Generalized tonic-clonic may also be called grand mal or convulsive seizures. They can be scary to watch if you’ve never seen one before. The person loses consciousness, falls, stiffens (the tonic portion of the seizure), and jerks (the clonic portion of the seizure). Although a convulsive seizure looks painful, the person is not conscious during the seizure and not aware of what is happening. After the seizure, however, the person may feel pain from tongue biting, muscle soreness, headache, or bruises from falling. The seizure is often followed by confusion and tiredness, in what is called the postictal period. These seizures usually last less than 3 minutes, but the time can seem like an eternity to others.

What to do:

  • Stay calm. 
  • Help the person lie down, and place something soft under the head and neck.
  • Keep the person (especially the head) away from sharp or hard objects such as the corner of a table. 
  • Time how long the seizures lasts, especially the jerking movements. 
  • Turn the person onto one side with the head and mouth angled toward the ground. This helps saliva or fluids to drain out of the mouth. It also prevents the tongue from blocking the airway.
  • Loosen all tight clothing. For example, undo top shirt buttons, belts, and skirt or pant buttons. Remove any eyeglasses or tight neck chains. 
  • Do not try to take out contact lenses. You could easily scratch someone’s eye by trying to remove the small lens during a seizure.
  • Do not hold the person down; you may injure the person or get injured yourself.
  • Do not put anything in the person's mouth. The tongue cannot be swallowed during a seizure, yet you could get hurt. The muscles for chewing are very strong, so a finger can be bitten, or, an object can be bitten off and cause choking. 
  • After the seizure is over:
    • Do not try to restrain the person. He or she may be confused and become agitated or fight against the restraints.
    • Try to keep the person in a safe place. Walking around may be okay, but keep them away from a street, stairs, or other potentially dangerous place. 
    • Do not give pills, beverages, or food until the person is fully alert.
    • Stay with the person until he or she is fully alert and oriented. Be careful. The person may say they are fine, but still be quite confused. 
  • Ask a series of questions that require more than a yes or no answer. 
  • For example, ask "What is your address?" and "What is the date?"
  • During and after the seizure, keep onlookers away. One or two people can give first aid. It can be embarrassing for the person to awaken to a crowd of people.
  • After the seizure is over and calm has been restored, the eyewitness should tell the person who had the seizure what actually happened and how long it lasted. 
  • Provide reassurance and support!
  • Get emergency help: (joe, anything else? This is elsewhere but thought best to keep here as well)
    • If this is the person's first tonic-clonic seizure. 
    • If the seizure lasts longer than 5 minutes.
    • If the person has one seizure after another. 
    • If the person is injured or if injury is suspected.
    • If the person isn’t returning to their baseline.
    • If you don’t know the person and they are alone. (Joe I added this)
    • If the person asks for help. 
    • If the person is pregnant or the seizure occurs in water. 

What else can be done?

  • Ideally, a person who has tonic clonic seizures has a plan on what to do during or after the seizure. If you know the person, follow their Seizure 
  • Action Plan on what else to do. Examples of what else to do after a seizure includes:
    • If the person has a vagus nerve stimulator, use the magnet by swiping it across the generator. 
    • If a person has a rescue seizure medication prescribed, follow the instructions on when and how to give the medicine. Know when to give a second dose of medicine if seizures don’t stop. (link to seizure preparedness and giving prn meds). This is especially important for people who live far from a hospital or who are travelling to remote areas (going camping, for instance). Examples of drugs used as rescue medicines include: diazepam given by rectum (Diastat), lorazepam or other forms of diazepam that can be given under the tongue or into the nose. (Joe, should this be here or just link? I think it may help to be here if it’s not too long)
  • After the seizure is over:
    • Acetaminophen (Tylenol) or ibuprofen (Advil) is helpful for minor 
    • The person should see a doctor if they have severe back pain or head pain. There could be a serious injury that needs treatment. 
    • Let an emergency responder move the person and take them by ambulance. 
    • A fever may follow a seizure, usually because of the muscle activity pains. and the effects of the seizure. If a person has a fever that is over 102°F, lasts more than 6 hours, or starts more than 3 hours after a seizure, the person should see a doctor. Sometimes secretions pass down the respiratory tract during the seizure and cause pneumonia.
Reviewed by: Joseph I. Sirven, MD | Patricia O. Shafer, RN, MN on 3/2014
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