Generalized Tonic-clonic Seizure: Its Symptoms And Characteristics
Of all the seizures that a person can suffer during an epileptic seizure, generalized tonic-clonic seizure It is probably the best known in popular culture.
Although it is not the only type of seizure that people with epilepsy can suffer, it is the most prototypical, and in this article we are going to learn more about its particularities, as well as possible causes and treatments.
Generalized tonic-clonic seizure, also called ‘grand mal’, is a type of epileptic seizure in which both tonic and clonic contractions of the muscles occur. This variety of seizure is the one most associated with the prototypical image of an epileptic seizure, and is usually associated with metabolic deregulations in the body of the sufferer.
It is normally believed that people who suffer from epilepsy only suffer from this type of seizure, but the truth is that only 10% of epileptic patients suffer from this type of seizure without being accompanied by other varieties.
Symptoms
There are several symptoms that a person may suffer before, during and after suffering generalized tonic-clonic seizures.
Although In most cases, seizures appear without warning, suddenly and abruptly, some people may suffer a prodrome. This warns that something is not going well in your body, and that you will suffer an epileptic seizure. Normally, the prodrome manifests itself in the form of premonitory feelings that predict that a crisis will occur.
Once the seizures begin, up to three different phases occur during the epileptic seizure, which are the tonic phase, the clonic phase and the postictal phase.
1. Tonic phase
Usually, the tonic phase is the first of the phases when you have this type of seizure.
The first thing that occurs is rapid loss of consciousness although it is not always given completely.
Skeletal muscles tense causing the limbs to become rigid and the patient to fall to the ground because they cannot stand.
The eyes roll back or stop focusing on a specific point, and the mouth remains open.
This phase lasts only about ten or twenty seconds and despite the loss of consciousness, the person is able to articulate some sounds, mostly due to the violent expulsion of air from the lungs. This is known as an ictal cry.
The skin turns blue, because breathing has lost its rhythm and there is a deprivation of oxygen in the body.
The sympathetic system responds forcefully causing blood pressure to increase, the heart to beat faster and the pupil of the eye to expand (mydriasis).
One of the risks during the tonic phase is biting the tongue, since the jaw is clenched very tightly. You can also bite your cheek and cause a large mouth injury.
2. Clonic phase
After the tonic phase comes the clonic phase, which is a state in which the tension experienced during the previous phase gives way to muscle relaxation Lasts longer than the tonic phase, lasting about a minute.
Relaxation is not complete, since the muscles immediately tense again and then relax thus causing the seizures themselves.
The person shakes violently, this being the moment in which they can be injured against objects in the room. You can also roll while lying on the ground.
3. Postictal phase
Once the tonic and clonic phases have occurred, the postictal phase comes, in which multiple events can occur.
The patient’s brain may see its blood circulation altered in addition to altering neurotransmitter levels.
The person is totally confused, in addition to suffering amnesia, although they will progressively become aware that they have suffered a crisis.
It is quite likely that the person, after having suffered physically and psychologically during the episode, will start crying and vomit.
Possible causes
Although epilepsy has been thoroughly studied, it is known that Most of the seizures associated with this problem are idiopathic that is, they appear suddenly without a clear cause that allows an explanation as to why they appear.
However, it has been seen that certain types of epileptic seizures that occur unilaterally At the cerebral level, only involving one of the two hemispheres, they can evolve into seizures that involve both hemispheres, thus causing a tonic-clonic seizure. Thus, we are talking about unilateral focal epileptic seizures that evolve into more complex and bilateral seizures.
It has been hypothesized that certain deregulations at the level of neurotransmitters and chemical substances present in the central nervous system would be behind the appearance of this type of seizures. Some triggers of this type of crisis, in addition to certain genetic predisposition to suffer from them are fatigue, malnutrition, sleep deprivation, stress, hypertension, diabetes, rapid light changes (flickers and flashes), elevated estrogen levels and antihistamines.
Throughout the history of psychiatry, with the use of electroconvulsive treatments for different types of psychological disorders, generalized tonic-clonic seizures have been replicated under laboratory and apparently therapeutic conditions.
In the case of people who suffer from symptomatic epilepsy, it has been seen, through neuroimaging techniques, that have neurons with lesions, causing them to inappropriately transmit nerve signals and, thus, the movements typical of the crisis occur.
Diagnosis
The diagnosis can be done by using neuroimaging techniques, especially with electroencephalography (EEG). However, it should be said that for the diagnosis using this tool to be reliable, it is necessary to record brain activity while the tonic phase of the seizure occurs or immediately after it has occurred.
During the tonic phase, there is a progressive increase in low-voltage brain activity, with fast waves, followed by high-amplitude electrical discharges. On the other hand, during the clonic phase, short waves occur. EEG shows many spikes during the tonic phase, and then transition to a more irregular synalepha during the clonic phase.
Treatment
When a person has generalized tonic-clonic seizures, people around them should make sure that the person having them is safe. a recumbent posture in order to prevent, while losing consciousness, accidentally introducing saliva into the airways and suffocating.
You must be close to the person to see how the epileptic episode is occurring and calculate how long the seizure is lasting. If possible, all objects should be moved away from the area to prevent the person from colliding with them. It is not recommended to hold the person while they are convulsing or to put objects in their mouth, since they can contracture their extremities, herniate and, if something is put in their mouth, they can choke on it.
As for treatment, as with other types of epileptic seizures, To avoid them, anticonvulsant drugs are prescribed Also, if the brain area involved in the appearance of these crises is known, a surgical intervention can be performed, in addition to stimulating the vagus nerve.
To prevent nutritional conditions from occurring that contribute to a higher incidence of these crises, the dietary route is chosen, subjecting the person to a ketogenic diet, that is, high in fats and proteins.
