Neurological Disorders: Grand mal seizure

Grand mal seizure is a type of seizure disorder (or fits disorder) and it is generally a manifestation of the disease of the brain.

The expression “generally” is used above because sometimes this seizure is just a neurological manifestation of an underlying systemic disease like electrolyte disturbances like hypoglycemia (low blood glucose) or low blood sodium etc and in these situations there is no actual brain pathology involved rather the seizure is caused due to brain irritation from a non brain cause.

If term grand-mal-epilepsy is used then it indicates there is a brain pathology causing this seizure, also the seizures present in recurrent fashion to fulfill the definition of epilepsy.

The preferred term now-a-days for this seizure is generalized tonic clonic convulsions (GTC).

As the name implies it is a generalized type of seizure, means the seizure manifestations are seen diffused involving all four extremities. In focal seizures only one limb or one side of the body is involved.

A GTC may be primary or secondary. In primary type (also known as idiopathic) no known structural or other pathologies exist to explain the cause of the seizure. There may be a family history but not more than that. This type of seizure is associated with certain primary epilepsy syndromes like JME (Juvenile Myoclonic Epilepsy).

• Brain tumors (primary or metastatic)
• Head injuries
• Stroke
• Scar tissue
• Medication side effect e.g. tramadol, bupropion
• Infections like encephalitis or meningitis
• Electrolyte abnormalities (e.g. low blood sodium etc)

See that the cause may not be always found or a secondary seizure then the preferred term is cryptogenic epilepsy.

A seizure may pass through 3 distinct phases called as

1) Aura
2) Actual seizure attack
3) Post ictal state.

Aura occurs at the beginning of a seizure. Not all seizures will present with aura. This could be almost any manifestations including experiencing strange smell, taste etc.

During the actual seizure attack patient quickly passes out. Initially there will be stiffening of the extremities and body followed by rhythmic convulsive movements (shaking). Patient may bite the tongue. Bowel and/or bladder incontinence can occur too.

Post ictal state occurs after the seizure. Not all types of seizures will have a post ictal state but a grand mal seizure will always have this phase. During this phase patients are unconscious and remain sleepy even after the actual seizure attack is over. Some patients may regain consciousness and awareness quickly but many patients appear groggy, sleepy confused for varying amount of time after the tonic-clonic activities are over.

A neurologist is frequently involved in the care of these patients.