Tonic-Clonic_Seizure

Tonic Clonic based on appearance

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Bancaud 1981 The most frequently encountered of the generalized seizures are the generalized tonic-clonic seizures, often known as grand mal. Some patients experience a vague ill-described warning, but the majority lose consciousness without any premonitory symptoms. There is a sudden sharp tonic contraction of muscles, and when this involves the respiratory muscles there is stridor, a cry or moan, and the patient falls to the ground in the tonic state, occasionally injuring himself in falling. He lies rigid, and during this stage tonic contraction inhibits respiration and cyanosis may occur. The tongue may be bitten and urine may be passed involuntarily. This tonic stage then gives way to clonic convulsive movements lasting for a variable period of time. During this stage small gusts of grunting respiration may occur between the convulsive movements, but usually the patient remains cyanotic and saliva may froth from the mouth. At the end of this stage, deep respiration occurs and all the muscles relax, after which the patient remains unconscious for a variable period of time and often awakes feeling stiff and sore all over. He then frequently goes into a deep sleep and when he awakens feels quite well apart from soreness and frequently headache. Generalized tonic-clonic convulsions may occur in childhood and in adult life; they are not as frequent as absence seizures, but vary from one a day to one every three months and occasionally to one every few years. Very short attacks without postictal drowsiness may occur on occasion. Engel 2001 Tonic-Clonic Seizure

Bancaud 1981 EEG Seizure Type Rhythm at 10 or more c/sec decreasing in frequency and increasing in amplitude during tonic phase, interrupted by slow waves during clonic phase. EEG Interictal Expression Polyspike and waves or spike and wave, or, sometimes, sharpa and slow wave discharges. Tonic-clonic seizures are grand mal Preictal some have vague ill-described warning majority lose consciousness w/o premonitory symptoms Ictal Tonic Sudden sharp tonic contraction of muscles Involvement of respiratory muscles: stridor, cry or moan, patient falls to the ground, occasionally injuring themselves Lies rigid, tonic contraction inhibits respiration & cyanosis occurs Tongue may be bitten, urine passed involuntarily Clonic Convulsive movements for a variable period of time small gusts of grunting respiration between convulsive movements usually patient remains cyanotic, saliva may growth from mouth Postictal Deep respiration and all muscles relax patient remains unconscious for a variable period of time awakes feeling stiff and sure all over Frequently goes into a deep sleep Awakens feeling well but has soreness and headache ILAE 1989 Affects the face Luders 1998 Tonic-Clonic Seizure Simple, unnatural movements Like Broadman 4&6 stimulation Blume 2001 1.1.3 Tonic-Clonic: A sequence consisting of a tonic followed by a clonic phase. Variants such as clonic-tonic-clonic may be seen. 1.1.3.1 Generalized Tonic-Clonic Seizure: Noun: Bilateral symmetric tonic contraction and then bilateral clonic contractions of somatic muscles, usually associated with autonomic phenomena. Engel 2001 Blume 2003 A GTC seizure may evolve immediately from a dyscongitive one and is heralded by contralateral head and eye deviation. Alternatively GTC seizures may appear independently. Berg 2010

Initial Phase: -tonic posturing of all limbs Tonic Phase: -muscle sustained contractions -tend to slow Evolve to Clonic Phase: -contractions of progressively decreasing frequency until contractions disappear completely -Same muscles in tonic & clonic phase Sequence: Infrequent focal to tonic-clonic evolution (May need to have Tonic followed by Clonic Seizure) Bancaud 1981 Tonic-clonic seizures are grand mal Preictal some have vague ill-described warning majority lose consciousness w/o premonitory symptoms Ictal Tonic Sudden sharp tonic contraction of muscles Involvement of respiratory muscles: stridor, cry or moan, patient falls to the ground, occasionally injuring themselves Lies rigid, tonic contraction inhibits respiration & cyanosis occurs Tongue may be bitten, urine passed involuntarily Clonic Convulsive movements for a variable period of time small gusts of grunting respiration between convulsive movements usually patient remains cyanotic, saliva may growth from mouth Postictal Deep respiration and all muscles relax patient remains unconscious for a variable period of time awakes feeling stiff and sure all over Frequently goes into a deep sleep Awakens feeling well but has soreness and headache ILAE 1989 Affects the face Luders 1998 Simple, unnatural movements Like Broadman 4&6 stimulation Blume 2001 1.1.3 Tonic-Clonic: A sequence consisting of a tonic followed by a clonic phase. Variants such as clonic-tonic-clonic may be seen. 1.1.3.1 Generalized Tonic-Clonic Seizure: Noun: Bilateral symmetric tonic contraction and then bilateral clonic contractions of somatic muscles, usually associated with autonomic phenomena.