II. Cause

  1. Idiopathic
  2. Congenital cerebral lesion
  3. Posttraumatic cerebral scar
  4. Brain Tumor

III. Symptoms

  1. Aura may precede Seizure
    1. Irritability
    2. Apathy
    3. Giddiness
    4. Headache
    5. Scintillating scotomata
    6. Nausea
    7. Choking sensation
    8. Paresthesia
    9. Myalgia

IV. Signs

  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 with
    1. Tongue or lip biting
    2. Urinary or Fecal Incontinence on awakening

V. Labs

  1. Complete Blood Count (CBC)
    1. Postictal Leukocytosis in peripheral blood
  2. Prolactin
    1. Elevated following Seizure

VI. Diagnosis

  1. Electroencephalogram (EEG)
    1. Paroxysmal diffuse outbursts of high voltage
    2. Many spikes in fast rhythm

VII. Management: Prophylaxis (Same as for Partial Seizure)

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Ontology: Tonic - clonic seizures (C0494475)

Definition (NCI) A generalized tonic-clinic seizure, characterized by loss of consciousness. This type of seizure may be preceded by an aura and is frequently followed by a period of confusion and lethargy (post-ictal state).
Definition (NCI_FDA) A symptomatic form of epilepsy often preceded by an aura; characterized by loss of consciousness with generalized tonic- clonic seizures.
Concepts Disease or Syndrome (T047)
MSH D012640
ICD10 G40.6 , G40.4
SnomedCT 192995009, 54200006, 65155005
English Grand mal seizures, unspecified (with or without petit mal), Generalized Tonic-Clonic Seizure, Grand Mal Seizure, Grand Mal, Grand-Mal Seizure, Seizure(s) Grand Mal, Generalized tonic clonic seizures, Seizures, generalized tonic-clonic, Generalized clonic-tonic seizures, Seizures, tonic-clonic, Generalized tonic-clonic seizures (GTCS), grand mal seizure, Generalised tonic-clonic seizure, Generalised tonic-clonic seizures, Grand mal epileptic fit, Grand mal fit, Seizure grand mal, Seizure, Tonic-Clonic, Seizures, Tonic Clonic, Tonic-Clonic Seizure, Tonic-Clonic Seizures, Seizures, clonic-tonic, tonic clonic seizure, Seizure;tonic-clonic, clonic seizures tonic, grand mal, generalized seizures tonic clonic, tonic-clonic convulsion, generalized tonic clonic seizure, clonic tonic seizures, mal grand seizure, generalized tonic-clonic seizure, tonic clonic seizures, tonic-clonic seizures, clonic tonic seizure, epileptic fit grand mal, grand mal seizures, seizure clonic tonic, clonic generalized seizures tonic, Grand mal seizures, Grand mal seizure NOS, Seizures, generalized tonic-clonic (GTCS), Grand mal seizure (disorder), SEIZURES, GRAND-MAL, GRAND-MAL SEIZURES, Grand mal convulsion, Grand mal seizure, Grand mal, Grand mal seizure (finding), Generalized tonic-clonic seizure, Tonic-clonic seizures, Tonic-clonic seizure, Tonic-clonic convulsion, Tonic-clonic seizure (finding), Tonic - clonic seizures, grand mal; seizure, haut mal, seizure; grand mal, Seizures, Tonic-Clonic, Generalized tonic-clonic seizures, tonic-clonic seizure
Italian Crisi convulsive tonico-cloniche generalizzate, Crisi convulsiva da grande male, Crisi convulsiva tonico-clonica generalizzata, Attacco di grande male, Attacco di grande male epilettico, Crisi convulsive tonico-cloniche, Attacchi tonico-clonici
Dutch tonisch-clonische insulten, grand mal insult, grand mal epileptisch insult, grand mal aanval, insult grand mal, gegeneraliseerde tonisch-clonische convulsie, gegeneraliseerd tonisch-clonisch insult, aanval; grand mal, grand mal; aanval, Grandmalaanvallen (met of zonder petit mal), niet gespecificeerd, gegeneraliseerde tonisch-clonische convulsies
French Crise d'épilepsie grand mal, Crise épileptique de grand mal, Crise tonico-clonique généralisée, Crise de grand mal, Crises tonico-cloniques, Crises convulsives généralisées tonico-cloniques
German Grand-mal-Krampfanfall, Krampfanfall, Grand-mal, klonisch-tonische Krampfanfaelle, generalisierter klonisch-tonischer Krampfanfall, Grand-mal-Epilepsieanfall, Grand-mal-Anfall, Tonisch-klonische Anfälle, Anfälle, tonisch-klonische, Grand-mal-Anfaelle, nicht naeher bezeichnet (mit oder ohne Petit mal), Generalisierte tonisch-klonische Anfaelle
Portuguese Crise epiléptica de grande mal, Crise de grande mal, Convulsão tonicoclónica generalizada, Crises tonicoclónicas, Crises tónico-clónicas generalizadas
Spanish Ataque de gran mal, Crisis de gran mal, Ataque de gran mal epiléptico, Crisis tónico-clónica generalizada, Crisis tónico-clónicas, convulsiones tónico - clónicas (hallazgo), convulsiones tónico - clónicas, epilepsia generalizada tónico - clónica, gran mal (hallazgo), gran mal, Crisis tonicoclónicas generalizadas
Japanese 強直性間代性痙攣発作, 全身性強直性間代性発作, 大発作痙攣, 大発作てんかんの発作, ダイホッサテンカンノホッサ, ダイホッサケイレン, ゼンシンセイキョウチョクセイカンダイセイホッサ, キョウチョクセイカンタイセイケイレンホッサ, キョウチョクセイカンダイセイケイレンホッサ, ゼンシンセイキョウチョクセイカンタイセイホッサ
Czech Generalizovaný tonicko-klonický záchvat, Epileptický záchvat typu grand mal, Záchvat grand mal, Generalizované tonicko-klonické záchvaty, Tonicko-klonické záchvaty, tonicko-klonické záchvaty
Korean 상세불명의 대발작(소발작이 있든지 없든지)
Hungarian Grand mal epilepsiás roham, Tonusos-clonusos görcsrohamok, Generalizált tonusos-clonusos epilepsiás roham, Generalizált tónusos-clonusos epilepsiás roham, Grand mal roham, Grand mal epilepsiás convulsio, Generalizált tonusos-clonusos görcsrohamok, Grand mal görcsroham
Norwegian Tonisk-kloniske anfall