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Generalized Tonic Clonic SeizureAka: Grand Mal Seizure, Major Motor Seizure, GTCS

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  1. Cause
    1. Idiopathic
    2. Congenital cerebral lesion
    3. Posttraumatic cerebral scar
    4. Brain Tumor
  2. 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
  3. 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
  4. Labs
    1. Complete Blood Count (CBC)
      1. Postictal Leukocytosis in peripheral blood
    2. Prolactin
      1. Elevated following Seizure
  5. Diagnosis
    1. Electroencephalogram (EEG)
      1. Paroxysmal diffuse outbursts of high voltage
      2. Many spikes in fast rhythm
  6. Management: Prophylaxis (Same as for Partial Seizure)
    1. Phenytoin
    2. Carbamazepine
    3. Phenobarbital
    4. Primidone
    5. Valproic Acid
    6. Intractable Seizures have been treated with surgery
      1. Zimmerman (2003) Mayo Clin Proc 78:109

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)A symptomatic form of epilepsy often preceded by an aura; characterized by loss of consciousness with generalized tonic- clonic seizures.
ConceptsSign or Symptom (T184)
MSHD012640
EnglishGeneralized clonic-tonic seizures, Generalized tonic clonic seizures, Generalized Tonic-Clonic Seizure, Generalized tonic-clonic seizures, Grand mal, grand mal seizure, Grand-Mal Seizure, Grand-mal seizures, SEIZURE GRAND MAL, Tonic - clonic seizures, Tonic-clonic convulsion, Tonic-clonic seizure, Tonic-Clonic Seizures
Spanishconvulsiones tonico - clonicas, epilepsia generalizada tonico - clonica, gran mal
Parent ConceptsSeizures (C0036572), Generalized seizures (C0234533), Tonic - clonic seizures (C0494475), Finding of brain (C0576471), Duplicate concept (C1274013)
SourcesCSP, CST, MSH, MTH, NCI, OMIM, QMR, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)



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