Signs and tests
Diagnosis of a grand mal seizure is based on the symptoms and excluding other medical problems that can look like a seizure (such as heart arrhythmia). A neuromuscular examination may or may not reveal neurologic deficits (decreases in brain functions) when the person is not actively having seizures.
An EEG may show characteristic changes and in some cases may show the focus (location of the cause of the seizure). An EEG can be normal in between seizures and a normal EEG does not rule out a seizure disorder.
Tests for the cause may include various blood tests (depending on the suspected cause), including:
Tests for the cause may include procedures such as:
Disorders that may cause symptoms resembling seizures include transient ischemic attacks, rage, or panic attacks.
Treatment
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.
- Do not attempt to hold the person down during the seizure.
- 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 blocking 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.
If a person has repeated or prolonged seizures without regaining consciousness or returning to normal behavior, the body may develop a severe lack of oxygen. This an emergency situation - seek immediately medical help.
EMERGENCY TREATMENT BY MEDICAL PERSONNEL
- Measures to protect the airway may be needed, including use of tubes to keep the airway open. Breathing should be supported as needed.
- Thiamine 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.
- General anesthesia with muscle-paralyzing medications may be needed.
- After status epilepticus is controlled, the patient will be given anticonvulsants. Tests will be done to determine the cause of the condition, if it is not already known.
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:
- Date and time of the seizure
- How long it lasted
- What body parts were affected
- Type of movements or other symptoms
- Possible causes
- Behavior after the seizure
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 may not require treatment.
Anti-seizure medicines may prevent or reduce the number of future seizures. Medicines may be used alone or in combination with another drug.
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.
Informational jewelry or cards (such as Medic-Alert bracelets) alerting others about the seizures may help a patient receive prompt medical treatment if a one occurs.
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