Generalized Tonic-Clonic Seizure

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Treatment

If a generalized seizure occurs, give appropriate emergency first aid.

EMERGENCY FIRST-AID TREATMENT

• Protect the person from injury. Clear the area of furniture or other objects that may cause injury from falls during the seizure.
• Do not attempt to force a hard object (such as a spoon, or a tongue depressor, etc.) between the teeth. You can cause more damage than you can prevent by doing this!
• Do not attempt to restrain or hold the person down during the seizure.
• Protect the person from inhaling vomit or mucus. Turn the person to the side if vomiting occurs. Keep the person on his or her side while sleeping after the seizure is over.
• If the person having a seizure turns blue or stops breathing, try to position the head to prevent the tongue from obstructing the airway. Breathing usually starts on its own once the seizure is over.
• CPR or mouth-to-mouth breathing is rarely needed after seizures and cannot be performed during the seizure.
• Repeated or prolonged seizures without regaining consciousness or returning to normal behavior between them (status epilepticus) may cause severe lack of oxygen in the body. This an emergency situation requiring immediate professional assistance!

EMERGENCY TREATMENT BY MEDICAL PERSONNEL (status epilepticus)

• Measures to protect the airway may be needed, including use of tubes to keep the airway open. Breathing should be supported as needed.
• Thiamine and/or intravenous glucose may be given.
• Medications such as diazepam (Valium) or lorazepam, or anticonvulsant medications such as phenytoin or phenobarbital, may control prolonged, repeated generalized seizures. They are usually injected into a vein. Other medical treatment may be needed, including general anesthesia with muscle-paralyzing medications.
• After status epilepticus is controlled, anticonvulsants may be begun and tests are performed to determine the cause of the condition, if not known already.
  

AFTER THE SEIZURE

• Treat any injuries from bumps or falls.
• Record details of the seizure to report to the health care provider. Important details include the date and time of the seizure, how long it lasted, which body parts were affected, the type of movements or other symptoms, possible causes, behavior after the seizure, and other factors noted.

Treating the cause, if one has been identified, may stop seizures. This may include medication, surgical repair of tumors or brain lesions, or other treatments. An isolated seizure with an obvious trigger (such as fever and toxic reaction) is treated by eliminating or avoiding the precipitating factor.

An isolated seizure without an obvious trigger (the examination and EEG are normal and there are no abnormalities on other testing) may not require treatment.

Oral anticonvulsants (anti-seizure medications) may prevent or reduce the number of future seizures. The response is individual, and the medication and dosage may have to be adjusted repeatedly. There are numerous medications which may be effective alone or when used in combination. Side effects of these medications and plasma drug-levels will need to be monitored to various degrees, depending on which medications are used.

Women who might get pregnant may need to take additional medications or vitamins to reduce the risk of birth defects associated with some of these medications. Such women may need to be followed in a high-risk pregnancy clinic.

Patients who continue to have seizures despite several medications may benefit from a vagal nerve stimulator (implantable device that stimulates a nerve in the neck) or from brain surgery to remove tissue responsible for causing the seizures.

The use of informational jewelry or cards (such as Medic-Alert or similar products) that indicate a seizure disorder may be advised to help the patient receive prompt medical treatment if a seizure occurs.