Tonic-clonic

A tonic-clonic seizure is what most people think of when they think of a seizure.

Fast facts

• Tonic-clonic seizures used to be called grand mal seizures
• When a tonic-clonic seizure has a generalised onset it’s called a generalised tonic-clonic seizure
• Tonic-clonic seizures can have a focal onset and then spread to affect both sides of the brain. When this happens it’s called a focal to bilateral tonic-clonic seizure
• Focal to bilateral tonic-clonic seizures may begin with the symptoms of a focal seizure. This can act as warning that a tonic-clonic seizure is on the way. Some people call this an aura
• Typically, a tonic-clonic seizure will last 1 to 3 minutes

A tonic-clonic seizure lasting more than 5 minutes, or going from one seizure into another without recovering in between, is a medical emergency.

What happens

There are a range of symptoms during a tonic-clonic seizure. The seizure happens in 2 phases: the tonic phase, followed by the clonic phase.

1. During the tonic phase:

• Loss of consciousness – you won’t be aware of what’s happening
• Muscles going stiff and falling to the floor, if standing
• A sound like you are crying out. If you cry out it’s the sound of the air being squeezed out of the lungs, not because you’re in pain

2. During the clonic phase:

• Quick and rhythmic jerking or convulsions of your body
• Losing control of your bladder and/or bowels
• A blue tinge around the mouth, if your breathing is affected
• Dribbling, and if you’ve bitten your tongue or mouth the dribble could have blood in it

If you have tonic-clonic seizures

It’s helpful for others to:

• Assess the situation – is there a risk of injury? Remove any nearby objects that could cause you injury
• Cushion your head (with a jumper, for example) to protect your head from injury
• Time the seizure – if the seizure lasts longer than 5 minutes call an ambulance
• When the seizure is over and the shaking has stopped, put you on your side in the recovery position
• Stay with you until you have come round and recovered
• Be calm and reassuring

It’s not helpful to:

• Try to move you
• Try to bring you round – it’s not possible
• Restrain you
• Put anything in your mouth
• Give you any food or drink, until you have fully recovered

When to call an ambulance

People should call for an ambulance if:

• They know it’s your first seizure or
• The seizure continues for more than 5 minutes or
• You have one tonic-clonic seizure after another without recovering in between
• You have an injury during the seizure that needs urgent medical attention

After the seizure

Afterwards, you may have a headache or difficulty remembering what happened and feel tired or confused. You might want to sleep and it can take a few days to feel fully recovered.

Sometimes people experience a temporary weakness or can’t move part of their body after a seizure. This is called Todd’s paresis or Todd’s paralysis. It can last from a few minutes to a few days before going away.

Keeping a seizure diary really helps people to understand their seizures better.

What percentage of your seizures are you recording in a seizure diary?

Go to the Seizures menu