Normally, the brain’s nerve cells (neurons) communicate with one another by firing tiny electric signals that pass from cell to cell. The firing pattern of these electric signals reflects how busy the brain is. The location of these signals indicates what the brain is doing, such as thinking, seeing, feeling, hearing, controlling the movement of muscles, etc.
A seizure occurs when the firing pattern of the brain’s electric signals suddenly becomes very abnormal and unusually intense, either in an isolated area of the brain or throughout the brain.
If the whole brain is involved, the electrical disturbance is called a generalized seizure. This type of seizure used to be called a grand mal seizure. The most easily recognizable symptom of a generalized seizure is the body stiffness and jerking limbs known as tonic-clonic motor activity.
Epilepsy is the condition of being prone to repeated seizures, but this can be any kind of seizures, not just generalized seizures. A person can have a seizure without having epilepsy. Today, seizure disorder is the term used more commonly than epilepsy.
A seizure can be provoked by any situation that seriously disturbs the physical or chemical environment of the brain. Some common triggers include:
- A severe chemical imbalance in the blood — Abnormal levels of blood acids, sodium, calcium or blood sugar (especially in diabetics)
- Drug reactions — Reactions to illegal drugs (crack cocaine, amphetamines and others), anesthetics or prescription medications (penicillin, anti-asthma drugs, anticancer drugs and many others)
- Drug withdrawal — Withdrawal from alcohol or sedatives
- Medical illnesses — Extreme high blood pressure (hypertension), eclampsia (a complication of pregnancy), liver failure, kidney failure, sickle-cell disease, systemic lupus erythematosus (lupus or SLE), and many others
- A local problem involving the brain — Head trauma, developmental brain disorders, stroke, brain tumors, and infections in or near the brain (brain abscess, encephalitis, meningitis)
- Other causes — High fever, sleep deprivation, starvation, flashing lights (even from video games), intermittent noise and, rarely, menstruation
If doctors can successfully treat the physical or chemical disturbance in the brain, the seizure problem often goes away. If not, seizures may return again and again, whenever the underlying problem flares up.
Sometimes, a person will experience an unprovoked generalized seizure, one that occurs for no apparent reason. In some people, this type of seizure may be related to a genetic (inherited) vulnerability that makes the brain cells unusually sensitive to minor changes in the environment.
In other cases, seizures may be related to scarring caused by prior head trauma or by a previous stroke, brain tumor or brain infection.
Many people who have one unprovoked seizure never experience a second one. However, if a second seizure occurs, the risk of having a third or even more is about 80 percent. For this reason, doctors often regard the second seizure as a sign of epilepsy.
What are the symptoms of grand mal seizures?
Symptoms of grand mal seizures are related to abnormal electrical activity in the brain, and include auras, muscle rigidity, and muscle spasms.
Aura symptoms of grand mal seizures
The aura is the initial phase of a grand mal seizure and may be marked by:
- Abnormal sensations
- Changes in hearing, taste or smell
- Dizziness or vertigo
- Loss of vision or changes in vision
- Tonic-clonic symptoms of grand mal seizures
Following the aura, the seizure will progress into tonic and clonic phases, which are marked by:
- Biting your cheek or tongue
- Incontinence (loss of control of urine or stools)
- Loss of consciousness
- Muscle contraction of the entire body (tonic phase, which usually lasts several seconds)
- Muscle twitching, spasms, or seizures of the entire body (clonic phase, which may last for a few minutes)
- Serious symptoms that might indicate a life-threatening condition
Grand mal seizures can be life threatening. Seek immediate medical care (call 911) for any seizure, as prompt medical treatment may reduce the risk and severity of future seizures.
If you have had symptoms of a seizure, your doctor will begin by looking for an underlying medical trigger, such as low blood sugar or eclampsia.
If your doctor can confirm a definite medical reason for your seizure, your treatment will be geared toward correcting the underlying illness.
If your seizure appears to be unprovoked (not triggered by any underlying medical problem), your doctor will review your medical history, family history and any eyewitness reports of your seizure symptoms.
Next, the doctor will do a thorough physical and neurological examination and order routine blood tests. In most cases, the results of your examinations and blood tests will be normal.
Your doctor also may order an electroencephalogram (EEG), a painless test that detects the electrical activity in your brain and translates it into a series of printed patterns. In 40 percent to 50 percent of people with epilepsy, the first EEG will show a specific combination of patterns that confirms the diagnosis.If the first EEG is normal, repeat EEG tests usually will detect the abnormal brain-wave pattern.
Sometimes, even when a series of EEG tests fails to show evidence of seizure activity, the diagnosis can be based on evidence from the reports of people who have seen your seizure episodes.
In some cases, the doctor may also order a magnetic resonance imaging (MRI) or computed tomography (CT) scan of your brain to look for evidence of a local problem, such as a brain tumor or scarring from a previous brain injury. These scans are especially important if:
- You are an adult with your first generalized seizure.
- You have an unusual pattern of symptoms.
- Your neurological exam is abnormal.
- You have a history of brain damage (birth trauma, head injury, train tumor, encephalitis, meningitis).
What causes grand mal seizures?
