Tonic-clonic seizure
(Grand mal)
Begin with abrupt loss of consciousness, usually no warning or aura
Attack last 60 to 90 seconds.
Tonic phase
- Patient suddenly becomes rigid, trunk and extremities are extended, and the patient falls to the ground.
- Patient is often apnoeic during this period (may be cyanotic)
- Often urinate and/or vomit.
Clonic phase
- Coarse trembling evolving into a symmetrical rhythmic jerking of the trunk and extremities
After the attack
- Flaccid, unconscious
- Often deep rapid breathing
- Consciousness returns gradually
- Post-ictal confusion and fatigue may persist for several hours.