Trying to restrain someone who is having a seizure may cause her/him to become combative.

Tonic-clonic seizures, formerly known as grand mal seizures, comprise two stages: a tonic phase and a clonic phase. These intense seizures can be frightening to experience or observe, as extreme muscle spasms may temporarily arrest breathing.

What You Need to Know

• Tonic-clonic seizures involve both tonic (stiffening) and clonic (twitching or jerking) phases of muscle activity.
• Tonic-clonic seizures may start with a simple partial seizure or aura. The person may experience changes in sensation, mood or emotion leading up to the tonic-clonic seizure.
• If you are with someone who has a tonic-clonic seizure:
  1. Do not put anything in their mouth.
  2. Turn them onto their side.
  3. Make sure the area around their body is clear of objects that could hurt them.
  4. Time the seizure.
• Treatment for tonic-clonic seizures can involve medication, surgery, nerve stimulation, dietary therapy or a combination of these approaches.

Symptoms of a Tonic-Clonic (Grand Mal) Seizure

Aura

The seizure may start with a simple or complex partial seizure known as an aura. The person may experience abnormal sensations such as a particular smell, vertigo, nausea, or anxiety. If the person is familiar with having seizures, they may recognize the warning signs of a seizure about to begin.

Tonic Activity

When the tonic-clonic seizure begins, the person loses consciousness and may fall. Strong tonic spasms of the muscles can force air out of the lungs, resulting in a cry or moan, even though the person is not aware of their surroundings. There may be saliva or foam coming from the mouth. If the person inadvertently bites their tongue or cheek, blood may be visible in the saliva.

Stiffness of the chest muscles may impair breathing, the person’s face may look bluish or gray, and he or she may make gasping or gurgling sounds.

Clonic Activity

Jerking movements affect the face, arms and legs, becoming intense and rapid. After one to three minutes, the jerking movements slow down and the body relaxes, sometimes including the bowel or bladder. The person may let out a deep sigh and return to more normal breathing.

After the Seizure (Postictal Period)

After a seizure, the person may remain unconscious for several minutes as the brain recovers from the seizure activity. He or she may appear to be sleeping or snoring.

Gradually the person regains awareness and may feel confused, exhausted, physically sore, sad or embarrassed for a few hours. The person may not remember having a seizure, and may have other memory loss. Occasionally, people may have abnormal or combative behavior after a tonic-clonic seizure while the brain is recovering.

What to Do If Someone Has a Tonic-Clonic (Grand Mal) Seizure

Witnessing a person having a tonic-clonic seizure can be upsetting, but it’s important to remember that most seizures resolve on their own after one to three minutes. To offer assistance:

• Protect the person from injury by helping them to the floor and clearing away furniture or other items. Do not attempt to hold the person still.

• Do not put anything in the person’s mouth. It is physically impossible to swallow one’s tongue, and putting things in the mouth may lead to injury.

• Time the seizure.

• A seizure lasting more than 5 minutes is an emergency. Call 911.

• Calm reassurance can be helpful to a person who is recovering from a seizure.

Diagnosis and Treatment of Tonic-Clonic (Grand Mal) Seizures

After a person’s first seizure, it is important to consult with a physician. Parents or family members who observe the seizure can note the details and help create a written report that the person can take to the doctor. A video recording of the event (if available) can also aid in diagnosis.

To ascertain the cause of the seizure, the doctor may prescribe magnetic resonance imaging (MRI) or other tests to look for scarred areas in the brain. Electroencephalography (EEG) can help distinguish seizure disorders from other conditions.

If the doctor determines the person has a seizure disorder such as epilepsy, an individualized approach to treatment can help manage it. A range of therapies, including anti-seizure medication, nerve stimulation, dietary therapy and surgical procedures can address the seizures and, in many cases, bring them under control.

Imagine you're at the movie theater when, suddenly, the guy in front of you in the concession line falls to the ground, shaking violently, popcorn spilling everywhere—he's having a seizure. Or you're talking to your mom at the mall when her arm starts twitching and she stares blankly, unresponsive to your voice.

What would you do? What should you do?

Many of us would probably freeze or freak out. Seizures can be absolutely terrifying. Some are totally disabling, while others aren't as obvious—in each case, it's what happens when electrical activity in the brain goes haywire. And chances are, you know someone who's had one. About 3.4 million people in the U.S. live with epilepsy, according to the CDC. But you can have a seizure for a lot of other reasons, too. That's why Eat This, Not That! Health talked with medical experts to find out how to help someone having a seizure.

We know, this is a hard one. Seizures can be scary if you've never seen one. Watching someone you care about drop to the ground with convulsions is one of the hardest things you can imagine. But now is not the time to panic. "Take a deep breath, and don't get scared," says Patty Shafer RN, MN, senior director for health information with the Epilepsy Foundation. "Helping someone having a seizure is easy. Remember these three things: Stay. Safe. Side. Just stay with them, keep them in a safe place, and turn them on their side if they lose consciousness."