Grand mal seizures may occur just once or, if they recur, may be an indication of epilepsy. All seizures are caused by abnormal electrical activity in the brain, which may be a result of injury, illness, a genetic condition, or may have no known cause. In patients with epilepsy, a grand mal seizure may arise from a trigger, such as mental or physical stress.
Causes of grand mal seizures
Abnormal electrical activity in the brain may arise from a variety of causes, many of which can be serious or potentially life threatening including:
- Alcohol and drug withdrawal
- Brain infection
- Brain injury
- Brain tumor
- Certain genetic conditions such as phenylketonuria (inability to break down the amino acid phenylalanine)
- Encephalitis (inflammation and swelling of the brain due to a viral infection or other causes)
- Recent brain surgery
- Triggers of grand mal seizures
A single grand mal seizure, especially in people with epilepsy, may result from a trigger including:
- Consumption of alcohol or other drugs
- Emotional stress
- Lack of sleep
- Medication side effects
- Trauma to the head
What are the risk factors for grand mal seizures?
A number of factors increase the risk of developing grand mal seizures. Not all people with risk factors will get grand mal seizures. Risk factors for grand mal seizures include:
- Family history of certain genetic conditions
- Family history of epilepsy
- Recent brain surgery
- Recent head injury
- Recent infection of the brain
- Reducing your risk of grand mal seizures
If you are prone to seizures or have epilepsy, trigger avoidance may be the best way to avoid a grand mal seizure. Eating a balanced diet and leading a healthy lifestyle may also minimize your risk of seizure.
You may be able to lower your risk of grand mal seizures by:
- Avoiding alcohol and drugs
- Avoiding emotional stress
- Eating a healthy, balanced diet
- Following the treatment plan prescribed by your medical professional
- Getting enough sleep
About half of all people who have one unprovoked seizure never have another.
Most people who have epilepsy can avoid seizures if they get enough sleep and take prescribed medications as directed. Most people with epilepsy need to take medication indefinitely. Never stop medication without specific instructions from your physician.
If you have had only a couple of seizures and have a normal EEG, your doctor might reevaluate the need for medication if you have no seizures after two to five years.
Most of the time epilepsy cannot be prevented. But whether or not you have epilepsy, you can help prevent a generalized seizure by observing the following:
- Avoid using illegal drugs.
- Drink alcohol in moderation or not at all.
- Faithfully follow your doctor’s treatment plan if you have diabetes or high blood pressure.
- Protect yourself from head trauma by wearing seat belts and bicycle helmets. If you play sports, wear appropriate protective headgear.
- If you are pregnant, see your doctor regularly for prenatal care.
If you have had only one unprovoked seizure, you may not have another. For this reason, your doctor may decide to monitor your condition without prescribing medication.
In most cases, you will be considered to have a low risk of a second seizure if you have no history of brain injury (tumor, trauma, infections), no family history of epilepsy and normal results on diagnostic tests, including an EEG.
If you have had at least two seizure episodes and have been diagnosed with epilepsy, your doctor will treat you with an anti-epileptic medication (an anticonvulsant). Common anti-epileptic medications used to treat generalized seizures include valproate (Depakote), carbamazepine (Tegretol, Carbatrol and others), phenytoin (Dilantin), and topiramate (Topamax).
If your seizures cannot be controlled with one drug alone, your doctor will try a combination of two drugs.
When To Call a Professional
Call your doctor immediately if you or anyone in your family experiences a series of symptoms that appear to be a generalized seizure. If you already have been diagnosed with epilepsy, call your doctor if you continue to have seizures even though you are taking anti-epileptic medication.
If you witness someone having a generalized seizure that lasts for more than five minutes, call for emergency medical help immediately. Also call for emergency medical help immediately if you witness someone having a generalized seizure who:
- Does not awaken soon after the seizure is over
- Is a pregnant woman
- Is wearing medical identification jewelry stating that he or she has diabetes
- Has a seizure after head trauma
- Has a seizure while swimming
Many factors play a role in determining whether a person with generalized epilepsy eventually becomes seizure-free.
Overall, the outlook is best in those who have had very few seizures before beginning treatment, have good seizure control with only one anti-epileptic drug, have a normal EEG between seizures, have no history of brain damage, and have a normal neurological exam at the end of treatment.
In many cases, the outlook is very good. With proper treatment, up to 70 percent of people with epilepsy ultimately become seizure-free for five or more years. Eventually, about 30 percent are able to discontinue medication permanently.
Most children with generalized seizures can lead normal lives, including participating in organized sports, with minimal restrictions.
What are the potential complications of grand mal seizures?
Grand mal seizures may occur just once, in which case complications are limited. Recurrent seizures, however, may have a profound impact on your life. Complications of untreated or poorly controlled grand mal seizures can be serious, even life threatening in some cases.
You can help minimize your risk of serious complications by following the treatment plan you and your health care professional design specifically for you. Complications of grand mal seizures include:
- Absenteeism from work or school
- Brain damage
- Damage to your tongue or mouth due to biting during seizure
- Injury during seizure
- Pulmonary aspiration (inhaling blood, vomited material, or other substances into lungs)
- Status epilepticus (recurrent seizures without recovery)
- Withdrawal or depression