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class="interlanguage-link interwiki-ca mw-list-item"><a href="https://ca.wikipedia.org/wiki/Crisi_convulsiva_tonicocl%C3%B2nica" title="Crisi convulsiva tonicoclònica – Catalan" lang="ca" hreflang="ca" data-title="Crisi convulsiva tonicoclònica" data-language-autonym="Català" data-language-local-name="Catalan" class="interlanguage-link-target"><span>Català</span></a></li><li class="interlanguage-link interwiki-cs mw-list-item"><a href="https://cs.wikipedia.org/wiki/Epilepsie_pouze_s_generalizovan%C3%BDmi_tonicko-klonick%C3%BDmi_z%C3%A1chvaty" title="Epilepsie pouze s generalizovanými tonicko-klonickými záchvaty – Czech" lang="cs" hreflang="cs" data-title="Epilepsie pouze s generalizovanými tonicko-klonickými záchvaty" data-language-autonym="Čeština" data-language-local-name="Czech" class="interlanguage-link-target"><span>Čeština</span></a></li><li class="interlanguage-link interwiki-de mw-list-item"><a href="https://de.wikipedia.org/wiki/Konvulsion" title="Konvulsion – German" lang="de" hreflang="de" data-title="Konvulsion" data-language-autonym="Deutsch" data-language-local-name="German" class="interlanguage-link-target"><span>Deutsch</span></a></li><li class="interlanguage-link interwiki-es mw-list-item"><a href="https://es.wikipedia.org/wiki/Crisis_convulsivas_t%C3%B3nico-cl%C3%B3nicas" title="Crisis convulsivas tónico-clónicas – Spanish" lang="es" hreflang="es" data-title="Crisis convulsivas tónico-clónicas" data-language-autonym="Español" data-language-local-name="Spanish" class="interlanguage-link-target"><span>Español</span></a></li><li class="interlanguage-link interwiki-fr mw-list-item"><a href="https://fr.wikipedia.org/wiki/Crise_d%27%C3%A9pilepsie_g%C3%A9n%C3%A9ralis%C3%A9e_tonico-clonique" title="Crise d'épilepsie généralisée tonico-clonique – French" lang="fr" hreflang="fr" data-title="Crise d'épilepsie généralisée tonico-clonique" data-language-autonym="Français" data-language-local-name="French" class="interlanguage-link-target"><span>Français</span></a></li><li class="interlanguage-link interwiki-ga mw-list-item"><a href="https://ga.wikipedia.org/wiki/Taom_t%C3%B3nach_cl%C3%B3nach" title="Taom tónach clónach – Irish" lang="ga" hreflang="ga" data-title="Taom tónach clónach" data-language-autonym="Gaeilge" data-language-local-name="Irish" class="interlanguage-link-target"><span>Gaeilge</span></a></li><li class="interlanguage-link interwiki-ko mw-list-item"><a href="https://ko.wikipedia.org/wiki/%EC%A0%84%EC%8B%A0%EA%B0%95%EC%A7%81%EA%B0%84%EB%8C%80%EB%B0%9C%EC%9E%91" title="전신강직간대발작 – Korean" lang="ko" hreflang="ko" data-title="전신강직간대발작" data-language-autonym="한국어" data-language-local-name="Korean" class="interlanguage-link-target"><span>한국어</span></a></li><li class="interlanguage-link interwiki-hy mw-list-item"><a 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data-mw-deduplicate="TemplateStyles:r1236090951">.mw-parser-output .hatnote{font-style:italic}.mw-parser-output div.hatnote{padding-left:1.6em;margin-bottom:0.5em}.mw-parser-output .hatnote i{font-style:normal}.mw-parser-output .hatnote+link+.hatnote{margin-top:-0.5em}@media print{body.ns-0 .mw-parser-output .hatnote{display:none!important}}</style><div role="note" class="hatnote navigation-not-searchable">"Grand mal" redirects here. For other uses, see <a href="/wiki/Grand_Mal_(disambiguation)" class="mw-redirect mw-disambig" title="Grand Mal (disambiguation)">Grand Mal (disambiguation)</a>.</div> <p class="mw-empty-elt"> </p> <div class="shortdescription nomobile noexcerpt noprint searchaux" style="display:none">Medical condition</div><style data-mw-deduplicate="TemplateStyles:r1257001546">.mw-parser-output .infobox-subbox{padding:0;border:none;margin:-3px;width:auto;min-width:100%;font-size:100%;clear:none;float:none;background-color:transparent}.mw-parser-output .infobox-3cols-child{margin:auto}.mw-parser-output .infobox .navbar{font-size:100%}@media screen{html.skin-theme-clientpref-night .mw-parser-output .infobox-full-data:not(.notheme)>div:not(.notheme)[style]{background:#1f1f23!important;color:#f8f9fa}}@media screen and (prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .infobox-full-data:not(.notheme) div:not(.notheme){background:#1f1f23!important;color:#f8f9fa}}@media(min-width:640px){body.skin--responsive .mw-parser-output .infobox-table{display:table!important}body.skin--responsive .mw-parser-output .infobox-table>caption{display:table-caption!important}body.skin--responsive .mw-parser-output .infobox-table>tbody{display:table-row-group}body.skin--responsive .mw-parser-output .infobox-table tr{display:table-row!important}body.skin--responsive .mw-parser-output .infobox-table th,body.skin--responsive .mw-parser-output .infobox-table td{padding-left:inherit;padding-right:inherit}}</style><table class="infobox ib-medical-condition"><tbody><tr><th colspan="2" class="infobox-above" style="background:#ccc">Generalized tonic–clonic seizure</th></tr><tr><th scope="row" class="infobox-label">Other names</th><td class="infobox-data">Grand mal seizure, tonic–clonic seizure</td></tr><tr style="background-color: #f8f9fa;"><td colspan="2" class="infobox-full-data"><span class="mw-default-size" typeof="mw:File/Frameless"><a href="/wiki/File:Spike-waves.png" class="mw-file-description"><img alt="The electroencephalogram recording of a person with childhood absence epilepsy showing a seizure. The waves are black on a white background." src="//upload.wikimedia.org/wikipedia/commons/thumb/2/26/Spike-waves.png/220px-Spike-waves.png" decoding="async" width="220" height="230" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/2/26/Spike-waves.png/330px-Spike-waves.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/2/26/Spike-waves.png/440px-Spike-waves.png 2x" data-file-width="478" data-file-height="500" /></a></span></td></tr><tr><td colspan="2" class="infobox-full-data">Generalized 3 Hz <a href="/wiki/Spike-and-wave" title="Spike-and-wave">spike-and-wave</a> discharges on an <a href="/wiki/Electroencephalogram" class="mw-redirect" title="Electroencephalogram">electroencephalogram</a></td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Medical_specialty" title="Medical specialty">Specialty</a></th><td class="infobox-data"><a href="/wiki/Neurology" title="Neurology">Neurology</a></td></tr></tbody></table> <p>A <b>generalized tonic–clonic seizure</b>, commonly known as a <b>grand mal seizure</b> or <b>GTCS</b>,<sup id="cite_ref-1" class="reference"><a href="#cite_note-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> is a type of <a href="/wiki/Generalized_seizure" class="mw-redirect" title="Generalized seizure">generalized seizure</a> that produces bilateral, convulsive <a href="/wiki/Tonic_(physiology)" title="Tonic (physiology)">tonic</a> and <a href="/wiki/Clonic" class="mw-redirect" title="Clonic">clonic</a> muscle contractions. Tonic–clonic seizures are the <a href="/wiki/Seizure_type" class="mw-redirect" title="Seizure type">seizure type</a> most commonly associated with <a href="/wiki/Epilepsy" title="Epilepsy">epilepsy</a> and seizures in general and the most common seizure associated with <a href="/wiki/Metabolic_disorder" title="Metabolic disorder">metabolic imbalances</a>.<sup id="cite_ref-:0_2-0" class="reference"><a href="#cite_note-:0-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> It is a misconception that they are the sole type of seizure, as they are the main seizure type in approximately 10% of those with epilepsy.<sup id="cite_ref-:0_2-1" class="reference"><a href="#cite_note-:0-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> </p><p>These seizures typically initiate abruptly with either a <a href="/wiki/Focal_seizure" title="Focal seizure">focal</a> or <a href="/wiki/Generalized_seizure" class="mw-redirect" title="Generalized seizure">generalized</a> onset. A <a href="/wiki/Prodrome" title="Prodrome">prodrome</a> (a vague sense of impending seizure) may also be present before the seizure begins. The seizure itself includes both tonic and clonic contractions, with tonic contractions usually preceding clonic contractions. After these series of contractions, there is an extended <a href="/wiki/Postictal_state" title="Postictal state">postictal state</a> where the person is unresponsive and commonly sleeping with loud snoring. There is usually pronounced confusion upon awakening.<sup id="cite_ref-:1_3-0" class="reference"><a href="#cite_note-:1-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup> </p> <meta property="mw:PageProp/toc" /> <div class="mw-heading mw-heading2"><h2 id="Causes">Causes</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Generalized_tonic%E2%80%93clonic_seizure&action=edit&section=1" title="Edit section: Causes"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>The vast majority of generalized seizures are <a href="/wiki/Idiopathic" class="mw-redirect" title="Idiopathic">idiopathic</a>.