Seizure

Generalized Tonic Clonic Seizure

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Generalized Tonic Clonic Seizure, Grand Mal Seizure, Generalized Tonic Clonic Epilepsy, Major Motor Seizure, GTCS, Generalized Epilepsy, Generalized Seizure

  • See Also
  1. Absence Seizure
  2. Focal Seizure (Partial Seizure)
  • Types
  • Generalized Seizures
  1. Generalized Tonic-Clonic Seizure
    1. Generalized convulsive activity
  2. Myoclonic Seizure
    1. Rhythmic jerking of arms (may involve head and neck)
  3. Atonic Seizure (e.g. drop attack)
    1. Sudden, brief loss of Muscle tone
  4. Tonic Seizure
    1. Brief (<1 minute), bilateral increased extremity motor tone
  5. Absence Seizure
    1. Non-motor Seizure
  • Cause
  1. Idiopathic
  2. Congenital cerebral lesion
  3. Posttraumatic cerebral scar
  4. Brain Tumor
  • Symptoms
  • Aura (may precede Seizure)
  1. Irritability
  2. Apathy
  3. Giddiness
  4. Headache
  5. Scintillating scotomata
  6. Nausea
  7. Choking Sensation
  8. Paresthesia
  9. Myalgia
  1. Sudden Loss of consciousness
  2. Tonic Phase
    1. Muscular rigidity with Opisthotonos
    2. Adduction and flexion of arms
    3. Extension of legs
  3. Clonic Phase
    1. Generalized body musculature jerking
  4. Flaccid coma
    1. Loss of postural tone
    2. Loss of Deep Tendon Reflexes
    3. Unconsciousness
    4. Apnea, Cyanosis
  5. Associated findings
    1. Tongue or lip biting
    2. Urinary or Fecal Incontinence on awakening
  • Labs
  1. Complete Blood Count (CBC)
    1. Postictal Leukocytosis in peripheral blood
  2. Prolactin
    1. Elevated following Seizure
  • Diagnosis
  1. Electroencephalogram (EEG)
    1. Paroxysmal diffuse outbursts of high voltage
    2. Many spikes in fast rhythm
  • Management
  • Prophylaxis of Generalized Tonic-Clonic Seizures in Children (age <16 years)
  1. Level C evidence
    1. Carbamazepine (Tegretol)
    2. Phenobarbital
    3. Phenytoin (Dilantin)
    4. Topiramate (Topamax) - also Level D evidence for use in Myoclonic Seizures
    5. Valproic Acid (Depakene) - also Level D evidence for use in Myoclonic Seizures
  2. Level D evidence
    1. Oxcarbazepine (Trileptal)
  • Management
  • Prophylaxis for both GTCS and Myoclonic Seizures in Younger Adults (age >16 years)
  1. Level C evidence
    1. Carbamazepine (Tegretol)
    2. Lamotrigine (Lamictal)
    3. Oxcarbazepine (Trileptal)
    4. Phenobarbital
    5. Phenytoin (Dilantin)
    6. Topiramate (Topamax)
    7. Valproic Acid (Depakene)
  2. Level D evidence
    1. Gabapentin (Neurontin)
    2. Levetiracetam (Keppra)
    3. Vigabatrin (Sabril)
  • References
  1. Liu (2017) Am Fam Physician 96(2): 87-96 [PubMed]