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Symptoms
By Mayo Clinic staffGrand 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.
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. If this happens, emergency care should be sought as quickly as possible.
Additionally, seek medical advice:
- When the number of seizures experienced increases significantly without explanation
- When new signs or symptoms of seizures appear
- Ropper AH, et al. Epilepsy and other seizure disorders. In: Ropper AH, et al. Adams and Victor's Principles of Neurology. 9th ed. New York, N.Y.: McGraw-Hill Medical Pub. Division; 2009. http://www.accessmedicine.com/content.aspx?aID=3632229. Accessed April 22, 2009.
- Seizures and epilepsy: Hope through research. National Institute of Neurological Disorders and Stroke. http://www.ninds.nih.gov/disorders/epilepsy/detail_epilepsy.htm?css=print. Accessed April 24, 2009.
- Seizure disorders. The Merck Manuals: The Merck Manual for Healthcare Professionals. http://www.merck.com/mmpe/print/sec16/ch214/ch214a.html. Accessed April 26, 2009.
- Stafstrom CE, et al. Pathophysiology of seizures and epilepsy. http://www.uptodate.com/index/home.html. Accessed April 17, 2009.
- Sheth RD. Epilepsy in infancy and childhood. In: Rakel RE, et al. Rakel & Bope: Conn's Current Therapy 2008. 60th ed. Philadelphia, Penn.: Saunders Elsevier; 2008. http://www.mdconsult.com/das/book/body/134947244-2/834264406/1621/460.html?printi. Accessed April 26, 2009.
- Elger CE. Modern management of epilepsy: A practical approach. Epilepsy and Behavior. 2008;12:501.
- Practice parameter update: Management issues for women with epilepsy - Focus on pregnancy (an evidence based review): Teratogenesis and perinatal outcomes. St. Paul, Minn.: American Academy of Neurology. http://www.neurology.org/cgi/content/abstract/WNL.0b013e3181a6b312v1. Accessed April 27, 2009.
- Britton JW (expert opinion). Mayo Clinic, Rochester, Minn. May 14, 2009.