<sup id="cite_ref-4" class="reference"><a href="#cite_note-4"><span class="cite-bracket">[</span>4<span class="cite-bracket">]</span></a></sup> Some generalized seizures start as a smaller seizure that occurs solely on one side of the brain, however, and is referred to as a focal (or partial) seizure. These unilateral seizure types (formerly known as <a href="/wiki/Simple_partial_seizure" class="mw-redirect" title="Simple partial seizure">simple partial seizure</a> or a <a href="/wiki/Complex_partial_seizure" class="mw-redirect" title="Complex partial seizure">complex partial seizure</a> and now referred to as focal aware seizure and focal impaired awareness seizure, respectively<sup id="cite_ref-:2_5-0" class="reference"><a href="#cite_note-:2-5"><span class="cite-bracket">[</span>5<span class="cite-bracket">]</span></a></sup>) can then spread to both <a href="/wiki/Cerebral_hemisphere" title="Cerebral hemisphere">hemispheres</a> of the brain and cause a generalized tonic-clonic seizure. This type of seizure has a specific term called "focal to bilateral tonic clonic seizure."<sup id="cite_ref-:2_5-1" class="reference"><a href="#cite_note-:2-5"><span class="cite-bracket">[</span>5<span class="cite-bracket">]</span></a></sup> Other precipitating factors include chemical and <a href="/wiki/Neurotransmitter" title="Neurotransmitter">neurotransmitter</a> imbalances and a genetically or situationally determined <a href="/wiki/Seizure_threshold" title="Seizure threshold">seizure threshold</a>, both of which have been implicated. The seizure threshold can be altered by <a href="/wiki/Fatigue_(medical)" class="mw-redirect" title="Fatigue (medical)">fatigue</a>, malnutrition, lack of sleep or rest, <a href="/wiki/Hypertension" title="Hypertension">hypertension</a>, <a href="/wiki/Stress_(biological)" class="mw-redirect" title="Stress (biological)">stress</a>, <a href="/wiki/Diabetes" title="Diabetes">diabetes</a>, the presence of <a href="/wiki/Strobe" class="mw-redirect" title="Strobe">strobe</a>-flashes or simple light/dark patterns, raised <a href="/wiki/Estrogen" title="Estrogen">estrogen</a> levels at <a href="/wiki/Ovulation" title="Ovulation">ovulation</a>, <a href="/wiki/Fluorescent_lighting" class="mw-redirect" title="Fluorescent lighting">fluorescent lighting</a>, rapid motion or flight, <a href="/wiki/Blood_sugar" class="mw-redirect" title="Blood sugar">blood sugar</a> imbalances, anxiety, <a href="/wiki/Antihistamines" class="mw-redirect" title="Antihistamines">antihistamines</a> and other factors.<sup id="cite_ref-6" class="reference"><a href="#cite_note-6"><span class="cite-bracket">[</span>6<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-7" class="reference"><a href="#cite_note-7"><span class="cite-bracket">[</span>7<span class="cite-bracket">]</span></a></sup> Tonic–clonic seizures can also be induced deliberately with <a href="/wiki/Electroconvulsive_therapy" title="Electroconvulsive therapy">electroconvulsive therapy</a>.<sup id="cite_ref-8" class="reference"><a href="#cite_note-8"><span class="cite-bracket">[</span>8<span class="cite-bracket">]</span></a></sup> </p><p>In the case of symptomatic <a href="/wiki/Epilepsy" title="Epilepsy">epilepsy</a>, the cause is often determined by <a href="/wiki/MRI" class="mw-redirect" title="MRI">MRI</a> or other <a href="/wiki/Neuroimaging" title="Neuroimaging">neuroimaging</a> techniques showing that there is some degree of damage to a large number of neurons.<sup id="cite_ref-9" class="reference"><a href="#cite_note-9"><span class="cite-bracket">[</span>9<span class="cite-bracket">]</span></a></sup> The lesions (i.e., scar tissue) caused by the loss of these neurons can result in groups of neurons forming a seizure "focus" area with episodic abnormal firing that can cause seizures if the focus is not abolished or suppressed via anticonvulsant drugs. </p> <div class="mw-heading mw-heading2"><h2 id="Mechanism">Mechanism</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Generalized_tonic%E2%80%93clonic_seizure&action=edit&section=2" title="Edit section: Mechanism"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p><b>Prodrome</b> </p><p>Most generalized tonic–clonic seizures begin without warning and abruptly, but some epileptic patients describe a prodrome. The prodrome of a generalized tonic–clonic seizure is a sort of premonitory feeling hours before a seizure. This type of prodrome is distinct from stereotypic <a href="/wiki/Aura_(symptom)" title="Aura (symptom)">aura</a> of focal seizures that become generalized seizures. </p><p><b>Phases</b> </p><p>A tonic–clonic seizure comprises three