tonic clonic seizure

   Clonic Tonic Seizures: Symptoms, 




Causes and Treatment

Clonic tonic seizures, formerly called "crises of great evil", consist of a type of generalized seizure. That is, it is an imbalance in brain activity that involves both hemispheres of the brain.

This results in people suffering from it losing consciousness and experiencing very strong muscle contractions. Since the abnormal electrical signals cause manifestations that affect the nerves, muscles or glands.

clonic tonic seizures

Most clonic tonic seizures have an unknown cause or appear spontaneously (called idiopathic). Although they occur frequently in people with epilepsy. On the other hand, they can also occur from a high fever, a low blood sugar level, or any brain injury. Drug or alcohol abuse is a factor that makes the person more prone to suffer from tonic clonic seizures, especially if they have a family history of seizures.

Some people may have clonic tonic seizures once in their life, and never experience them again. On the other hand, in others it may be part of a more serious condition that must be treated, such as epilepsy.

 In this case, the patient must follow certain recommendations and may need anticonvulsant drugs. Phases and symptoms of clonic tonic seizures

 The tonic clonic seizures are named for the 2 phases that appear in their development (tonic and clonic). However, prior to these, another stage known as "aura" may appear. Next, each of them is explained: Phase of the aura

 In this previous phase, the person suddenly experiences a strange sensation. Feelings of sadness, happiness, anger or fear for no apparent reason. That can make the person start screaming or crying involuntarily.

Similarly, alterations in the senses are presented as visual, tactile, auditory, gustatory or olfactory hallucinations. As well as a distorted spatial sensation, seeing objects larger or smaller than normal.

There may also be difficulties in speaking and a feeling of unreality or disconnection with the environment

 Another very typical sign of the aura is the "déjà vu", that is, to feel as if you had previously lived a new situation. Like the jamais vu, which means a sense of strangeness in a habitual situation. Tonic phase The tonic phase of tonic clonic seizures is characterized by great muscular rigidity and loss of consciousness.

This lasts around 15 or 30 seconds, and usually does not last more than a minute. At this stage, the back and neck arc. The muscles of the chest also contract, so there is great difficulty in breathing. This causes a choking sensation, and can also cause the skin of the face and lips to acquire a bluish tone.
The "epileptic scream" can also occur, which arises when the diaphragm and the vocal cords contract, expelling the air from the lungs outward. There is a mistaken belief that the person during tonic clonic seizures could "swallow their own tongue".

 Then you think you should put something in your mouth to avoid it. However, swallowing the tongue is impossible, and attempting to open the jaw when squeezing tightly can cause more harm than good.
 The real reason why a handkerchief or other object that can bite can be placed in the mouth is to avoid that in the next phase (clonic phase), it bites its own tongue or dental cheek. Clonic phase The last stage of clonic tonic seizures is the clonic phase. It is characterized by contractions and rapid muscle spasms.



 The muscles of the legs, head and elbows flex and then relax slowly. The frequency of spasms at the beginning is very high, but as time goes by it decreases little by little.

As the crisis passes, the person can emit deep sighs, as he gradually recovers a normal breathing rhythm.

The total duration of seizures can be from 1 to 3 minutes. If it lasts more than 5 minutes it is a medical emergency and urgent health intervention is necessary.

During this period the person does not react to stimuli, and is likely to remain unconscious for another few minutes. In these minutes you can define another phase called "postictal period". During this, the brain is very active trying to stop the neural impulses to stop the crisis and return to normal.

Gradually the person will wake up during the next 10 to 30 minutes. Subsequently, it may seem sleepy and confused. He also usually feels a great weakness or tiredness, as well as presenting headaches and muscles during the following 24 hours.
Causes

The nerve cells in the brain (called neurons) communicate with each other by sending electrical and chemical signals. The location of these signals tells us what the brain is doing; how to think, hear, see, feel or control the movement of muscles.

