II. Types: Generalized Seizures

  1. Generalized Tonic-Clonic Seizure
    1. Generalized convulsive activity
  2. Myoclonic Seizure
    1. Rhythmic jerking of arms (may involve head and neck)
  3. Atonic Seizure (e.g. drop attack)
    1. Sudden, brief loss of Muscle tone
  4. Tonic Seizure
    1. Brief (<1 minute), bilateral increased extremity motor tone
  5. Absence Seizure
    1. Non-motor Seizure

III. Cause

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

IV. Symptoms: Aura (may precede Seizure)

  1. Irritability
  2. Apathy
  3. Giddiness
  4. Headache
  5. Scintillating scotomata
  6. Nausea
  7. Choking Sensation
  8. Paresthesia
  9. Myalgia

V. Signs: Generalized Tonic-Clonic Seizure

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

VI. Labs

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

VII. Diagnosis

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

VIII. Management: Prophylaxis of Generalized Tonic-Clonic Seizures in Children (age <16 years)

  1. Level C evidence
    1. Carbamazepine (Tegretol)
    2. Phenobarbital
    3. Phenytoin (Dilantin)
    4. Topiramate (Topamax) - also Level D evidence for use in Myoclonic Seizures
    5. Valproic Acid (Depakene) - also Level D evidence for use in Myoclonic Seizures
  2. Level D evidence
    1. Oxcarbazepine (Trileptal)

IX. Management: Prophylaxis for both GTCS and Myoclonic Seizures in Younger Adults (age >16 years)

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Related Studies

Ontology: Epilepsy, Generalized (C0014548)

Definition (MSH) Recurrent conditions characterized by epileptic seizures which arise diffusely and simultaneously from both hemispheres of the brain. Classification is generally based upon motor manifestations of the seizure (e.g., convulsive, nonconvulsive, akinetic, atonic, etc.) or etiology (e.g., idiopathic, cryptogenic, and symptomatic). (From Mayo Clin Proc, 1996 Apr;71(4):405-14)
Concepts Disease or Syndrome (T047)
MSH D004829
SnomedCT 155043003, 192989008, 192994008, 155038005, 19598007
English Epilepsies, Generalized, Generalized Epilepsies, SEIZURE DIS GENERALIZED, Epilepsy, Generalized, Generalized Seizure Disorder, Generalized Seizure Disorders, Seizure Disorder, Generalized, Seizure Disorders, Generalized, Epilepsy, Generalized [Disease/Finding], generalized seizure disorder, generalized epilepsy nos, epilepsy generalized, generalized epilepsy (diagnosis), generalized epilepsy, Generalised epilepsy (disorder), Generalised epilepsy, Generalized epilepsy, Generalized epilepsy (disorder), epilepsy; generalized, epilepsy; syndrome, generalized, generalized; epileptic, Generalized epilepsy, NOS, Generalised epilepsy [Ambiguous], Generalized Epilepsy
Swedish Epilepsi, generaliserad
Czech epilepsie generalizovaná
Portuguese Transtorno de Crise Generalizada, Transtorno Convulsivo Generalizado, Epilepsia Generalizada
Finnish Yleistynyt epilepsia
Italian Disturbo convulsivo generalizzato, Epilessia generalizzata
Japanese てんかん-全身, 全般てんかん, 全般癲癇, 全身てんかん, てんかん-強直, 全般原発てんかん, てんかん-全般原発, 脱力てんかん, 癲癇-全般, てんかん-脱力, 強直てんかん, てんかん-全般
Polish Padaczka uogólniona
Norwegian Generalisert anfallssykdom, Generalisert epilepsi
Dutch epilepsie; gegeneraliseerd, epilepsie; syndroom, gegeneraliseerd, gegeneraliseerd; epilepsie, Epilepsie, gegeneraliseerde, Gegeneraliseerde epilepsie
Spanish epilepsia generalizada (trastorno), epilepsia generalizada, Epilepsia Generalizada, Trastorno de Crisis Generalizada
French Épilepsie généralisée
German Epilepsie, generalisierte, Epilepsie, primär generalisierte, Epileptische Anfälle, generalisierte

Ontology: Tonic-Clonic Epilepsy (C0014549)