phases: the <i><a href="/wiki/Tonic_(physiology)" title="Tonic (physiology)">tonic</a></i> phase, <i><a href="/wiki/Clonic" class="mw-redirect" title="Clonic">clonic</a></i> phase and <a href="/wiki/Postictal_state" title="Postictal state"><i>postictal</i></a> phase. </p> <ul><li><b>Tonic phase</b></li></ul> <dl><dd>The tonic phase is usually the first phase and consciousness will quickly be lost (though not all generalized tonic–clonic seizures involve a full loss of consciousness), and the skeletal muscles will suddenly tense, often causing the extremities to be pulled towards the body or rigidly pushed away from it, which will cause the patient to fall if standing or sitting. There may also be upward deviation of the eyes with the mouth open.<sup id="cite_ref-:1_3-1" class="reference"><a href="#cite_note-:1-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup> The tonic phase is usually the shortest part of the seizure, normally lasting only 10–20 seconds.<sup id="cite_ref-:0_2-2" class="reference"><a href="#cite_note-:0-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> The patient may also express brief vocalizations like a loud moan upon entering the tonic stage, due to air being forcefully expelled from the lungs. This vocalization is commonly referred to as an "<a href="/wiki/Ictal" class="mw-redirect" title="Ictal">ictal</a> cry." Starting in the tonic phase, there may also be bluing of the skin from respiration impairment as well as pooling of saliva in the back of the throat. Increased blood pressure, pupillary size and heart rate (sympathetic response) may also be noted with clenching of the jaw possibly resulting in biting the tongue.<sup id="cite_ref-:1_3-2" class="reference"><a href="#cite_note-:1-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup></dd></dl> <ul><li><b>Clonic phase</b></li></ul> <dl><dd>The clonic phase is an evolution of the tonic phase and is caused by muscle relaxations superimposed on the tonic phase muscle contractions. This phase is longer than the tonic phase with the total ictal period usually lasting no longer than 1 min.<sup id="cite_ref-:0_2-3" class="reference"><a href="#cite_note-:0-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> Skeletal muscles will start to contract and relax rapidly, causing convulsions. These may range from exaggerated twitches of the limbs to violent shaking or vibrating of the stiffened extremities. The patient may roll and stretch as the seizure spreads. Initially, these contractions may be high frequency and low amplitude, which will progress to decreased frequency and high amplitude. An eventual decrease in contraction amplitude just before seizure cessation is also typical.<sup id="cite_ref-:0_2-4" class="reference"><a href="#cite_note-:0-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup></dd></dl> <ul><li><b>Postictal phase</b></li></ul> <dl><dd>The postictal phase causes are multifactorial to include alteration of cerebral blood flow and effects on multiple neurotransmitters.<sup id="cite_ref-10" class="reference"><a href="#cite_note-10"><span class="cite-bracket">[</span>10<span class="cite-bracket">]</span></a></sup> These changes after a generalized tonic–clonic seizure cause a period of <a href="/wiki/Postictal_state" title="Postictal state">postictal sleep</a> with <a href="/wiki/Stertorous" class="mw-redirect" title="Stertorous">stertorous</a> breathing. Confusion and total amnesia upon regaining consciousness are also usually experienced and slowly wear off as the patient becomes gradually aware that a seizure occurred and remembers their identity and location. Impaired consciousness duration can last several hours after a seizure, especially with a compounding central nervous system condition or a prolonged seizure.<sup id="cite_ref-:0_2-5" class="reference"><a href="#cite_note-:0-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> Occasionally the patient may vomit or burst into tears from the experienced mental trauma. An additional smaller seizure can also occur several minutes after the main seizure, particularly if the patient's seizure threshold has been brought unusually low by known factors or combinations of such. Examples include: severe hangovers, sleep deprivation, elevated estrogen at ovulation, prolonged physical tiredness, and drug use or abuse (including, but not limited to, <a href="/wiki/Stimulant" title="Stimulant">stimulants</a>, <a href="/wiki/Alcohol_(drug)" title="Alcohol (drug)">alcohol</a> and <a href="/wiki/Caffeine" title="Caffeine">caffeine</a>).