Generalized tonic-clonic seizure: its symptoms and characteristics.

A review of the most important characteristics of this type of epilepsy.

Of all the seizures that a person may experience during an epileptic seizure, generalized tonic-clonic seizures are the most common, generalized tonic-clonic seizure is probably the best known in popular culture.

While it is not the only type of seizure that people with epilepsy may experience, it is the most prototypical, and in this article we will learn more about its particularities, as well as possible causes and treatments.

Generalized tonic-clonic seizure: what is it?

The generalized tonic-clonic seizure, also called 'grand mal', is a type of seizure.is a type of epileptic seizure in which both tonic and clonic contractions of the muscles occur. This variety of seizure is the one most associated with the prototypical image of epileptic seizure, and is usually associated with metabolic dysregulation in the body of the sufferer.

It is usually believed that people suffering from epilepsy only suffer from this type of seizure, but the truth is that only 10% of epileptic patients suffer from this type of seizure without being accompanied by other varieties.

Symptoms

There are several symptoms that a person may suffer before, during and after suffering generalized tonic-clonic seizures.

Although most cases, seizures appear without warning, suddenly and abruptly.Although in most cases seizures occur without warning, suddenly and abruptly, some people may experience a prodrome. This is a warning that something is not going right in your body, and that a seizure will occur. Normally, the prodrome manifests itself in the form of premonitory feelings that foretell the onset of a seizure.

Once the seizures have started, there are up to three different phases during the seizure, which are the tonic phase, the clonic phase and the postictal phase.

1. Tonic phase

The tonic phase is usually the first of the phases when having this type of seizure.

The first thing that occurs is the rapid loss of consciousness.The first thing that occurs is the rapid loss of consciousness, although it is not always complete.

The skeletal muscles tightencausing the limbs to become rigid and the patient falls to the floor because of inability to stand.

The eyes roll or are no longer directed to a particular point, and the mouth remains open.

This phase lasts only about ten to twenty seconds and despite the loss of consciousness, the person is able to articulate some sounds, mostly due to the violent expulsion of air from the lungs. This is known as ictal scream.

The skin turns blue, because respiration has lost its rhythmicity and there is oxygen deprivation in the organism.

The sympathetic system responds in a forced mannerThe sympathetic system responds in a forced manner, causing the Blood Pressure to increase, the heart to beat faster and the pupil of the eye to expand (mydriasis).

One of the risks during the tonic phase is that of biting the tongue, since the jaw is clenched very tightly. You can also bite your cheek and cause a large mouth injury.

2. Clonic phase

After the tonic phase comes the clonic phase, which is a state in which the tension experienced during the previous phase gives way to muscular relaxation. It lasts longer than the tonic phase, lasting about one minute.

The relaxation is not complete, since the muscles immediately the muscles immediately become tense again and then relax.The person shakes violently, and at this stage the seizures themselves may occur.

The person shakes violently, being in this phase the moment in which it can be injured against objects that are in the room. It can also go rolled lying on the floor.

3. Postictal phase

Once the tonic and clonic phases have occurred, comes the postictal phase, in which multiple events can occur.

The patient's brain may see its blood circulation altered, in addition to altered blood levels.The patient's brain may have its blood circulation altered, in addition to altered neurotransmitter levels.

The person is totally confused and suffers amnesia, although he/she will gradually become aware that he/she has suffered a seizure.

It is quite probable that the person, after having suffered physically and psychologically during the episode, starts crying and vomiting.

Possible causes

Although epilepsy has been studied in depth, it is known that most of the seizures associated with this problem are idiopathic, i.e., they appear suddenly without a clear cause to explain their onset.that is to say, they appear suddenly without a clear cause that allows to give an explanation to the reason of their appearance.

However, it has been found that certain types of epileptic seizures certain types of epileptic seizures that occur unilaterally at the cerebral level, only at the cerebral level, involving only one of the two hemispheres, can evolve into seizures involving both hemispheres, thus giving rise to a tonic-clonic seizure. Thus, we speak of unilateral focal seizures evolving into more complex bilateral seizures.

It has been hypothesized that certain dysregulation at the level of neurotransmitters and chemical substances present in the central nervous system would be behind the appearance of this type of seizures. Some triggers of this type of seizures, in addition to a certain genetic predisposition to suffer them, are certain genetic predisposition to suffer themThe main causes of seizures are fatigue, malnutrition, sleep deprivation, stress, hypertension, diabetes, rapid light changes (flickering and flashing), elevated estrogen levels and antihistamines.

Throughout the history of psychiatry, with the use of electroconvulsive treatments for different types of psychological disorders, it has been possible to replicate generalized tonic-clonic seizures under laboratory and apparently therapeutic conditions.

In the case of people suffering from symptomatic epilepsy, it has been seen, by means of neuroimaging techniques, that neurons with lesions, causing them to inappropriately transmit nerve signals and, thus, the movements and, thus, the movements characteristic of the crisis are produced.

Diagnosis

The diagnosis can be made can be made by the use of neuroimaging techniques, especially electroencephalography (EEG).especially with electroencephalography (EEG). However, it should be noted that for a reliable diagnosis using this tool, it is necessary to record brain activity during or immediately after the tonic phase of the seizure has occurred.

During the tonic phase, there is a progressive increase in low-voltage brain activity, with rapid waves, followed by high-amplitude electrical discharges. In contrast, during the clonic phase there are short waves. The electroencephalogram is shown with many peaks during the tonic phase, and then a more irregular synalephaly during the clonic phase.

Treatment

When a person suffers from generalized tonic-clonic seizures, the people around them should make sure that the sufferer is in a a recumbent postureThis is to prevent the person from accidentally drawing saliva into the airway while unconscious and suffocating.

Stay close to the person to see how the epileptic episode is occurring and estimate how long the seizure is lasting. If possible, move all objects away from the area to prevent the person from bumping into them. to prevent the person from bumping into them. It is not recommended to hold the person while he/she is convulsing, nor to introduce objects in the mouth, since it can contract the extremities, herniate and, if something is put in the mouth, the person can choke on it.

As for treatment, as with other types of epileptic seizures, drugs are prescribed to prevent them, anticonvulsant drugs are prescribed to prevent seizures.. Also, if the brain area involved in the occurrence of these seizures is known, surgery can be performed, in addition to vagus nerve stimulation.

Para evitar que se den las condiciones nutricionales que contribuyan a una mayor incidencia de estas crisis, se opta por la vía dietética, sometiendo a la persona a una dieta cetogénica, es decir, alta en grasas y proteínas.

Referencias bibliográficas:

• Krumholz, A., Wiebe, S., Gronseth, G., et al. (2007). Practice Parameter: evaluating an apparent unprovoked first seizure in adults (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology and the American Epilepsy Society. Neurology, 69(21). 1996-2007.
• Schachter S. C. (2009). Seizure disorders. Med Clin North Am. 93(2), 342-351