Definition (MSH) A generalized seizure disorder characterized by recurrent major motor seizures. The initial brief tonic phase is marked by trunk flexion followed by diffuse extension of the trunk and extremities. The clonic phase features rhythmic flexor contractions of the trunk and limbs, pupillary dilation, elevations of blood pressure and pulse, urinary incontinence, and tongue biting. This is followed by a profound state of depressed consciousness (post-ictal state) which gradually improves over minutes to hours. The disorder may be cryptogenic, familial, or symptomatic (caused by an identified disease process). (From Adams et al., Principles of Neurology, 6th ed, p329)
Concepts Disease or Syndrome (T047)
MSH D004830
SnomedCT 352818000
English Epilepsies, Tonic-Clonic, Epilepsy, Grand Mal, Epilepsy, Tonic Clonic, Epilepsy, Tonic-Clonic, Tonic-Clonic Epilepsies, Tonic-Clonic Epilepsy, CONVULSIONS GRAND MAL, EPILEPSY GRAND MAL, TONIC/ CLONIC CONVULSIONS, Grand mal, TONIC CLONIC CONVULSION DIS, MAJOR MOTOR SEIZURE DIS, SEIZURE DIS TONIC CLONIC, TONIC CLONIC SEIZURE DIS, GRAND MAL SEIZURE DIS, SEIZURE DIS GRAND MAL, SEIZURE DIS MAJOR MOTOR, Tonic-clonic convulsion, generalized convulsive tonic-clonic seizure, grand mal epilepsy (diagnosis), tonic-clonic epilepsy, generalized convulsive grand mal seizure, tonic-clonic epilepsy (diagnosis), grand mal epilepsy, Clonic-tonic convulsions, Tonic/ clonic convulsions, Convulsion grand mal, Convulsions grand mal, Grand mal convulsion, Major convulsion, Epilepsy grand mal, Convulsion Disorder, Tonic-Clonic, Convulsion Disorders, Tonic-Clonic, Disorder, Tonic-Clonic Convulsion, Disorders, Tonic-Clonic Convulsion, Tonic Clonic Convulsion Disorder, Tonic-Clonic Convulsion Disorder, Tonic-Clonic Convulsion Disorders, Convulsion Syndrome, Tonic-Clonic, Convulsion Syndromes, Tonic-Clonic, Syndrome, Tonic-Clonic Convulsion, Syndromes, Tonic-Clonic Convulsion, Tonic Clonic Convulsion Syndrome, Tonic-Clonic Convulsion Syndrome, Tonic-Clonic Convulsion Syndromes, Convulsion, Tonic Clonic, Convulsions, Tonic Clonic, Tonic Clonic Convulsion, Tonic Clonic Convulsions, Disorder, Tonic-Clonic Seizure, Disorders, Tonic-Clonic Seizure, Seizure Disorder, Tonic Clonic, Seizure Disorder, Tonic-Clonic, Seizure Disorders, Tonic-Clonic, Tonic Clonic Seizure Disorder, Tonic-Clonic Seizure Disorder, Tonic-Clonic Seizure Disorders, Seizure Syndrome, Tonic-Clonic, Seizure Syndromes, Tonic-Clonic, Syndrome, Tonic-Clonic Seizure, Syndromes, Tonic-Clonic Seizure, Tonic Clonic Seizure Syndrome, Tonic-Clonic Seizure Syndrome, Tonic-Clonic Seizure Syndromes, Convulsion, Grand Mal, Convulsions, Grand Mal, Grand Mal Convulsion, Grand Mal Convulsions, Grand Mal Seizure Disorder, Seizure Disorder, Grand Mal, Major Motor Seizure Disorder, Seizure Disorder, Major Motor, Epilepsy, Major, Major Epilepsies, Major Epilepsy, Epilepsy, Tonic-Clonic [Disease/Finding], grand mal, disorders grand mal seizures, Epilepsy;grand mal, tonic clonic convulsion, clonic epilepsy tonic, tonic-clonic convulsion, grand mal convulsion, Tonic-clonic epilepsy, Grand mal epilepsy, Tonic-clonic epilepsy (disorder), epilepsy; grand mal, epilepsy; major, grand mal; epilepsy, major; epileptic, Grand Mal Epilepsy, Epileptic seizures, tonic-clonic, Major epilepsy
French GRAND MAL EPILEPTIQUE, Convulsions grand mal, Grand mal, Convulsions tono-cloniques, Epilepsie grand mal, Crises tonico-cloniques, Convulsions tonico-cloniques, Grande convulsion, Convulsion tonico-clonique, CONVULSIONS GRAND MAL, CONVULSIONS TONICOCLONIQUES, Convulsion grand mal, Grand mal épileptique, Crise tonico-clonique, Crise tonicoclonique