<sup id="cite_ref-11" class="reference"><a href="#cite_note-11"><span class="cite-bracket">[</span>11<span class="cite-bracket">]</span></a></sup></dd></dl> <div class="mw-heading mw-heading2"><h2 id="Diagnosis">Diagnosis</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Generalized_tonic%E2%80%93clonic_seizure&action=edit&section=3" title="Edit section: Diagnosis"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Diagnosis can be made definitively by <a href="/wiki/Electroencephalography" title="Electroencephalography">Electroencephalography</a> (EEG), which records the electrical activity of the brain. This is typically done after a seizure episode in a clinical setting with an attempt to "capture" a seizure while it happens. According to "Harrisons Manual of Medicine," the EEG during the tonic phase will show a "progressive increase in low-voltage fast wave activity, followed by generalized high-amplitude, poly spike discharges."<sup id="cite_ref-:0_2-6" class="reference"><a href="#cite_note-:0-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> The clonic phase EEG will show "high amplitude activity that is typically interrupted by slow waves to create a spike-and-slow-wave pattern."<sup id="cite_ref-:0_2-7" class="reference"><a href="#cite_note-:0-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> Additionally, the postictal phase will show suppression of all brain activity, then slowing that gradually recovers as the patient awakens. </p> <div class="mw-heading mw-heading2"><h2 id="Management">Management</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Generalized_tonic%E2%80%93clonic_seizure&action=edit&section=4" title="Edit section: Management"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>For a person experiencing a tonic–clonic seizure, first-aid treatment includes rolling the person over into the <a href="/wiki/Recovery_position" title="Recovery position">recovery position</a>, which can prevent <a href="/wiki/Asphyxia" title="Asphyxia">asphyxiation</a> by preventing fluid from entering the lungs.<sup id="cite_ref-12" class="reference"><a href="#cite_note-12"><span class="cite-bracket">[</span>12<span class="cite-bracket">]</span></a></sup> Other general actions to take as recommended by the <a href="/wiki/Epilepsy_Foundation" title="Epilepsy Foundation">Epilepsy Foundation</a> include staying with a person until a seizure is over, paying attention to length of seizure as a possible indication for <a href="/wiki/Status_epilepticus" title="Status epilepticus">status epilepticus</a> and/or indication to give rescue medication and call for emergency help, moving close objects out of the way to prevent injury. It is also not recommended to hold a person down that is having a seizure, as that can lead to injury. Nor should anything be put in a person's mouth, as these items can become choking hazards and, depending on what is put in, can potentially break the person's teeth.<sup id="cite_ref-13" class="reference"><a href="#cite_note-13"><span class="cite-bracket">[</span>13<span class="cite-bracket">]</span></a></sup> Long-term therapy may include the use of <a href="/wiki/Antiepileptic" class="mw-redirect" title="Antiepileptic">antiepileptic</a> drugs, <a href="/wiki/Epilepsy_surgery" title="Epilepsy surgery">surgical therapy</a>, diet therapy (<a href="/wiki/Ketogenic_diet" title="Ketogenic diet">ketogenic diet</a>), <a href="/wiki/Vagus_nerve_stimulation" title="Vagus nerve stimulation">vagus nerve stimulation</a>, or <a href="/wiki/Radiosurgery" title="Radiosurgery">radio surgery</a>.<sup id="cite_ref-:1_3-3" class="reference"><a href="#cite_note-:1-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Terminology">Terminology</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Generalized_tonic%E2%80%93clonic_seizure&action=edit&section=5" title="Edit section: Terminology"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Generalized tonic–clonic seizures can have a focal onset (described above) that progresses into a generalized seizure or be a generalized seizure at onset. The term "Grand Mal" is nonspecific, referring to generalized tonic–clonic seizures with either a focal or generalized onset. Due to this lack of specificity in describing the onset of a seizure and being considered an archaic term, it is not typically used by medical professionals.