You might be surprised to hear that not everyone has convulsive seizures. "Seizures might look like a tonic-clonic seizure—you shake, have very rigid body tone, collapse and lose your consciousness," says Dr. Lance Lee, a neurologist from Glendale, California. "But it can also be that you're staring and not responding. Some people just pick on things, or twitch involuntarily, one arm or leg shaking uncontrollably." Some people even wander around during seizures. So make sure they don't walk into traffic, or fall down stairs—they won't be aware of their surroundings.

When someone has a seizure, they may foam at the mouth, turn rigid, and pass out—their skin may even turn a little blue. Don't try to give them rescue breaths or CPR unless instructed to by emergency personnel. "Their heart will be pounding like crazy, and their blood pressure shoots up, so it's the opposite state of cardiac arrest," says Dr. Lee. "So CPR isn't needed because their heart is working." During a tonic-clonic seizure, it might look like the person has stopped breathing – this happens when their chest muscles tighten. Their breathing will slowly return to normal as their muscles relax.

One of the most important things you can do to help someone having a seizure is to turn them onto their side if they fall. "A person having a seizure could drool or vomit, and then choke if they're on their back," says Dr. Elizabeth Felton MD, Ph.D., Assistant Professor in the Department of Neurology at the University of Wisconsin-Madison.

Convulsive seizures sometimes make a person shake violently. You should never try to restrain someone having a seizure—this can lead to injury. According to the Epilepsy Foundation, people don't fight on purpose during a seizure, but if you restrain them when they're already confused, it could make the person more agitated and aggressive.

People sometimes worry that a person having a seizure will swallow their tongue, so they try to force a stick into their mouth to bite down on. But that's dangerous. First of all, they're having uncontrolled convulsions, so they could bite you severely. Or choke on whatever it is you're trying to give them. "Do not put anything into their mouth—that includes your fingers!" says Dr. Felton.

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Making sure the person is in a safe environment during a seizure is critical—so if you see it happen, stay by their side. Encourage other onlookers to step back and give the person some room. It can be confusing and embarrassing to wake up on the floor surrounded by the frightened faces of complete strangers. Do your best to explain calmly what happened, who and where you are, and don't leave until they're ready for you to do so.

If someone has a seizure in the water, get them out and call 911. Drowning is a major risk factor. "You can drown when you have a seizure in water, whether you're in a swimming pool or a bathtub," says Shafer. "If you fall facedown, it only takes a half-inch of water to cover your airways."

Try to time the seizure if you have your watch or iPhone. If it lasts five minutes or longer, it's time to call 911. "Seizures that last too long can cause complications, and that's a medical emergency," says Shafer. She recommends you call 911 if it's the person's first seizure, or they're injured, pregnant, or they have more than one seizure in a row without regaining consciousness.

It's not safe to put anything into a person's mouth when they're having a seizure. If they're not fully awake and don't know what's going on, or having convulsions, they might choke. "Some people with epilepsy are prescribed rescue medication, which is used either during a prolonged seizure to help stop it or after a seizure to prevent more than one at a time," says Dr. Felton. "If the rescue medication is a pill, it shouldn't be given during a seizure if they're out of it."

It takes time to recover from an electrical storm in your brain. The postictal phase is the technical name for the time immediately following a seizure when your brain and body begin to recover. It usually lasts between 5 and 30 minutes, but can be longer in the case of more severe seizures. "Some patients may be confused or seem 'out of it' for a while," says Dr. Felton. The person will be in an altered state during this phase, and may experience memory loss, sleepiness, headaches, nausea or speech impairment. In rare cases, patients may experience postictal psychosis, characterized by hallucinations, paranoia and aggression. Call 911 if you suspect postictal psychosis.

Seizures are a telltale symptom of epilepsy, but you can have seizures without being diagnosed with the condition. "We really look at whether it was a provoked or unprovoked seizure to help determine whether a person has epilepsy," says Dr. Lee. "Unprovoked means the person is otherwise healthy, no fever, no drugs, normal brain scan, and out of the blue they're having a seizure. Provoked seizures happen because of a reason. You have meningitis, a bladder infection, you had a high fever, your electrolytes are out of control, your body is under a lot of stress. That can happen to anybody. I could have a fever of 105 and have a seizure. That doesn't mean you have epilepsy. And as a physician, I wouldn't treat those seizures at all. I would treat the fever. There's a huge difference."

Speaking of medications—if you have epilepsy, keeping up with your treatment regimen is essential. "We have a lot of excellent medications to treat seizures," says Dr. Lee. "Sometimes people worry about the side effects, but there is so much more benefit than harm in these medications. When you have a seizure, you could fall in the bathroom alone and hit your head. You could be driving and crash your car, and end up killing yourself or someone else. That's the kind of consequences we're talking about." Medications are very effective when taken properly—according to the Epilepsy Foundation, they work in 7 out of 10 people, so don't stop taking them without the advice of your doctor. And to live your happiest and healthiest life, don't miss these 70 Things You Should Never Do For Your Health.

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