Grand Mal Seizure
Grand mal seizure, also known as the generalized tonic-clonic seizure, is a subgroup of one of the two broad categories of seizures. These seizures arise from abnormal electrical impulses produced throughout the entire brain. It is the most common type of generalized seizure; the type people would always visualize whenever seizures are mentioned.
Grand mal seizure has three phases: the tonic phase, the clonic phase and the postictal or after seizure phase.
The symptoms of Grand mal seizures are phase-specific. Sometimes, people might experience either of the phases without the other.
The tonic phase is characterized by loss of consciousness, stiffening of muscles due to sudden contraction, which makes the person fall. The person is also experiencing a problem know as tongue swallowing. This is prevented by inserting something into the patient’s mouth. However, this hurts the patient the more tightly the jaw is closed.
The Clonic Phase
The clonic phase is marked by rhythmic contraction of muscles with alternate flexing and relaxation. The initial signs of the clonic phase are muscle spasms. The frequency of flexing and relaxation of muscles gradually comes down until jerking stops. Usually, the person would sigh deeply and then start breathing normally. The clonic phase can last for a minute or more.
The Postictal or After-Seizure phase
It occurs after the tonic and clonic phase. The person goes into a deep sleep due to fatigue and confusion. Also during the postictal phase, the patient may experience severe headaches and unconsciousness may persist for minutes after convulsion has ceased. This period is marked by a tremendous activity of the brain which tries to bring the brain cells under control to stop the seizure.
Abnormal synchronization of electrical impulses throughout the brain causes seizures. This happens through the intercommunication between brain cells across their synapses or gap junctions.
Most cases of Grand mal seizures are caused by epilepsy. However, there are other conditions that can create Grand mal seizures.
- 1. Injuries – Traumatic injuries such as head injuries, injury due to previous lack of oxygen and stroke.
- 2. Infections such as encephalitis, meningitis or history of such infections.
- 3. Congenital or developmental abnormalities such as blood vessel malformations in the brain, genetic syndromes, and brain tumors.
- 4. Metabolic disturbances such as very low levels of blood glucose, sodium, calcium or magnesium.
- 5. Syndromes related to withdrawal from alcohols and drugs.
Diagnostic procedures employed in the diagnosis of grand mal seizures include:
- 1. A neurological examination which tests the muscle condition such as reflexes, muscle tone, muscle strength and sensory function. It also tests motor symptoms such as gait, posture, coordination, and balance.
- 2. A test of intellectual to assess thinking, judgment, and memory using appropriate questions.
- 3. Blood tests such as determination of blood glucose levels, estimation of sodium, calcium and magnesium levels.
- 4. Brain scan using EEG – Electroencephalogram which shows the electrical activity of the brain. Abnormal brain wave patterns are seen in epileptic patients even in the absence of seizures. The EEG result is compared with the observable symptoms which occur in the seizure process to help determine the type of seizure the patient had for best treatment options.
- 5. Brain scan using computerized tomography (CT) or magnetic resonance imaging (MRI). These produce images of the brain and can reveal structural abnormalities, cyst, and tumors.
Most people experience Grand mal seizures once in a lifetime. Moreover, people who have had grandma seizures need to take daily anti-seizure medications to prevent future occurrence. Some physicians would not start treatment until second or repeated seizures occur.
Treatment is usually based on an individual’s symptoms and the accompanying diagnosis. Available therapy includes medical therapy, nerve stimulation, dietary therapy or surgery.
Anti-seizure medications, e.g., carbamazepine, phenytoin, and Gabapentin are used. Single medications are quite effective in epileptic patients. While in non-epileptic patients a combination of drugs is mostly required.
Other care and support include giving patients emergency bracelets to wear always to help emergency caregiver know which drugs to use or not use.
Stem Cell Treatment of Grand Mal Seizure
Drugs used for epilepsy work well for only a few people. There is a need for more effective therapies. Recent laboratory experiments suggest that soon, stem cell therapy would be a better and safer solution to epilepsy, including Grand mal seizure. Two approaches have been considered.
- 1. Transplantation of neurons – in this approach, neurons of inhibitory activity are formed from stem cells, from a part of the brain responsible for inhibitory activity.
- 2. Induced pluripotent stem cells – here cells of the connective tissue of the epileptic patient are collected and used to create stem cells of any type of cell in the body. These cells can then be made into neurons.