<sup id="cite_ref-:1_3-4" class="reference"><a href="#cite_note-:1-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="See_also">See also</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Generalized_tonic%E2%80%93clonic_seizure&action=edit&section=6" title="Edit section: See also"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <ul><li><a href="/wiki/Focal_seizure" title="Focal seizure">Focal seizure</a></li> <li><a href="/wiki/Absence_seizure" title="Absence seizure">Absence seizure</a></li> <li><a href="/wiki/Epileptic_seizure" class="mw-redirect" title="Epileptic seizure">Epileptic seizure</a></li> <li><a href="/wiki/Non-epileptic_seizure" title="Non-epileptic seizure">Non-epileptic seizure</a></li> <li><a href="/wiki/Tonic_(physiology)" title="Tonic (physiology)">Tonic (physiology)</a></li> <li><a href="/wiki/Clonus" title="Clonus">Clonus</a></li> <li><a href="/wiki/Postictal_state" title="Postictal state">Postictal state</a></li> <li><a href="/wiki/Electroencephalography" title="Electroencephalography">Electroencephalography</a></li></ul> <div class="mw-heading mw-heading2"><h2 id="References">References</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Generalized_tonic%E2%80%93clonic_seizure&action=edit&section=7" title="Edit section: References"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <style data-mw-deduplicate="TemplateStyles:r1239543626">.mw-parser-output .reflist{margin-bottom:0.5em;list-style-type:decimal}@media screen{.mw-parser-output .reflist{font-size:90%}}.mw-parser-output .reflist .references{font-size:100%;margin-bottom:0;list-style-type:inherit}.mw-parser-output .reflist-columns-2{column-width:30em}.mw-parser-output .reflist-columns-3{column-width:25em}.mw-parser-output .reflist-columns{margin-top:0.3em}.mw-parser-output .reflist-columns ol{margin-top:0}.mw-parser-output .reflist-columns li{page-break-inside:avoid;break-inside:avoid-column}.mw-parser-output .reflist-upper-alpha{list-style-type:upper-alpha}.mw-parser-output .reflist-upper-roman{list-style-type:upper-roman}.mw-parser-output .reflist-lower-alpha{list-style-type:lower-alpha}.mw-parser-output .reflist-lower-greek{list-style-type:lower-greek}.mw-parser-output .reflist-lower-roman{list-style-type:lower-roman}</style><div class="reflist"> <div class="mw-references-wrap mw-references-columns"><ol class="references"> <li id="cite_note-1"><span class="mw-cite-backlink"><b><a href="#cite_ref-1">^</a></b></span> <span class="reference-text"><a rel="nofollow" class="external text" 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dt:last-child::after,.mw-parser-output .hlist li li:last-child::after{content:")";font-weight:normal}.mw-parser-output .hlist ol{counter-reset:listitem}.mw-parser-output .hlist ol>li{counter-increment:listitem}.mw-parser-output .hlist ol>li::before{content:" "counter(listitem)"\a0 "}.mw-parser-output .hlist dd ol>li:first-child::before,.mw-parser-output .hlist dt ol>li:first-child::before,.mw-parser-output .hlist li ol>li:first-child::before{content:" ("counter(listitem)"\a0 "}</style><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"></div><div role="navigation" class="navbox" aria-label="Navbox" style="width:100%; margin:0.5em 0 0.5em 0;;padding:3px"><table class="nowraplinks navbox-inner" style="border-spacing:0;background:transparent;color:inherit"><tbody><tr><th scope="row" class="navbox-group" style="width:1%;background: #EAECF0;color:black;">Classification</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"><div style="position:relative; float:right; font-size:0.8em;"><a href="https://www.wikidata.org/wiki/Q1406803" class="extiw" title="d:Q1406803">D</a></div><div class="hlist" style="text-align:left;"><ul><li><b><a href="/wiki/International_Statistical_Classification_of_Diseases_and_Related_Health_Problems" class="mw-redirect" title="International Statistical Classification of Diseases and Related Health Problems">ICD</a>-<a href="/wiki/ICD-10" title="ICD-10">10</a></b>: <a rel="nofollow" class="external text" href="https://icd.who.int/browse10/2019/en#/G40.3">G40.3</a></li><li><b><a href="/wiki/International_Statistical_Classification_of_Diseases_and_Related_Health_Problems" class="mw-redirect" title="International Statistical Classification of Diseases and Related Health Problems">ICD</a>-<a href="/wiki/List_of_ICD-9_codes" title="List of ICD-9 codes">9-CM</a></b>: <a rel="nofollow" class="external text" href="http://www.icd9data.com/getICD9Code.ashx?icd9=345.3">345.3</a></li><li><b><a href="/wiki/Medical_Subject_Headings" title="Medical Subject Headings">MeSH</a></b>: <a rel="nofollow" class="external