common type seen in patients with epilepsy. […] Generalized tonic-clonic seizures arise within and rapidly involve bilateral cortical, subcortical, and brainstem networks of the brain. […] A focal seizure-originating from either left or right hemisphere – can rapidly spread and evolve into a bilateral tonic-clonic seizure (previously known as a secondary generalized seizure), which can be difficult to differentiate from a primary generalized tonic-clonic seizure.

• #28 Pathophysiology of Generalized Tonic-Clonic Seizures | SpringerLink

  https://link.springer.com/10.1007%2F978-1-84882-128-6_32

  The clinical features of generalized tonic clonic seizures (GTCS) were described in previous Chapters (Epilepsy with Generalized Tonic-Clonic Seizures Only; Generalized Tonic-Clonic Seizures). GTCS are a common and dangerous type of seizure, which can be primarily or secondarily generalized. Primary GTCS begin with tonic stiffening, followed by a clonic pattern of rhythmic jerking, followed by a post-ictal phase of altered mental state. The EEG shows generalized spike-wave discharges and high-amplitude polyspikes at all the scalp electrodes. These findings indicate wide cerebral cortical involvement during GTCS. There is highly suggestive clinical evidence for brainstem involvement in GTCS. Thus, brainstem and/or spinal cord generators can cause various types of convulsive muscular activity, such as the opisthotonos of strychnine poisoning, the tonic stiffening in extension of decerebrate posturing. […] Mechanisms of human inherited epilepsies.

• #29 Pathophysiology of Generalized Tonic-Clonic Seizures | SpringerLink

  https://link.springer.com/10.1007%2F978-1-84882-128-6_32

  The clinical features of generalized tonic clonic seizures (GTCS) were described in previous Chapters (Epilepsy with Generalized Tonic-Clonic Seizures Only; Generalized Tonic-Clonic Seizures). GTCS are a common and dangerous type of seizure, which can be primarily or secondarily generalized. Primary GTCS begin with tonic stiffening, followed by a clonic pattern of rhythmic jerking, followed by a post-ictal phase of altered mental state. The EEG shows generalized spike-wave discharges and high-amplitude polyspikes at all the scalp electrodes. These findings indicate wide cerebral cortical involvement during GTCS. There is highly suggestive clinical evidence for brainstem involvement in GTCS. Thus, brainstem and/or spinal cord generators can cause various types of convulsive muscular activity, such as the opisthotonos of strychnine poisoning, the tonic stiffening in extension of decerebrate posturing. […] Mechanisms of human inherited epilepsies.

• #30

  https://europepmc.org/books/n/statpearls/article-23343/?extid=29489255&src=med

  The intrinsic properties of thalamic neurons and the synaptic connections between populations of neurons in the nucleus reticularis thalami and thalamocortical relay nuclei aid in the production of different firing patterns that affect the state of the brain. Particularly, the transitions from tonic firing to highly synchronized burst firing mode in thalamic neurons can lead to seizures that rapidly generalize. Studying the role of the thalamus in generalized epilepsy syndromes, there may be new opportunities to better treat pharmaco-resistant generalized epilepsy through thalamic modulation and dietary therapy. […] Generalized tonic-clonic seizures, formerly grand mal seizures, are described as seizures with a tonic phase followed by clonic muscle contractions. They arise within and rapidly affect the brain’s bilateral cortical, subcortical, and brainstem networks.

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

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

  Some experimental evidence suggests that the mechanisms of ictal initiation could be different for some or even all of these subtypes of GTCS, and that there may even be more than one mechanism of initiation within each of the subtypes. […] The analysis of these theories by their main protagonists can be found in the classic book The Physiopathogenesis of the Epilepsies and in reviews. Gastaut attributed the entire GTCS to be a diffuse subcortical reticular discharge, which leads to activation of inhibitory systems and, at the end of the seizure, to a transient postictal state of cortical depression. […] Animal and human data suggest that the various types of generalized epileptic seizures involve selective networks (while sparing others) that engage in abnormally synchronous and high-frequency neuronal oscillation. The pathophysiology of absence seizures is better understood than that of any other type of generalized seizure. The pathophysiology of GTCS is different than that of absence seizures, but there may be a similar interplay of oscillations in networks intensely involving not the whole brain homogeneously but, rather, the focal bilateral regions most intensely, especially the frontal and parietal association cortex, thalamus, basal ganglia, and brain stem.

