Tonic-clonic seizures, formerly called grand mal seizures, are the sort most people think of when “seizure” is mentioned. The most memorable and frightening type of seizure to the observer, they are the most common seizure type in children, although not in adults, and despite common misconceptions are unlikely to result in brain damage or in death.In a tonic-clonic seizure, the person initially stiffens and simultaneously loses consciousness (and thus is unaware of events). The stiffening is called the tonic phase and causes the individual to fall to the ground. The eyes “roll back in the head,” the head goes back, the back arches, and the arms stiffen, as do the legs. This is similar to what happens during a myoclonic, extensor seizure, but this tonic phase of a tonic-clonic seizure happens more slowly. The extension is continued for what seems like an eternity but rarely lasts more than thirty seconds.Since during this tonic (stiff) phase all the muscles are contracted, the chest muscles contract as well, and it is difficult for the person to breathe. He often turns somewhat blue about the lips and face (due as much to the face being flushed with the bluish blood of the veins as to the lack of oxygen). A child’s saliva may cause a gurgling sound in his mouth or throat.It is the blueness and gurgling sound that may cause observers to exclaim, “My God, he’s swallowed his tongue!” This is a common misconception. A person can’t swallow his tongue since it is attached to the back of the throat. “Quick, stick something in his mouth to keep him from biting his tongue!” someone else may advise, but this is bad advice. At the onset of the tonic phase of a seizure, the jaw becomes tightly clenched, and attempts to pry it open and put something in are likely to result in broken teeth.After the tonic phase of a tonic-clonic seizure, rhythmic jerking begins. This is the clonic phase. The fists are tightly clenched, the arms repeatedly flex at the elbows and then briefly relax. The legs flex at the hip and knee joint in a similar fashion; the head may flex and then fall backwards. These movements are rhythmic and rapid, initially several per second, but then slowing. They are not the flailing movements or trembling often seen in imitation (pseudo) seizures. This rhythmic jerking seems to last forever, although only occasionally does it last more than a few minutes. Then the jerking becomes less severe and occurs at a slower rate, finally ceasing. The end of the jerking is usually accompanied by a deep sigh, after which normal breathing resumes.*61\208\8*

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