Wednesday, January 21, 2015

Blog #33: The Tonic-Clonic Seizure


(This blog was originally posted on May 20, 2013)

 
 
 
When people think of a seizure, a convulsing body on the ground is what typically comes to mind. This kind of generalized or “tonic-clonic” seizure is believed to begin with abnormal electrical discharges emanating from deep at the center of the brain—probably in the thalamic region—which spread to the cortex (the brain cell outer-layer) of both hemispheres (halves) of the brain. The thalami are the way-stations for every neurocortical function in the body; sensations are perceived and movement regulation involves this region. Tonic-clonic seizures literally affect all parts of the body, and people often turn blue because the brain “turns off” the breathing response until the seizure has run its course. It is interesting that this type of seizure usually does not affect normal function of the heart.
When this type of seizure occurs, it starts without any warning and usually lasts one or two minutes. The person suddenly stiffens and falls, then jerks and shakes. It is common to bite the lip or tongue, and the person may lose control of the bladder or bowel. It can be very frightening to witness someone having a tonic-clonic seizure; however, the event rarely has serious consequences for the patient unless the person injures part of the body when he or she falls. The seizure stops when it “exhausts itself” and the person is then confused and is unaware of what happened. It can take a few hours until he or she returns to “normal,” and it is common to experience a headache and just want to sleep.
There is no “treatment” for a routine tonic-clonic seizure while it is happening. The immediate concern is to prevent injury by guiding the person to the floor. Turn the individual onto his or her side so any vomit or excessive saliva would fall out from the mouth rather than choking on it and aspirating it into the lungs. This could cause the person to fatally choke or result in pneumonia. It is also important to prevent contact with hot surfaces or water to avoid risk of serious burn or drowning. Convulsions lasting more than several minutes, however, can be dangerous. These interfere with breathing and can cause brain injury. Medical support and anti-seizure medication injections to stop the convulsion then are necessary.



 

Lance Fogan, M.D. is Clinical Professor of Neurology at the David Geffen School of Medicine at UCLA. DINGS is his first novel.

 


 

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