In people who have seizures, the electrical activity of the brain is abnormally synchronized. During crises, it becomes much more intense than normal.

This can occur in an isolated area of ​​the brain or in its entirety. When it happens throughout the brain, it is called generalized seizure. On the other hand, when it appears in a localized area, it is called focal or partial crisis. Clonic tonic seizures are a type of generalized seizures.

In most cases, the cause of clonic tonic seizures is unknown. When this happens, they are called idiopathic seizures. However, in other cases, clonic tonic seizures may appear as a consequence of other conditions.

However, it is important to note that seizures are more likely to occur if the person has a genetic predisposition to them. Each of us is more or less likely to suffer seizures. In some people they are triggered much more easily, while others do not suffer at any time in their lives.

Some conditions that can lead to the appearance of clonic tonic seizures are:

- Problems that affect the brain: convulsions can be a consequence of head injuries, strokes, tumors ... As well as infections that involve the central nervous system such as encephalitis, meningitis or brain abscess.

- Serious imbalances of substances in the blood, or alterations in the metabolism. For example, imbalances in the levels of sodium, calcium, magnesium or glucose (have more or less blood sugar than normal, as in diabetes.)

- Congenital anomalies: for example, there are genetic syndromes where clonic tonic seizures such as Batten's disease occur. Another hereditary syndrome that presents them is juvenile myoclonic epilepsy.

They are also facilitated by malformations in the blood vessels that can cause a stroke.

- Diseases such as high fever, high blood pressure (hypertension), eclampsia (seizures or coma during pregnancy), liver failure, kidney failure, lupus, among others.

- Reactions to certain medications and drugs. For example, side effects of certain anesthetic drugs, penicillin, anti-cancer drugs or for asthma. As they can appear by overdose of illegal drugs such as cocaine or amphetamines.

- Abstinence from alcohol or drugs.

- Other causes that facilitate tonic clonic seizures are sleep deprivation, high fever, flashing lights and intermittent noises.
Diagnosis



   There are several steps to perform the diagnosis of tonic-clonic seizures: -

 Medical history: the doctor will have an interview with the patient about other previous seizures or previous medical conditions. Information from people who were during the seizures may also be necessary to describe what happened.

It can be very useful for the doctor to also know what the person was doing before having seizures. This will help you know the reason that triggered them. -

 Neurological examination: consists of certain tests to check the balance, reflexes and coordination. It will also be necessary to evaluate muscle tone and strength.

This test also includes tests to detect abnormalities in memory, attention, or executive functions. -

Blood tests: this test is necessary to find other medical causes of the seizures. For example, it is advisable if you suspect diabetes or unevenness in certain substances present in the body. -

 Electroencephalogram (EEG) or Magnetic Resonance (MR). These are scanners that reflect possible anomalies in the functioning of the brain. It serves to observe in detail the electrical patterns of the brain, as well as to obtain images of certain areas of the brain.

Other circumstances must also be taken into account when diagnosing the patient. For example: -
Have hyperventilation or imbalances of electrolytes (which are chemical substances in the body such as calcium, magnesium, potassium or sodium). -

 Long QT syndrome (abnormality in potassium and sodium that reaches the heart, which can cause arrhythmias). -

Sleep apnea. -

Simple fainting. -

Spasms of sobbing or emotional apnea. The latter refers to episodes that occur in children where they stop breathing suddenly after intense emotion. -

Dystonia (continuous muscle contraction due to neurological reasons). -

 It is also necessary to make a differential diagnosis to rule out tonic-clonic seizures of other conditions, such as: complex partial seizures, confusional states, acute memory disorders, dizziness or dizziness, migraine variants, narcolepsy, syncope, among others. Forecast As mentioned above, suffering a single clonic tonic seizure from a single triggering factor does not usually have long-term effects. However, if a second attack occurs, the risk of a third occurrence is 80%. Doctors usually consider a second seizure as a sign of epilepsy.
People affected by tonic clonic seizures can lead a normal life if treated properly. For example, by controlling electrical or chemical differences in the brain or other underlying conditions, the problem may disappear. Certain complications can arise from tonic clonic seizures. The most commons are: -