• #32 JLE – Epileptic Disorders – The Moro reflex: insights into the pathophysiology of generalized tonic-clonic seizures and infantile spasms

  https://www.jle.com/fr/revues/epd/e-docs/the_moro_reflex_insights_into_the_pathophysiology_of_generalized_tonic_clonic_seizures_and_infantile_spasms_322801/article.phtml

  The Moro reflex (MR) is a primitive reflex that disappears after the first three months of life. […] Given their semiological resemblance, epileptic spasms and generalized tonic-clonic seizures might be due (at least partly) to the pathological activation of the same neural archaic circuit involved in the genesis of the MR. […] The neuronal network underlying these different phenomena might be located in the pons. […] In these seizure types, the activation of the same neural circuitry involved in the MR could occur through either direct excitation or through an indirect liberating mechanism, secondary to epileptic disruption of cortical inhibitory control on subcortical structures. […] The movements of the upper extremities in epileptic spasms, in the initial phase of generalized tonic-clonic seizures, and the MR might involve a distinct neural circuitry, which is (or becomes) hyperexcitable as a consequence of a pathological condition (epilepsy) or physiological brain immaturity (the MR).

• #33 JLE – Epileptic Disorders – The Moro reflex: insights into the pathophysiology of generalized tonic-clonic seizures and infantile spasms

  https://www.jle.com/fr/revues/epd/e-docs/the_moro_reflex_insights_into_the_pathophysiology_of_generalized_tonic_clonic_seizures_and_infantile_spasms_322801/article.phtml

  The Moro reflex (MR) is a primitive reflex that disappears after the first three months of life. […] Given their semiological resemblance, epileptic spasms and generalized tonic-clonic seizures might be due (at least partly) to the pathological activation of the same neural archaic circuit involved in the genesis of the MR. […] The neuronal network underlying these different phenomena might be located in the pons. […] In these seizure types, the activation of the same neural circuitry involved in the MR could occur through either direct excitation or through an indirect liberating mechanism, secondary to epileptic disruption of cortical inhibitory control on subcortical structures. […] The movements of the upper extremities in epileptic spasms, in the initial phase of generalized tonic-clonic seizures, and the MR might involve a distinct neural circuitry, which is (or becomes) hyperexcitable as a consequence of a pathological condition (epilepsy) or physiological brain immaturity (the MR).

• #34 JLE – Epileptic Disorders – The Moro reflex: insights into the pathophysiology of generalized tonic-clonic seizures and infantile spasms

  https://www.jle.com/fr/revues/epd/e-docs/the_moro_reflex_insights_into_the_pathophysiology_of_generalized_tonic_clonic_seizures_and_infantile_spasms_322801/article.phtml

  The Moro reflex (MR) is a primitive reflex that disappears after the first three months of life. […] Given their semiological resemblance, epileptic spasms and generalized tonic-clonic seizures might be due (at least partly) to the pathological activation of the same neural archaic circuit involved in the genesis of the MR. […] The neuronal network underlying these different phenomena might be located in the pons. […] In these seizure types, the activation of the same neural circuitry involved in the MR could occur through either direct excitation or through an indirect liberating mechanism, secondary to epileptic disruption of cortical inhibitory control on subcortical structures. […] The movements of the upper extremities in epileptic spasms, in the initial phase of generalized tonic-clonic seizures, and the MR might involve a distinct neural circuitry, which is (or becomes) hyperexcitable as a consequence of a pathological condition (epilepsy) or physiological brain immaturity (the MR).

• #35 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. […] Generalized tonic-clonic seizures arise within and rapidly involve bilateral cortical, subcortical, and brainstem networks of the brain. […] The etiology of most of the generalized tonic-clonic seizures is underlying epilepsy from genetic causes (previously categorized as idiopathic). Besides genetic generalized epilepsy, tonic-clonic seizures can be secondary to epilepsy due to structural, infectious, metabolic, or immune-related pathologies. […] Seizures are thought to arise secondary to an imbalance between excitation and inhibition of neurons. Imbalance of excitation and inhibition can be the result of alteration in genes or from acquired etiologies. Genetic pathologies can produce dysfunction at the circuit level (e.g., abnormal synaptic connectivity) to the receptor level (imbalance between excitatory glutamate and inhibitory gamma-aminobutyric acid [GABA] receptors) to ionic channel level(example, sodium channel dysfunction in Dravet syndrome). […] Acquired cerebral insults such as trauma, strokes, or tumors can alter cerebral neuronal circuits similarly.