Italian Convulsione da grande male, Grande male epilettico, Grande male, Epilessia da grande male, Convulsione tonico-clonica, Convulsione maggiore, Sindrome convulsiva tonico-clonica, Epilessia tipo grande male, Disturbo convulsivo tonico-clonico, Disturbo da convulsione tonico-clonica, Convulsioni tonico-cloniche, Epilessia major, Convulsioni da grande male, Disturbo convulsivo da grande male, Disturbo convulsivo motorio maggiore, Sindrome da convulsione tonico-clonica, Epilessia tonico-clonica
Dutch tonisch-clonische convulsie, epilepsie grand mal, grand mal epilepsie, grote convulsie, convulsie grand mal, clonisch-tonische convulsies, convulsies grand mal, tonisch-clonische epilepsie, tonisch/clonische convulsies, grand mal, epilepsie; grand mal, epilepsie; major, grand mal; epilepsie, major; epilepsie, grand mal convulsie, Epilepsie, tonisch-clonische, Grand mal, Tonisch-clonische convulsie, Tonisch-clonische epilepsie
German klonisch-tonische Konvulsionen, schwere Konvulsion, Grand-mal, klonisch-tonische Konvulsion, Grand-mal-Anfall, klonisch-tonische Epilepsie, EPILEPSIE GRAND MAL, KONVULSIONEN GRAND MAL, TONISCHE / KLONISCHE KRAEMPFE, Grand mal Konvulsion, Epilepsie, Grand mal, Epilepsie, tonisch-klonische, Epilepsia major, Grand-mal-Epilepsie, Epileptische Anfälle, tonisch-klonische, Generalisierte motorische epileptische Anfälle
Portuguese Epilepsia tipo grande mal, Convulsão major, Convulsão tonicoclónica, Convulsão do grande mal, Convulsões do grande mal, Grande mal, Grande mal epiléptico, Convulsões tonicoclónicas, Epilepsia tonicoclónica, Transtorno Convulsivo de Grande Mal, Transtorno de Crise Motora Maior, Epilepsia de Grande Mal, Transtorno de Crise Tônico-Clônica, CONVULCOES TONICO/CLONICAS, CONVULSOES DE GRANDE MAL, GRANDE MAL EPILEPTICO, Transtorno de Crise Convulsiva Tônico-Clônica, Transtorno Convulsivo Motor Maior, Transtorno de Crise Epiléptica Tônico-Clônica, Transtorno de Crise de Grande Mal, Convulsão de grande mal, Epilepsia Maior, Epilepsia Tônico-Clônica
Spanish Epilepsia de gran mal, Convulsión mayor, Gran mal, Convulsiones de gran mal, Trastorno Convulsivo de Gran Mal, Epilepsia Tónico-Clónica, Trastorno de Crisis Tónico-Clónica, CONVULSIONES DE TIPO GRAN MAL, CONVULSIONES TONICO/CLONICAS, EPILEPSIA TIPO GRAN MAL, Epilepsia tónico-clónica, Convulsiones tónico-clónicas, Convulsión tónico-clónica, Trastorno de Crisis de Gran Mal, Ataques de Gran Mal, Epilepsia Tonicoclónica, Trastorno Convulsivo Motor Mayor, epilepsia de gran mal, epilepsia tónico-clónica (trastorno), epilepsia tónico-clónica, Convulsión de gran mal, Epilepsia del Gran Mal, Epilepsia Mayor, Trastorno de Crisis Motora Mayor
Japanese 大きな痙攣, 大発作痙攣, 大発作型痙攣, 強直性間代性痙攣, 強直性間代性てんかん, 間代性強直性痙攣, オオキナケイレン, ダイホッサテンカン, ダイホッサケイレン, ダイホッサガタケイレン, ダイホッサ, てんかん-強直間代性, 強直間代性てんかん, キョウチョクセイカンダイセイテンカン, カンタイセイキョウチョクセイケイレン, キョウチョクセイカンダイセイケイレン, キョウチョクセイカンタイセイテンカン, キョウチョクセイカンタイセイケイレン, カンダイセイキョウチョクセイケイレン, 大発作, 癲癇-強直間代性, てんかん-大発作, 大発作てんかん, 強直間代性癲癇, 発作-大
Swedish Epilepsi, tonisk-klonisk
Czech epilepsie tonickoklonická, epilepsie tonicko-klonická, epilepsie grand mal, Tonicko/ klonické křeče, Křeče typu grand mal, Grand mal záchvat, Tonicko-klonické křeče, Grand mal epilepsie, Tonicko-klonická epilepsie, Grand mal, Tonicko-klonická křeč, Epilepsie typu grand mal, Závažná křeč
Finnish Toonis-klooninen epilepsia
Polish Grand mal, Padaczka toniczno-kloniczna, Napad padaczkowy duży
Hungarian Grand-mal-convulsio, Nagyroham, Grand mal convulsio, Grand-mal epilepsia, Tonusos-clonusos convulsio, Clonusos-tonusos convulsiók, Grand-mal-convulsiók, Grand mal epilepsia, Grand mal, Tonusos-clonusos epilepsia, Tonusos/clonusos convulsiók
Norwegian Tonisk-klonisk epilepsi, Generalisert tonisk-klonisk epilepsi, Epilepsi med GTK-anfall, Epilepsi med generaliserte tonisk-kloniske anfall, Generalisert tonisk-klonisk anfall

