Tonic-Clonic Seizure Unit





Tonic-clonic seizure is one of the several types of seizures causedby abnormal impulses from the brain. This type of seizure, alsocalled &quotgrand mal&quot as implied by the name, combines thecharacteristics of tonic seizures and clonic seizures.&nbsp


As a neurological condition, tonic-clonic seizures are caused byabnormal paroxysmal release of cerebral neurons resulting fromcortical hyperexcitability. Seizures are classified based on thesource of abnormal paroxysmal release of neurons and in the case oftonic-clonic seizures. For tonic/clonic seizures, the abnormaldischarges take place in both sides of the brain (Engel, 2013).


Tonic-clonic seizures mainly occur in people diagnosed with epilepsy.The center for disease control and prevention (CDC) reports thatthere are 5.1 million people in the US alone with a history ofepilepsy. In the UK, the number is placed at 500,000 people. Thismeans that one in every 100 people may be living with epilepsy andexperience tonic-clonic seizure globally (WebMD 2016). The CDC putsthe figure higher at one in every 10 people has suffered from any ofthe different forms of seizures.


Tonic-clonic seizures are not exclusive to any age nether or anyother demographic aspect. Several health and genetic conditions maypredispose one to tonic-clonic seizures and even epilepsy. Braintumor or a ruptured blood vessel in the brain may trigger abnormalbrain impulses that cause tonic-clonic seizures. Other factors suchas deficiencies in sodium, calcium, glucose, or magnesium in the bodymay trigger seizures. In other cases, drug or alcohol abuse orwithdrawal may cause tonic-clonic seizures. Other studies havesuggested a genetic link to seizures and epilepsy though there is noconcrete evidence (Engel 2013).


It is very difficult to diagnose tonic-clonic seizures before theyhave occurred. In most cases, patients who have experiencedtonic-clonic seizures are referred to physicians for furtheranalysis. There are several methods that can be used to diagnose thistype of seizures.

a). Medicalhistory:- a patient’s medical history of past seizures, injury andother infections can be used to help determine which type of activitytriggers tonic-clonic seizures. This examination may also includethird parties such as people that may have been around during aseizure.

b). Neurologicalexams:- this test involves an assessment of the reflexes, balance,and coordination. Such tests are aimed at examining the functioningof different parts of the brain that control the differentactivities.

c). Medicalimaging:- Head CT or MRI scan or electroencephalogram (EEG) test maybe conducted. The EEG test examines patterns of electrical activityin the brain while the MRI provides an image of the brain for visualanalysis.

d). Blood tests:-Blood tests are used to test for health conditions that may triggertonic-clonic seizures.


Tonic seizures cause all muscles in the body to suddenly stiffenmeaning that one loses balance and may even fall over. Clonicseizures cause jerks that normally lasts up to two minutes. Loss ofconsciousness may also occur. Individual symptoms may include:

  1. Strange sensation called aura that may precede loss of consciousness

  2. Biting the cheek or tongue

  3. Involuntary crying of screaming

  4. Clenched teeth or jaw

  5. Loss of urine or stool control (incontinence)

  6. Difficulty in breathing

  7. Blue skin color

After the seizure,the person may experience additional symptoms such as:

  1. Confusion

  2. Drowsiness or sleepiness that lasts for 1 hour or longer (post-ictal state)

  3. Loss of memory (amnesia) about the seizure episode

  4. Headache

  5. Weakness of one side of the body for a few minutes to a few hours following seizure (Todd paralysis)


a). First aid

First aid duringepisodes of tonic-clonic seizures is very important as it preventsinjury in case of falls and may avert endangering the lives ofothers.

  • In case person is operating machinery e.g. driving kindly take over or stop the machinery

  • Lay the person on his/her side to ease breathing.

  • Clear the area around the person of anything hard or sharp.

  • Put something soft and flat, like a folded jacket, under his or her head.

  • Remove eyeglasses in case person is wearing any.

  • Loosen ties or anything around the neck that may make it hard to breathe.

  • Time the seizure. For seizures longer than 5 minutes, seek medical emergency services

  • Stay with the person until the seizure ends and he or she is fully awake (CDC, 2016).

After the seizure subsides, the person may experience confusion andloss of memory. One should stay calm and explain gently whathappened.

b). Medication

Antileptic medications can be prescribed by physicians. There aredifferent types of medications available that address various issues.The common medication prescribed according to WebMd (2016) include:carbamazepine (Carbatrol, Tegretol), phenytoin (Dilantin, Phenytek),oxcarbazepine (Trileptal), lamotrigine (Lamictal), phenobarbital andlorazepam (Ativan) (Engel, 2013).


Surgery might be an option in treating the seizures where medicationhas failed to achieve the desires results. This option is desirablewhere only parts of the brain are affected hence may not be suitablein treating tonic-clonic seizures.


Diet and mechanical devices are the main supplemental treatmentremedies. The Vagus nerve stimulation using a specialized deviceseeks to alter electric impulses in the brain. The matchbox sizeddevice that is developed by the American firm, Cyberonics, isimplanted under the skin near the clavicle and wires are tunneled upunder the skin towards the vagus nerve. The option is calledketogenic diet that involves consuming foods low in carbohydrates andrich in fats and proteins as they have been shown to reduce severityof seizures (Engel 2013).


Tonic-clonic seizures are a common occurrence as indicated above. Itis important to create public awareness among all people in order toequip them with knowledge on how to behave and conduct first aid incases of such tonic-clonic seizures. This way, the life of patientsbecome easier and injuries and accidents can be avoided.


CDC. (2016). SeizureFirst Aid. Retrieved from.


Clonic seizures(2016). Retrieved from

Engel, J. (2013).Seizures and epilepsy. Oxford: OUP.

WebMD (2016).Epilepsy Health Center. Retrieved from