Grand mal seizures have two stages:
- Tonic phase. Loss of consciousness occurs, and the muscles suddenly contract and cause the person to fall down. This phase tends to last about 10 to 20 seconds.
- Clonic phase. The muscles go into rhythmic contractions, alternately flexing and relaxing. Convulsions usually last for less than two minutes.
The following signs and symptoms occur in some but not all people with grand mal seizures:
- Aura. Some people experience a warning feeling (aura) before a grand mal seizure. This warning varies from person to person, but may include feeling a sense of unexplained dread, a strange smell or a feeling of numbness.
- A scream. Some people may cry out at the beginning of a seizure because the muscles around the vocal cords seize, forcing air out.
- Loss of bowel and bladder control. This may happen during or following a seizure.
- Unresponsiveness after convulsions. Unconsciousness may persist for several minutes after the convulsion has ended.
- Confusion. A period of disorientation often follows a grand mal seizure. This is referred to as postictal confusion.
- Fatigue. Sleepiness is common after a grand mal seizure.
- Severe headache. Headaches are common but not universal after grand mal seizures.
When to see a doctor
If you see someone having a seizure:
- Call for medical help.
- Gently roll the person onto one side and put something soft under his or her head.
- Loosen tight neckwear.
- Don't put anything in the mouth — the tongue can't be swallowed and objects placed in the mouth can be bitten or inhaled.
- Don't try to restrain the person.
- Look for a medical alert bracelet, which may indicate an emergency contact person and other information.
- Note how long the seizure lasts.
A grand mal seizure lasting more than five minutes, or immediately followed by a second seizure, should be considered a medical emergency in most people. This is also a medical emergency if the person is pregnant, injured or diabetic. Seek emergency care as quickly as possible.
Additionally, seek medical advice for you or your child:
June 10, 2014
- When the number of seizures experienced increases significantly without explanation
- When new signs or symptoms of seizures appear
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- Schachter SC. Evaluation of the first seizure in adults. http://www.uptodate.com/home. Accessed March 11, 2014.
- Seizure disorders. The Merck Manuals: The Merck Manual for Health Care Professionals. http://www.merckmanuals.com/professional/neurologic_disorders/seizure_disorders/seizure_disorders.html. Accessed March 11, 2014.
- Schmidt D, et al. Drug treatment of epilepsy in adults. British Medical Journal. 2014;348:g254.
- FDA Drug safety communication: Aseptic meningitis risk with use of seizure drug Lamictal. U.S. Food and Drug Administration. http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/ucm221847.htm. Accessed March 12, 2014.
- Ahmed R, et al. Epilepsy in pregnancy. Australian Family Physician. 2014;43:112.
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