• #36 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. […] During a seizure, there’s a burst of electrical activity in the brain that causes changes in behavior and movements. […] Tonic-clonic seizures may begin as focal seizures in a small area of the brain and spread to become generalized seizures that involve the whole brain. […] 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. […] Tonic-clonic seizures occur when there’s a surge of electrical activity over the surface of the brain. Many nerve cells fire at once, much faster than usual. […] However, tonic-clonic seizures are sometimes caused by other health problems, such as severe head injuries, infections, stroke, and dementias that cause degeneration in the brain.

• #37 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. Tonicclonic seizures are the seizure type most commonly associated with epilepsy and seizures in general and the most common seizure associated with metabolic imbalances. […] The vast majority of generalized seizures are idiopathic. Some generalized seizures start as a smaller seizure that occurs solely on one side of the brain, however, and is referred to as a focal (or partial) seizure. These unilateral seizure types can then spread to both hemispheres of the brain and cause a generalized tonic-clonic seizure. This type of seizure has a specific term called „focal to bilateral tonic clonic seizure.” Other precipitating factors include chemical and neurotransmitter imbalances and a genetically or situationally determined seizure threshold, both of which have been implicated.

• #38 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. […] Generalized tonic-clonic seizures arise within and rapidly involve bilateral cortical, subcortical, and brainstem networks of the brain. […] The etiology of most of the generalized tonic-clonic seizures is underlying epilepsy from genetic causes (previously categorized as idiopathic). Besides genetic generalized epilepsy, tonic-clonic seizures can be secondary to epilepsy due to structural, infectious, metabolic, or immune-related pathologies. […] Seizures are thought to arise secondary to an imbalance between excitation and inhibition of neurons. Imbalance of excitation and inhibition can be the result of alteration in genes or from acquired etiologies. Genetic pathologies can produce dysfunction at the circuit level (e.g., abnormal synaptic connectivity) to the receptor level (imbalance between excitatory glutamate and inhibitory gamma-aminobutyric acid [GABA] receptors) to ionic channel level(example, sodium channel dysfunction in Dravet syndrome). […] Acquired cerebral insults such as trauma, strokes, or tumors can alter cerebral neuronal circuits similarly.

• #39 Generalized Tonic-Clonic Seizure | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/28839

  Generalized tonic-clonic seizures arise within and rapidly involve bilateral cortical, subcortical, and brainstem networks of the brain. […] The etiology of most of the generalized tonic-clonic seizures is underlying epilepsy from genetic causes (previously categorized as idiopathic). Besides genetic generalized epilepsy, tonic-clonic seizures can be secondary to epilepsy due to structural, infectious, metabolic, or immune-related pathologies. […] Seizures are thought to arise secondary to an imbalance between excitation and inhibition of neurons. Imbalance of excitation and inhibition can be the result of alteration in genes or from acquired etiologies. Genetic pathologies can produce dysfunction at the circuit level (e.g., abnormal synaptic connectivity) to the receptor level (imbalance between excitatory glutamate and inhibitory gamma-aminobutyric acid [GABA] receptors) to ionic channel level (example, sodium channel dysfunction in Dravet syndrome).

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

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

  A generalized tonic-clonic seizure makes a persons whole body twitch, jerk, and become unconscious. Grand mal seizure is an older term for this. […] Epilepsy, a brain condition, commonly causes tonic-clonic seizures. Certain medications, some infections, and several other health conditions may also cause them. […] During a generalized tonic-clonic seizure, a person experiences rapid involuntary alternating jerking and stiffening of the body. This can involve the torso, arms, and legs on both sides of the body. The person is unaware of their surroundings and become unresponsive, sometimes losing consciousness. […] Both genetic and environmental factors can cause an imbalance. […] Some genetic factors include: abnormal neuronal connections that happen when the top layer of the brain does not form correctly, abnormal gamma-aminobutyric acid receptors that cannot properly monitor neuron activities, potassium channel mutations.

