Introduction
Generalized tonic-clonic seizures used to be called grand mal seizures and are the most classic and spectacular type of epileptic seizure (Asadi‐Pooya et al., 2020). This condition is characterized by abrupt and vigorous muscle contractions and unconsciousness. The tonic phase is usually the initial phase of these seizures, marked by muscle stiffness, often leading to the person falling if they are standing. This is followed by the clonic phase, associated with rhythmic jerking movements. Generalized tonic-clonic seizures may last from a few seconds to several minutes and may be followed by signs like tongue biting, urinary incontinence, and confusion on return to consciousness. Although they can be terrifying, it should be remembered that most people recover completely from a seizure (Meritam Larsen et al., 2023). But they can also have complications like status epilepticus, a prolonged seizure state which requires immediate medical attention. Appreciating the characteristics, precipitants, and measures to be taken toward generalized tonic-clonic seizures is necessary for the management of people with epilepsy.
Possible Causes and Symptoms
Many factors can lead to generalized tonic-clonic seizures, but in most cases, the actual cause is unidentified. According to Pardhi & Varade (2020), genetic predisposition remains a major factor, and some genetic mutations predispose to epilepsy. Also, structural abnormalities in the brain, which include tumors, stroke, or traumatic brain injury, can cause seizures by interfering with normal electrical activity. Moreover, alterations in neurotransmitters or brain chemistry modifications may affect seizure development (Asadi‐Pooya et al., 2020). Meningitis or encephalitis infections are provocative of seizures due to metabolic imbalances such as low blood sugar or electrolyte disturbances. In addition, drug or alcohol withdrawal, sleep deprivation, and stress will diminish the seizure threshold, which in turn will increase the possibility of seizures.
The manifestations of the symptoms of generalized tonic-clonic seizures usually occur in stages. The tonic phase is characterized by sudden stiffening of the muscles and often results in the individual falling if they are in a standing position (Pardhi & Varade, 2020). This is followed by the clonic phase, presented by the rhythmic jerking movements. The last phase is the clonic phase, which is the part of the course of a seizure when there is a loss of consciousness. Upon regaining consciousness, the person may exhibit other symptoms such as tongue biting, urinary incontinence, and confusion; they last around 1 to 3 minutes. Before a seizure, some individuals may describe symptoms in the form of auras. These auras can be very different but often include visuals, smells, or a feeling of fear (Meritam Larsen et al., 2023). Comprehending these potential etiologies and identifying the variety of manifestations of generalized tonic-clonic seizures are central for proper diagnosis, successful treatment, and suitable support for individuals who have epilepsy.
Diagnosis and treatment options
The diagnosis of generalized tonic-clonic seizures usually requires comprehensive assessment by a healthcare professional or epilepsy-specializing neurologist (Pardhi & Varade, 2020). The diagnosis is based on medical history, clinical examination, and diagnostic tests. Patients are able to comment on their experiences during the seizures, the absence of any warning signs (auras), and post-seizure symptoms. Other professionals who deal with healthcare also ask people about their triggers, family history of epilepsy, history of head injuries, or any neurological condition (Meritam Larsen et al., 2023). The objective of the physical examinations is to detect any neurological abnormalities and evaluate the patient’s general state of health.
Diagnostic tests are important in documenting the diagnosis and determining possible associated factors. According to Asadi‐Pooya et al. (2020), EEG is an important diagnostic tool that records the brain’s electrical activity and detects abnormal patterns typical of epilepsy. An EEG during interictal periods (times between seizures) may show a certain characteristic epileptiform discharge, although it is considered less conclusive than video-EEG monitoring wherein the seizure is captured in real time (Meritam Larsen et al., 2023). Imaging studies like magnetic resonance imaging (MRI) or computed tomography (CT) scans are usually carried out to detect structural anomalies of the brain, such as tumors or scars that could be a seizure source.
The goals of treatment for generalized tonic-clonic seizures are reducing seizure frequency and severity, improving the quality of life and minimizing side effects (Meritam Larsen et al., 2023). In most cases, the first-line treatment is antiseizure medications (antiepileptic drugs or AEDs). The medication selection is determined by factors such as the patient’s age, general state of health, frequency of the seizures, and possible side effects. Commonly used AEDs for generalized tonic-clonic seizures are valproate, lamotrigine, levetiracetam, and carbamazepine (Sheikh et al., 2020). To achieve complete seizure control and minimize side effects, regular monitoring of the effectiveness of medications and dosage adjustment or switching of medicines in case of need is a must.
In the case that medications are not effective in seizure control or cause unacceptable side effects, alternative forms of treatment can be considered. Examples of these include dietary therapies such as ketogenic diets, which are fatty and carbohydrate-restricted and have been proven to reduce seizure frequency in most of the patients, the children. According to Asadi‐Pooya et al. (2020), other surgeries that include resective surgery or neuromodulation procedures, including vagus nerve stimulation (VNS) or responsive neurostimulation (RNS), may also be considered in patients that have valproate-resistant epilepsy. Patients with generalized tonic-clonic seizures should be treated by a specialist team of neurologists, epileptologists, nurses, and other healthcare professionals to deliver individualized care that meets the requirements and preferences of each patient (Shorvon et al., 2018). Routine follow-up visits and continuous monitoring are critical to evaluate the response to treatment, to make changes in therapies as necessary, and to deal with any new concerns or complications. Moreover, patient and family education on epilepsy management, first aid for seizures, lifestyle changes, and psychosocial aspects is a very important part of the patient’s care.