Injuries to the head, tongue and lips. - Vertebral fractures. -

 Pneumonia due to aspiration. - Cardiac arrhythmia. -

Sudden death. The death rate for seizures is low, but may be higher in epilepsies accompanied by tonic clonic seizures. The incidence of sudden death in people with epilepsy is 24 times higher than in the general population. In these cases, there are certain risk factors. For example, the high frequency of seizures, a younger age, psychopathological problems or polytherapy (use of two or more drugs for the treatment of epilepsy).










It should be noted that people affected by seizures should avoid driving vehicles. As well as avoid manipulating dangerous equipment, swimming alone or swimming without anyone at home that can help them.
Treatment

There is no single treatment method for tonic clonic seizures. Each treatment must be adapted to the patient according to his diagnosis and his symptoms.

Many people are treated effectively through anticonvulsant drugs. It starts with a low dose that can be progressively increased according to medical indications. Although some patients need more than one medication to treat seizures.

Some of the most commonly used medications are carbamazepine, phenytoin, ocarbazepine, lamotrigine, phenobarbital and lorazepam.

It should be noted that some of these medications may interact with other drugs. For example, with oral contraceptives. Therefore, it is important to know what other medications the patient follows.

There are also other effective treatments. One of them that is beginning to be used and that gives very good results is neurofeedback. Through this technique, the electrical activity of the brain is regulated with reinforcing visual and / or auditory stimuli.

In this way, when the person has a more desirable brain electrical activity, sounds or videos that "reward" said activity appear.

In severe cases that resist treatment, surgery may be necessary. Although research indicates that surgery is more advisable for partial seizures, that is, those that affect only part of the brain.

Another method that has had positive results is the stimulation of the vagus nerve by placing an electrical device that stimulates it automatically.

On the other hand, to control seizures it is recommended not to consume alcohol or drugs. In addition to following a ketogenic diet, that is, high in protein and fat, and low in carbohydrates.

The ratio of proteins and fats to carbohydrates should be 4: 1. Studies have shown that it has seizure reduction efficacy in 50% of patients.

The ketogenic diet is generally used for intractable epilepsy, especially in children. It is prescribed less frequently in adults, because being a very restrictive diet it is difficult to comply with it.
Prevention of clonic tonic seizures

Certain simple actions in daily life can prevent the onset of clonic tonic seizures or their complications, for example:

- Take all the necessary precautions for driving vehicles. This is, the use of helmets on motorcycles, as well as seat belts and airbags.

- Handle food properly to avoid parasitic infections that can cause epilepsies.

- Reduce risk factors such as the consumption of alcohol, drugs, or tobacco. Maintain a healthy life avoiding sedentary lifestyle and controlling blood pressure and cholesterol.

- Rest properly, since sleep deprivation and stress can trigger seizures

References

    Generalized Seizures (Grand Mal Seizures). (s.f.) Retrieved on January 19, 2017, from Drugs.com: drugs.com.
    Generalized Tonic-Clonic Seizure. (s.f.) Retrieved on January 19, 2017, from Healthline: healthline.com.
    Generalized Tonic-Clonic Seizures. (June 30, 2015). Retrieved from Medscape: emedicine.medscape.com.
    Grand bad seizure. (June 10, 2014). Retrieved from MayoClinic: mayoclinic.org.
    Micheli, F. E., & Fernández Pardal, M. M. (2011). Neurology. Buenos Aires; Madrid: Panamericana Medical Publishing House.

   




  Tonic-clonic seizure. (s.f.). Retrieved on January 19, 2017, from the Epilepsy Foundation: epilepsy.com.     Tonic-Clonic (Grand Mal) Seizures. (s.f.). Retrieved on January 19, 2017, from Johns Hopkins Medicine: hopkinsmedicine.org