• #41 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. […] During a seizure, there’s a burst of electrical activity in the brain that causes changes in behavior and movements. […] Tonic-clonic seizures may begin as focal seizures in a small area of the brain and spread to become generalized seizures that involve the whole brain. […] 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. […] Tonic-clonic seizures occur when there’s a surge of electrical activity over the surface of the brain. Many nerve cells fire at once, much faster than usual. […] However, tonic-clonic seizures are sometimes caused by other health problems, such as severe head injuries, infections, stroke, and dementias that cause degeneration in the brain.

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

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

  Other potential causes of a tonic-clonic seizure include: injury, such as a head injury, infection, low levels of sodium, calcium, glucose, or magnesium, drug or alcohol misuse or withdrawal. […] Sometimes, healthcare professionals aren’t able to determine what causes the onset of seizures. In up to 50 percent of people diagnosed with epilepsy, the cause is unknown. […] If you’ve had one tonic-clonic seizure, it may have been an isolated event that doesn’t require treatment. A healthcare professional could decide to monitor you for further seizures before beginning a long-term course of treatment. […] Most people manage their seizures through medication. […] The U.S. Food and Drug Administration (FDA) has approved many medications for the treatment of tonic-clonic seizures. […] Brain surgery may be an option if medications aren’t successful in helping you manage your seizures.

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

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

  Environmental factors include: head trauma, high body temperature, which causes febrile seizures, infection, stroke, brain tumors, drug or alcohol withdrawal, electrolyte imbalances. […] 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. […] Although rare, it is possible that a person may sustain a life threatening injury during a seizure. Additionally, sometimes a person can have prolonged seizures. Having a long-lasting seizure can stop oxygen from reaching the brain and cause brain damage. […] Yes, it is possible to die from a tonic-clonic seizure. For example, some people may seriously injure themselves while having a seizure or drown if they have a seizure in water. It is also possible for someone to die from sudden unexpected death in epilepsy (SUDEP). According to the CDC, this happens in about 1 in every 1,000 people with the condition.

• #44 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. […] During a seizure, there’s a burst of electrical activity in the brain that causes changes in behavior and movements. […] Tonic-clonic seizures may begin as focal seizures in a small area of the brain and spread to become generalized seizures that involve the whole brain. […] 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. […] Tonic-clonic seizures occur when there’s a surge of electrical activity over the surface of the brain. Many nerve cells fire at once, much faster than usual. […] However, tonic-clonic seizures are sometimes caused by other health problems, such as severe head injuries, infections, stroke, and dementias that cause degeneration in the brain.

• #45 Generalized Tonic-Clonic Seizure – PubMed

  https://pubmed.ncbi.nlm.nih.gov/32119383/

  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. […] A generalized tonic-clonic seizure is a motor seizure and the most common type seen in patients with epilepsy. […] Generalized tonic-clonic seizures arise within and rapidly involve bilateral cortical, subcortical, and brainstem networks of the brain. […] A focal seizure-originating from either left or right hemisphere – can rapidly spread and evolve into a bilateral tonic-clonic seizure (previously known as a secondary generalized seizure), which can be difficult to differentiate from a primary generalized tonic-clonic seizure.

• #46 Generalized Tonic-Clonic Seizure – PubMed

  https://pubmed.ncbi.nlm.nih.gov/32119383/

  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. […] A generalized tonic-clonic seizure is a motor seizure and the most common type seen in patients with epilepsy. […] Generalized tonic-clonic seizures arise within and rapidly involve bilateral cortical, subcortical, and brainstem networks of the brain. […] A focal seizure-originating from either left or right hemisphere – can rapidly spread and evolve into a bilateral tonic-clonic seizure (previously known as a secondary generalized seizure), which can be difficult to differentiate from a primary generalized tonic-clonic seizure.