First Aim when experiencing generalized tonic-clonic seizures
A generalized tonic-clonic seizure needs prompt first aid for the safety and well-being of the person having the seizure. The main Aim is to avoid trauma during the seizure and provide supportive management until the seizure terminates. When somebody has a seizure, it is important to keep quiet and take immediate action. The first is to protect the person by eliminating nearby objects that could lead to injuries during the convulsive movements (Pardhi & Varade, 2020). If the area is free from sharp objects, there will be fewer instances of injury. A protective zone should be provided around the person’s head to prevent head injury. A folded jacket or a pillow under their head can give some softness to absorb any impact with the ground.
The patient should not be held or pushed forcefully while the seizure is in progress. Restraining may cause injuries or worsen muscle strain (Elmali et al., 2020). However, carefully lead the person away from hazards and use a calm and soothing voice to reassure them. The duration of the seizure should be timed as well since long seizures may necessitate fast emergency intervention by a doctor. After the seizure stops, care must be taken to tilt the person onto their side, so that the airway is kept open and aspiration of any fluids in the mouth is avoided. Post-seizure, monitor the person’s condition, comfort, and help as appropriate. In the case when the seizure would last more than five minutes, and in case of repeated seizures with absence of recovery between them, it is urgent to seek medical advice (Shorvon et al., 2018). Administering proper first aid during generalized tonic-clonic seizures is critical to minimize associated risks and provide quality care to patients with epilepsy.
Impact of Daily Life
This situation can profoundly impact the patient’s daily living. One of the major issues is safety because seizures can happen suddenly and put the patient in danger of accidents, especially during activities like driving, bathing, or cooking. Fearing a public seizure or seizure at work may result in social isolation or avoidance of specific circumstances restricting social and leisure time activities (Sheikh et al., 2020). People with epilepsy might also encounter stigma and discrimination because of misunderstandings about seizures, which may lead to loneliness and depression.
Apart from safety issues, seizure unpredictability can interfere with daily life and affect academic or job performance. Health-related absences, either due to seizures or medical consultations, result in absenteeism and decreased productivity, which hinders educational achievement or career growth (Elmali et al., 2020). The fear of having a seizure during a critical task or meeting can cause anxiety and other additional stress, thus further compromising health and mental well-being. Lack of knowledge of epilepsy among employers and educators and, therefore, inadequate support or accommodations for people with the condition.
Support and intervention
Integration of both support and resources for people with generalized tonic-clonic seizures is paramount in improving their welfare and efficient management of their condition. To make a correct diagnosis, ongoing medical management, and coordinated care, access to a full range of healthcare, including neurology specialists, epilepsy centers, and allied health professionals, is essential (Pardhi & Varade, 2020). Through education and awareness programs that provide knowledge of epilepsy, dispel myths, and reduce social stigma, people accept and integrate into society and start advocating for their needs and rights.
Patient support groups in the community and online forums allow people with epilepsy and their families to meet with other people, share their experiences, and gain support for each other (Elmali et al., 2020). These networks give emotional support, meaningful suggestions, and beneficial resources for dealing with the effects of seizures on daily life. According to Pardhi & Varade (2020), other than that, advocacy organizations and non-profit organizations that work with epilepsy also offer different types of services like educational materials, hotlines, subsidy programs, and community outreach events which are intended to meet needs across a diverse array of issues such as generalized tonic-clonic seizures.
Conclusion
Generalized tonic-clonic seizures can potentially affect all aspects of an individual’s life, from issues of safety and social interactions through academic or professional careers. However, individuals with access to fully inclusive support services and resources are able to manage their condition well, reduce the risk of injury and improve the quality of their lives. Through sensitization, education and encouraging inclusiveness such communities can help create a supportive environment that empowers those with epilepsy to deal with challenges, get appropriate care and thrive in spite of the challenges posed by seizures.
References
Asadi‐Pooya, A. A., & Homayoun, M. (2020). Tonic‐clonic seizures in idiopathic generalized epilepsies: Prevalence, risk factors, and outcome. Acta Neurologica Scandinavica, 141(6), 445-449.
Elmali, A. D., Auvin, S., Bast, T., Rubboli, G., & Koutroumanidis, M. (2020). How to diagnose and classify idiopathic (genetic) generalized epilepsies. Epileptic Disorders, 22(4), 399-420.
Meritam Larsen, P., Wüstenhagen, S., Terney, D., Gardella, E., Aurlien, H., & Beniczky, S. (2023). Duration of epileptic seizure types: A data‐driven approach. Epilepsia, 64(2), 469-478.
Pardhi, A. W., & Varade, S. W. (2020, July). An Overview of Detection and Prediction of Seizure or Epilepsy. In 2020 International Conference on Electronics and Sustainable Communication Systems (ICESC) (pp. 955-960). IEEE.
Sheikh, S. R., Thompson, N., Frech, F., Malhotra, M., & Jehi, L. (2020). Quantifying the burden of generalized tonic‐clonic seizures in patients with drug‐resistant epilepsy. Epilepsia, 61(8), 1627-1637.
Shorvon, S. D., Bermejo, P. E., Gibbs, A. A., Huberfeld, G., & Kälviäinen, R. (2018). Antiepileptic drug treatment of generalized tonic–clonic seizures: An evaluation of regulatory data and five criteria for drug selection. Epilepsy & Behavior, 82, 91-103.
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