text" href="https://meshb.nlm.nih.gov/record/ui?ui=D004830">D004830</a></li></ul></div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%;background: #EAECF0;color:black;">External resources</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"><div class="hlist" style="text-align:left;"><ul><li><b><a href="/wiki/MedlinePlus" title="MedlinePlus">MedlinePlus</a></b>: <a rel="nofollow" class="external text" href="https://www.nlm.nih.gov/medlineplus/ency/article/000695.htm">000695</a></li><li><b><a href="/wiki/EMedicine" title="EMedicine">eMedicine</a></b>: <a rel="nofollow" class="external text" href="https://emedicine.medscape.com/neuro/376-overview">neuro/376</a></li></ul></div></div></td></tr></tbody></table></div> <div class="navbox-styles"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236075235"></div><div role="navigation" class="navbox" aria-labelledby="Seizures_and_epilepsy" style="padding:3px"><table class="nowraplinks mw-collapsible autocollapse navbox-inner" style="border-spacing:0;background:transparent;color:inherit"><tbody><tr><th scope="col" class="navbox-title" colspan="2"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><style data-mw-deduplicate="TemplateStyles:r1239400231">.mw-parser-output .navbar{display:inline;font-size:88%;font-weight:normal}.mw-parser-output .navbar-collapse{float:left;text-align:left}.mw-parser-output .navbar-boxtext{word-spacing:0}.mw-parser-output .navbar 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href="/wiki/Template:Seizures_and_epilepsy" title="Template:Seizures and epilepsy"><abbr title="View this template">v</abbr></a></li><li class="nv-talk"><a href="/wiki/Template_talk:Seizures_and_epilepsy" title="Template talk:Seizures and epilepsy"><abbr title="Discuss this template">t</abbr></a></li><li class="nv-edit"><a href="/wiki/Special:EditPage/Template:Seizures_and_epilepsy" title="Special:EditPage/Template:Seizures and epilepsy"><abbr title="Edit this template">e</abbr></a></li></ul></div><div id="Seizures_and_epilepsy" style="font-size:114%;margin:0 4em"><a href="/wiki/Epileptic_seizure" class="mw-redirect" title="Epileptic seizure">Seizures</a> and <a href="/wiki/Epilepsy" title="Epilepsy">epilepsy</a></div></th></tr><tr><th scope="row" class="navbox-group" style="width:1%">Basics</th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Seizure_types" title="Seizure types">Seizure types</a></li> <li><a href="/wiki/Aura_(symptom)" title="Aura (symptom)">Aura (warning sign)</a></li> <li><a href="/wiki/Postictal_state" title="Postictal state">Postictal state</a></li> <li><a href="/wiki/Epileptogenesis" title="Epileptogenesis">Epileptogenesis</a></li> <li><a href="/wiki/Neonatal_seizure" title="Neonatal seizure">Neonatal seizure</a></li> <li><a href="/wiki/Epilepsy_in_children" title="Epilepsy in children">Epilepsy in children</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Management</th><td class="navbox-list-with-group navbox-list navbox-even hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Anticonvulsant" title="Anticonvulsant">Anticonvulsants</a></li> <li>Investigations <ul><li><a href="/wiki/Electroencephalography" title="Electroencephalography">Electroencephalography</a></li></ul></li> <li><a href="/wiki/Epileptologist" title="Epileptologist">Epileptologist</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Issues_for_people_with_epilepsy" title="Issues for people with epilepsy">Personal issues</a></th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Epilepsy_and_driving" title="Epilepsy and driving">Epilepsy and driving</a></li> <li><a href="/wiki/Epilepsy_and_employment" title="Epilepsy and employment">Epilepsy and employment</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Seizure_types" title="Seizure types">Seizure types</a></th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Focal_seizure" title="Focal seizure">Focal</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <dl><dt>Seizures</dt> <dd><a href="/wiki/Simple_partial_seizure" class="mw-redirect" title="Simple partial seizure">Simple partial</a></dd> <dd><a href="/wiki/Complex_partial_seizure" class="mw-redirect" title="Complex partial seizure">Complex partial</a></dd> <dd><a href="/wiki/Gelastic_seizure" title="Gelastic seizure">Gelastic seizure</a></dd></dl> <dl><dt>Epilepsy</dt> <dd><a href="/wiki/Temporal_lobe_epilepsy" title="Temporal lobe epilepsy">Temporal lobe epilepsy</a></dd> <dd><a href="/wiki/Frontal_lobe_epilepsy" title="Frontal lobe epilepsy">Frontal lobe epilepsy</a></dd> <dd><a