• #47 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. Tonicclonic seizures are the seizure type most commonly associated with epilepsy and seizures in general and the most common seizure associated with metabolic imbalances. […] The vast majority of generalized seizures are idiopathic. Some generalized seizures start as a smaller seizure that occurs solely on one side of the brain, however, and is referred to as a focal (or partial) seizure. These unilateral seizure types can then spread to both hemispheres of the brain and cause a generalized tonic-clonic seizure. This type of seizure has a specific term called „focal to bilateral tonic clonic seizure.” Other precipitating factors include chemical and neurotransmitter imbalances and a genetically or situationally determined seizure threshold, both of which have been implicated.

• #48 Generalized seizures (grand mal seizures) Guide: Causes, Symptoms and Treatment Options

  https://www.drugs.com/health-guide/generalized-seizures-grand-mal-seizures.html

  Normally, the brain’s nerve cells (neurons) communicate with one another by firing tiny electric signals that pass from cell to cell. […] A seizure occurs when the firing pattern of the brain’s electric signals suddenly becomes very abnormal and unusually intense, either in an isolated area of the brain or throughout the brain. […] If the whole brain is involved, the electrical disturbance is called a generalized seizure. This type of seizure used to be called a grand mal seizure. […] A seizure can be provoked by any situation that seriously disturbs the physical or chemical environment of the brain. […] Sometimes, a person will experience an unprovoked generalized seizure, one that occurs for no apparent reason. […] In some people, this type of seizure may be related to a genetic (inherited) vulnerability that makes the brain cells unusually sensitive to minor changes in the environment.

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

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

  Very low blood levels of glucose, sodium, calcium or magnesium can cause tonic-clonic seizures. […] Risk factors for tonic-clonic seizures include a family history of seizure disorders, any injury to the brain from trauma, sleep deprivation, and medical problems that affect the balance of minerals in the body.

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

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

  Risk factors for tonic-clonic seizures include a family history of seizure disorders, any injury to the brain, sleep deprivation, and heavy alcohol use. […] The goal of surgery is to stop seizures from happening. It may be an option if you have tried two different medicines and they don’t prevent your seizures. […] A diet that’s high in fat and protein and low in carbohydrates, known as a ketogenic diet, can improve seizure control.

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

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

  Severe head injuries can cause tonic-clonic seizures. […] Stroke and dementias that cause degeneration in the brain, such as Alzheimer’s disease, also can cause tonic-clonic seizures. […] Very low blood levels of glucose, sodium, calcium or magnesium can cause tonic-clonic seizures. […] Risk factors for tonic-clonic seizures include a family history of seizure disorders and any injury to the brain from trauma, a stroke, previous infection and other causes. […] Having a seizure at certain times can be dangerous for you or others. […] A seizure that causes either loss of awareness or control can be dangerous if you’re driving a car or operating other equipment. […] The goal of surgery is to stop seizures from happening. […] The electrodes produce electrical impulses that regulate brain activity. […] A diet that’s high in fat and protein and low in carbohydrates, known as a ketogenic diet, can improve seizure control.

• #52 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. […] Generalized tonic-clonic seizures arise within and rapidly involve bilateral cortical, subcortical, and brainstem networks of the brain. […] The etiology of most of the generalized tonic-clonic seizures is underlying epilepsy from genetic causes (previously categorized as idiopathic). Besides genetic generalized epilepsy, tonic-clonic seizures can be secondary to epilepsy due to structural, infectious, metabolic, or immune-related pathologies. […] Seizures are thought to arise secondary to an imbalance between excitation and inhibition of neurons. Imbalance of excitation and inhibition can be the result of alteration in genes or from acquired etiologies. Genetic pathologies can produce dysfunction at the circuit level (e.g., abnormal synaptic connectivity) to the receptor level (imbalance between excitatory glutamate and inhibitory gamma-aminobutyric acid [GABA] receptors) to ionic channel level(example, sodium channel dysfunction in Dravet syndrome). […] Acquired cerebral insults such as trauma, strokes, or tumors can alter cerebral neuronal circuits similarly.

