Epilepsy - Tonic-clonic seizures

Medium urgency
Very common-

Type of seizures caused by a general irritation of the brain which is accompanied by a loss of consciousness.

Sometimes, the cause remains unknown although these seizures are highly associated to traumas, infections, malignancies, and genetic and toxic substances that irritate brain tissues.

Tonic-clonic seizures go through three phases: the first one in which the patient's muscles stiffen; the second one in which they lose consciousness and start making generalised and repetitive movements; and the third one in which the patient wakes up, become bed-ridden, slow in thought and with amnesia of what happened.

Diagnosis is made by reviewing the patient's medical history, performing a full physical examination and an electroencephalogram. Additional imaging tests may be performed to complete the study. 

Treatment is based on correcting the triggering cause and antiepileptic drugs, which also help to prevent further episodes.

Bibliographic references
  1. Christian M Korff, Elaine Wirrell. ILAE classification of seizures and epilepsy. UpToDate. Oct 20, 2015.
  2. Steven C Schachter. Evaluation of the first seizure in adults. UpToDate. Aug 11, 2016.
  3. Steven C Schachter. Overview of the management of epilepsy in adults. UpToDate. Oct 12, 2016.
  4. Fountain NB, Van Ness PC, Swain-Eng R, et al. Quality improvement in neurology: AAN epilepsy quality measures: Report of the Quality Measurement and Reporting Subcommittee of the American Academy of Neurology. Neurology 2011; 76:94.
  5. Glauser T, Ben-Menachem E, Bourgeois B, et al. Updated ILAE evidence review of antiepileptic drug efficacy and effectiveness as initial monotherapy for epileptic seizures and syndromes. Epilepsia 2013; 54:551.
  6. Lowestein DH. Convulsiones y epilepsia.Harrison. Manual de Medicina. 16º edición. 929-937.
Author
Dr. Sara Vitoria
Copyright
© TeckelMedical 2026

Symptoms

    Seizures


    Confusion after seizure


    Difficulty remembering what happened after seizure


    Muscle stiffness due to a contraction


    Coma

Pre-hospital care recommendations

Move away all the objects that could harm the person during the crisis.
Try to place a pillow under the head.
Do not insert objects or the fingers in the person's mouth.
Turn the person onto their side during the seizures.