Grand Mal Seizure


Photo: medbullets

Grand mal seizure also known as generalized tonic-clonic seizure is a subgroup of one of the two broad categories of seizures. These seizures arise from abnormal electrical impulses produced throughout the entire brain. It is the most common type of generalized seizure; the type people would always visualize whenever seizures are mentioned.
Grand mal seizure has three phases: the tonic phase, the clonic phase and the postictal or after seizure phase.

The symptoms of Grand mal seizures are phase-specific. Sometimes, people might experience either of the phases without the other.

The tonic phase

The tonic phase is characterized by loss of consciousness, stiffening of muscles due to sudden contraction, which makes the person fall. You will observe that the person would attempt swallowing the tongue. This would make observers try preventing this act by inserting something into the patient’s mouth. This however hurts the patient the more as the jaw is already tightly closed.

The clonic phase
The clonic phase is marked by rhythmic contraction of muscles with alternate flexing and relaxation. The initial signs of the clonic phase are muscle spasms. The frequency of flexing and relaxation of muscles gradually comes down until jerking stops. Usually, the person would sigh deeply and then starts breathing normal. The clonic phase can last for a minute or more.

The postictal or After-seizure phase
It occurs after the tonic and clonic phase. The person goes into deep sleep due to fatique and confusion. Also during the postictal phase, the patient may experience severe headache and unconsciousness may persist for minutes after convulsion has ceased. This phase is marked by tremendous activity of the brain which tries to bring the brain cells under control in order to stop the seizure.


Generally, abnormal synchronization of electrical impulses throughout the brain causes seizures. This is made possible through the intercommunication between brain cells across their synapses or gap junctions.
Most cases of Grand mal seizures are caused by epilepsy. However, there are other conditions that can give rise to Grand mal seizures.
These include:

  • Injuries – traumatic injuries such as head injuries, injury due to previous lack of oxygen and stroke.
  • Infections such as encephalitis, meningitis or history of such infection
  • Congenital or developmental abnormalities such as blood vessel malformations in the brain, genetic syndromes and brain tumours
  • Metabolic disturbances such as very low levels of blood glucose, sodium, calcium or magnesium
  • Syndromes related to withdrawal from alcohols and drugs.

Diagnostic procedures employed in the diagnosis of grand mal seizures include:

  • Neurological examination which tests the muscle condition such as reflexes, muscle tone, muscle strength and sensory function. It also tests motor symptoms such as gait, posture, coordination and balance.
  • A test of intellectual to assess thinking, judgment and memory using appropriate questions.
  • Blood tests such as determination of blood glucose levels, estimation of sodium, calcium and magnesium levels.
  • Brain scan using EEG – Electroencephalogram which shows the electrical activity of the brain. Abnormal brain wave patterns are seen in epileptic patients even in the absence of seizures. The EEG result is compared with the observable symptoms which occur in the seizure process to help determine the type of seizure the patient had for best treatment options.
  • Brain scan using computerized tomography (CT) or magnetic resonance imaging (MRI). These produce images of the brain and can reveal structural abnormalities, cyst and tumours.

Most people experience Grand mal seizures once in a lifetime. Moreover, people who have had grandma seizures need to take daily anti-seizure medications to prevent future occurrence. Some physicians would not start treatment until second or repeated seizures occur.

Treatment is usually based on individual’s symptoms and diagnosis. Available therapy includes medical therapy, nerve stimulation, dietary therapy or surgery.

Anti-seizure medications eg carbamazepine, phenytoin and Gabapentin are used. Single medications are quite effective in epileptic patients. While in non-epileptic patients a combination of drugs is mostly required.

Other care and support include giving patients emergency bracelets to wear always to help emergency care-giver know which drugs to use or not.

Stem Cell Treatment of Grand Mal Seizure

Drugs used for epilepsy work well for only few people. There is need for more effective therapies. Recent laboratory experiments suggest that in the near future, stem cell therapy would be a better and safer solution to epilepsy, including Grand mal seizure. Two approaches have been considered.

  • Transplantation of neurons – in this approach, neurons of inhibitory activity are formed from stem cells of part of the brain specific for inhibitory activity.
  • Induced pluripotent stem cells – here cells of the connective tissue of the epileptic patient are collected and used to create stem cells of any type of cell in the body. These cells can then be made into neurons.

This is a blog post I wrote for a freelancer, Zache Sache also known as Ikechukwu Eboh.

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