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

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

  Generalized epilepsy is thought to be initiated by 3 different mechanisms: […] Abnormal response of hyperexcitable cortex to initially normal thalamic input […] Primary subcortical trigger […] Abnormal cortical innervation from subcortical structures. […] Physiologically, a seizure results from a paroxysmal high-voltage electrical discharge of susceptible neurons within an epileptogenic focus. These neurons are known to be hyperexcitable and, for unknown reasons, remain in a state of partial depolarization. […] The neurons surrounding the epileptogenic focus are GABA-ergic (ie, they release gamma-aminobutyric acid) and hyperpolarized, and they inhibit the epileptogenic neurons. At times, when the epileptogenic neurons overcome the surrounding inhibitory influence, the seizure discharge spreads to neighboring cortical structures and then to subcortical and brainstem structures.

• #54 Generalized tonic–clonic seizure – Wikipedia

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

  Most generalized tonicclonic seizures begin without warning and abruptly, but some epileptic patients describe a prodrome. The prodrome of a generalized tonicclonic seizure is a sort of premonitory feeling hours before a seizure. […] A tonicclonic seizure comprises three phases: the tonic phase, clonic phase and postictal phase. The tonic phase is usually the first phase and consciousness will quickly be lost, and the skeletal muscles will suddenly tense, often causing the extremities to be pulled towards the body or rigidly pushed away from it. The clonic phase is an evolution of the tonic phase and is caused by muscle relaxations superimposed on the tonic phase muscle contractions. The postictal phase causes are multifactorial to include alteration of cerebral blood flow and effects on multiple neurotransmitters. […] 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.

• #55 Generalized Motor Seizures Tonic Clonic | Information & Resources | Epilepsy Foundation New England

  https://epilepsynewengland.org/knowledge-center/types-of-seizures/generalized-motor-seizures-tonic-clonic

  A Generalized Onset Motor Seizure and is what most people think of when they hear the word „seizure.” An older term for this type of seizure is „grand mal.” A person loses consciousness, muscles stiffen, and jerking movements are seen. As implied by the name, they combine the characteristics of tonic seizures and clonic seizures. […] The tonic phase comes first: All the muscles stiffen. Air being forced past the vocal cords causes a cry or groan. The person loses consciousness and falls to the floor. The tongue or cheek may be bitten, so bloody saliva may come from the mouth. The person may turn a bit blue in the face. […] After the tonic phase comes the clonic phase: The arms and usually the legs begin to jerk rapidly and rhythmically, bending and relaxing at the elbows, hips, and knees. After a few minutes, the jerking slows and stops. Bladder or bowel control sometimes is lost as the body relaxes. Consciousness returns slowly, and the person may be drowsy, confused, agitated, or depressed.

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

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

  Some experimental evidence suggests that the mechanisms of ictal initiation could be different for some or even all of these subtypes of GTCS, and that there may even be more than one mechanism of initiation within each of the subtypes. […] The analysis of these theories by their main protagonists can be found in the classic book The Physiopathogenesis of the Epilepsies and in reviews. Gastaut attributed the entire GTCS to be a diffuse subcortical reticular discharge, which leads to activation of inhibitory systems and, at the end of the seizure, to a transient postictal state of cortical depression. […] Animal and human data suggest that the various types of generalized epileptic seizures involve selective networks (while sparing others) that engage in abnormally synchronous and high-frequency neuronal oscillation. The pathophysiology of absence seizures is better understood than that of any other type of generalized seizure. The pathophysiology of GTCS is different than that of absence seizures, but there may be a similar interplay of oscillations in networks intensely involving not the whole brain homogeneously but, rather, the focal bilateral regions most intensely, especially the frontal and parietal association cortex, thalamus, basal ganglia, and brain stem.

• #57

  https://europepmc.org/books/n/statpearls/article-23343/?extid=29489255&src=med

  The intrinsic properties of thalamic neurons and the synaptic connections between populations of neurons in the nucleus reticularis thalami and thalamocortical relay nuclei aid in the production of different firing patterns that affect the state of the brain. Particularly, the transitions from tonic firing to highly synchronized burst firing mode in thalamic neurons can lead to seizures that rapidly generalize. Studying the role of the thalamus in generalized epilepsy syndromes, there may be new opportunities to better treat pharmaco-resistant generalized epilepsy through thalamic modulation and dietary therapy. […] Generalized tonic-clonic seizures, formerly grand mal seizures, are described as seizures with a tonic phase followed by clonic muscle contractions. They arise within and rapidly affect the brain’s bilateral cortical, subcortical, and brainstem networks.

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