Ontology: Generalized seizures (C0234533)

Definition (CSP) clinical or subclinical disturbances of cortical function due to a sudden, abnormal, excessive, and disorganized discharge of brain cells; clinical manifestations include abnormal motor, sensory and psychic phenomena; recurrent seizures are usually referred to as EPILEPSY or "seizure disorder."
Concepts Disease or Syndrome (T047)
MSH D012640
SnomedCT 78538003, 246545002
Dutch gegeneraliseerde convulsie, convulsies gegeneraliseerd, gegeneraliseerde convulsies, convulsie; gegeneraliseerd, gegeneraliseerd; convulsie, Insult, gegeneraliseerd
French Convulsions généralisées, Convulsion généralisée, Crises généralisées
German generalisierte Konvulsion, Konvulsionen, generalisiert, Generalisierte Anfälle, Anfälle, generalisierte
Italian Convulsione generalizzata, Convulsioni generalizzate, Attacchi generalizzati
Portuguese Convulsões generalizadas, Convulsão generalizada, Crises Convulsivas Generalizadas
Spanish Convulsiones generalizadas, Convulsión generalizada, Crisis Convulsivas Generalizadas, convulsión generalizada (hallazgo), convulsión generalizada, crisis convulsiva generalizada (hallazgo), crisis convulsiva generalizada, crisis generalizada (hallazgo), crisis generalizada
Japanese 全身痙攣, ゼンシンケイレン
English generalized seizure, generalized convulsions (symptom), generalized convulsions, generalized seizures, generalized seizure (physical finding), seizure generalized, Convulsions generalised, Convulsions generalized, Generalized Seizure, Generalized Seizures, Seizure, Generalized, Seizures, generalized, epileptic fit, generalised seizure, seizures generalized, generalize seizures, generalizing seizures, Generalized convulsion (finding), Generalised seizure, Generalized seizure, Generalised fit, Generalized fit, Generalized seizure (finding), Generalized seizures, convulsions; generalized, generalized; convulsions, Generalized convulsion, NOS, Seizures, Generalized, Generalised convulsion, Generalized convulsion
Czech Křeče generalizované, Generalizované křeče, bilaterální záchvaty, generalizované záchvaty
Hungarian Generalizált görcsrohamok, Generalizált convulsiók, Generalizált convulsio
Norwegian Generaliserte anfall

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