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HomeHealth articlesseizureWhat Is a Grand Mal Seizure?

Grand Mal Seizure - Causes, Symptoms, Diagnosis, and Treatment

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The most apparent and recognized type of seizure is a tonic-clonic seizure, also known as a grand mal seizure. Read the article below to learn more about this.

Written by

Dr. Shikha

Medically reviewed by

Dr. Abhishek Juneja

Published At August 16, 2022
Reviewed AtOctober 6, 2022

What Is a Grand Mal Seizure?

A grand mal seizure, also known as a tonic-clonic seizure, is characterized by intense muscle contractions and loss of consciousness. These are the most commonly observed seizures and what most people imagine when they think of seizures in general. They are generalized seizures that involve the entire body.

During the tonic phase of the seizure, the muscles of the legs and arms tense. During the second phase, known as the clonic phase, the muscles of the arms, legs, and face begin to jerk. Only one part of the seizure may be experienced by some patients. Others may have both experiences. Seizures can last anywhere from one to three minutes. Any seizure that lasts more than five minutes should be treated immediately.

What Are the Causes of a Grand Mal Seizure?

Unusual electrical activity in the brain causes all seizures. Nerve cells in the brain ordinarily communicate with one another by delivering electrical and chemical impulses via synapses between them. When the electrical activity throughout the entire surface of the brain becomes abnormally coordinated, grand mal seizures occur. Healthcare practitioners are sometimes unable to establish what causes seizures to begin. Tonic-clonic seizures can be caused by a number of different medical disorders. A brain tumor or a ruptured blood vessel in the brain, which can cause a stroke, are two of the more severe disorders.

A tonic-clonic seizure can also be caused by the following factors:

  • An injury to the head.

  • Infections such as meningitis.

  • Drug or alcohol abuse or withdrawal from drugs.

  • Low levels of calcium, sodium, magnesium, or glucose in the body.

  • Stroke.

What Are the Symptoms of a Grand Mal Seizure?

When people think about seizures and epilepsy, they usually think of tonic-clonic seizures. The symptoms are observed in the following phases:

Aura: An aura is a simple or complex partial seizure that may precede the seizure. A person may experience unusual sensations such as a specific odor, vertigo, nausea, or anxiety. If the person has had seizures before, they may recognize the warning indications that a seizure is about to start. Many people have a period of time before a seizure when they feel or know it is coming. Prodrome, which is the time leading up to the seizure, can sometimes involve what is known as an aura. When seizure activity begins to affect specific parts of the brain, an aura develops. Auras are not seen in generalized seizures, including tonic-clonic seizures. However, if the seizure extends to the other half of the brain, focal seizures, which affect only one side of the brain, can become generalized tonic-clonic seizures. As a result, an aura preceding a focal seizure can serve as a warning sign that a tonic-clonic seizure is on the way.

Tonic Phase: The individual becomes unconscious and may fall as the tonic-clonic seizure occurs. Even if the person is not conscious of their surroundings, strong tonic spasms of the muscles, particularly the arms and legs, can become tight, giving the appearance of arching of the back and lifting the tummy upward and forcing air out of the lungs, resulting in a cry or groan as the breathing muscles pull the air out of the lungs. Saliva or foam may be flowing from the mouth. Blood may be evident in the saliva if the person bites their tongue or cheek by accident. The person's face may seem bluish or gray, and he or she may produce gasping or gurgling sounds due to chest muscle stiffness. It usually lasts for 10-30 seconds.

Clonic Phase: Convulsions, or full-body spasms or shaking, are a part of this phase, and they get more intense and quick as they progress. The jerking movements settle down after one to three minutes, and the body relaxes, including the bowels and bladder. The person may have no control over the bladder and intestines as this phase concludes, leading to involuntary urination or defecation. The person may breathe more normally after letting out a deep sigh. This phase usually lasts for 30-60 seconds or sometimes more.

Post Seizure Phase: Most people wake up after a seizure and revert to how they were before the seizure. For a few hours, the person may feel puzzled, weary, physically sore, depressed, or ashamed as they regain awareness. The individual may not recall having a seizure and may suffer from other memory problems. They may be disoriented, get a headache, or experience muscle aches. It may sometimes take even longer to wake up in severe circumstances, especially if the person has status epilepticus. The person may be unconscious for several minutes after a seizure as the brain recovers from the seizure activity. He or she may snore or appear to be sleeping.

How to Diagnose Grand Mal Seizure?

  • Making an accurate diagnosis requires a full description of what transpired during the seizure. Because people become unconscious during grand mal seizures, their doctor will most likely need to speak with a witness who was present during the seizures.

  • A neurological examination will also be performed by the doctor. Muscle tone, muscle reflexes, and strength are all examined during these exams. The doctor examines your walking style, balance, coordination, and posture.

  • An electroencephalogram (EEG) is one of the most important diagnostic instruments. This monitors brain electrical activity. In electrical activity patterns, the electroencephalogram (EEG) can detect odd spikes or waves. These patterns can be utilized to differentiate between different forms of epilepsy.

  • Magnetic resonance imaging (MRI) and computed tomography (CT) scans can reveal scar tissue, cancers, or structural issues in the brain. It can be used to find the location and reason for the seizure inside the brain.

What Is the Treatment for Grand Mal Seizure?

It is possible that one tonic-clonic seizure was an isolated occurrence that does not require treatment. Before starting a long-term treatment plan, the doctor may decide to monitor the patient for additional seizures.

  • Medications: The majority of people take medication to control their seizures. A patient begins with a modest dose of one medicine. As needed, the medical team will progressively increase the dose. Some patients need multiple medications to control their seizures. Drugs such as Carbamazepine, Lorazepam, and Lamotrigine are prescribed for the patients. It may take some time to figure out what dosage and type of medication are best suited for a patient.

  • Surgery: When medicine fails, surgery to remove or separate the focal site from the rest of the brain can sometimes end seizures. If the seizures persist despite taking two anti-seizure medications at appropriate doses, the healthcare professional may propose that the patient may be evaluated for epilepsy surgery.

  • Supplemental Treatment: Deep brain stimulation and responsive neurostimulation are the two types of brain stimulation that employ a modest electrical current delivered by a device placed in the brain. This current interferes with and attempts to interrupt a seizure's electrical activity.

Stimulation of the vagal nerve or the tenth cranial nerve leads directly to the brain. The left side of this nerve can be stimulated electrically to help patients have fewer seizures.


People who suffer from seizures can often lead full and productive lives. This is particularly true if the seizures are controlled by medicine or other means. It is critical to keep taking the seizure medication as directed by the doctor. Stopping your medicine can cause the body to have prolonged or repeated seizures, which can be fatal. Some ordinary activities may not be safe for a person if they have a history of seizures. A seizure while driving, bathing, or swimming, for example, could be fatal. Before trying these activities, consult a healthcare practitioner.

Dr. Abhishek Juneja
Dr. Abhishek Juneja



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