href="/wiki/Rolandic_epilepsy" title="Rolandic epilepsy">Rolandic epilepsy</a></dd> <dd><a href="/wiki/Sleep-related_hypermotor_epilepsy" title="Sleep-related hypermotor epilepsy">Sleep-related hypermotor epilepsy</a></dd> <dd><a href="/wiki/Panayiotopoulos_syndrome" title="Panayiotopoulos syndrome">Panayiotopoulos syndrome</a></dd> <dd><a href="/wiki/Vertiginous_epilepsy" title="Vertiginous epilepsy">Vertiginous epilepsy</a></dd></dl> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Generalised_epilepsy" class="mw-redirect" title="Generalised epilepsy">Generalised</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a class="mw-selflink selflink">Tonic–clonic</a></li> <li><a href="/wiki/Absence_seizure" title="Absence seizure">Absence seizure</a></li> <li><a href="/wiki/Atonic_seizure" title="Atonic seizure">Atonic seizure</a></li> <li><a href="/wiki/Automatism_(medicine)" title="Automatism (medicine)">Automatism</a></li> <li><a href="/wiki/Benign_familial_neonatal_seizures" title="Benign familial neonatal seizures">Benign familial neonatal seizures</a></li> <li><a href="/wiki/Lennox%E2%80%93Gastaut_syndrome" title="Lennox–Gastaut syndrome">Lennox–Gastaut syndrome</a></li> <li><a href="/wiki/Myoclonic_astatic_epilepsy" title="Myoclonic astatic epilepsy">Myoclonic astatic epilepsy</a></li> <li><a href="/wiki/Epileptic_spasms" class="mw-redirect" title="Epileptic spasms">Epileptic spasms</a></li> <li><a href="/wiki/Febrile_seizure" title="Febrile seizure">Febrile seizure</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Status_epilepticus" title="Status epilepticus">Status epilepticus</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Epilepsia_partialis_continua" title="Epilepsia partialis continua">Epilepsia partialis continua</a></li> <li><a href="/wiki/Complex_partial_status_epilepticus" title="Complex partial status epilepticus">Complex partial status epilepticus</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Myoclonic_epilepsy" title="Myoclonic epilepsy">Myoclonic epilepsy</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Progressive_myoclonus_epilepsy" title="Progressive myoclonus epilepsy">Progressive myoclonus epilepsy</a> <ul><li><a href="/wiki/Dentatorubral%E2%80%93pallidoluysian_atrophy" title="Dentatorubral–pallidoluysian atrophy">Dentatorubral–pallidoluysian atrophy</a></li> <li><a href="/wiki/Unverricht%E2%80%93Lundborg_disease" title="Unverricht–Lundborg disease">Unverricht–Lundborg disease</a></li> <li><a href="/wiki/MERRF_syndrome" title="MERRF syndrome">MERRF syndrome</a></li> <li><a href="/wiki/Lafora_disease" title="Lafora disease">Lafora disease</a></li></ul></li> <li><a href="/wiki/Early_myoclonic_encephalopathy" title="Early myoclonic encephalopathy">Early myoclonic encephalopathy</a></li> <li><a href="/wiki/Juvenile_myoclonic_epilepsy" title="Juvenile myoclonic epilepsy">Juvenile myoclonic epilepsy</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Related disorders</th><td class="navbox-list-with-group navbox-list navbox-even hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Sudden_unexpected_death_in_epilepsy" title="Sudden unexpected death in epilepsy">Sudden unexpected death in epilepsy</a></li> <li><a href="/wiki/Todd%27s_paresis" title="Todd's paresis">Todd's paresis</a></li> <li><a href="/wiki/Landau%E2%80%93Kleffner_syndrome" title="Landau–Kleffner syndrome">Landau–Kleffner syndrome</a></li> <li><a href="/wiki/Psychogenic_non-epileptic_seizure" title="Psychogenic non-epileptic seizure">Psychogenic non-epileptic seizure</a></li> <li><a href="/wiki/Epilepsy_in_animals" title="Epilepsy in animals">Epilepsy in animals</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Organizations</th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Citizens_United_for_Research_in_Epilepsy" title="Citizens United for Research in Epilepsy">Citizens United for Research in Epilepsy</a> (US)</li> <li><a href="/wiki/Epilepsy_Action" title="Epilepsy Action">Epilepsy Action</a> (UK)</li> <li><a href="/wiki/Epilepsy_Action_Australia" title="Epilepsy Action Australia">Epilepsy Action Australia</a></li> <li><a href="/wiki/Epilepsy_Foundation" title="Epilepsy Foundation">Epilepsy Foundation</a> (US)</li> <li><a href="/wiki/Epilepsy_Outlook" title="Epilepsy Outlook">Epilepsy Outlook</a> (UK)</li> <li><a href="/wiki/Epilepsy_Research_UK" class="mw-redirect" title="Epilepsy Research UK">Epilepsy Research UK</a></li> <li><a href="/wiki/Epilepsy_Society" title="Epilepsy Society">Epilepsy 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