tonic clonic epilepsy


Summary: A generalized seizure disorder characterized by recurrent major motor seizures. The initial brief tonic phase is marked by trunk flexion followed by diffuse extension of the trunk and extremities. The clonic phase features rhythmic flexor contractions of the trunk and limbs, pupillary dilation, elevations of blood pressure and pulse, urinary incontinence, and tongue biting. This is followed by a profound state of depressed consciousness (post-ictal state) which gradually improves over minutes to hours. The disorder may be cryptogenic, familial, or symptomatic (caused by an identified disease process). (From Adams et al., Principles of Neurology, 6th ed, p329)

Top Publications

  1. Maiga Y, Nogues B, Guillon B. [Exacerbation of tonicoclonic seizures in a juvenile myoclonic epileptic taking lamotrigine]. Rev Neurol (Paris). 2006;162:1125-7 pubmed
    ..Lamotrogine may induce exacerbation of generalised tonico-clonic seizures and myoclonic jerks in juvenile myoclonic epilepsy. ..
  2. Dehghani M, Dehghani S, Davarpanah M. Epididymo-orchitis and central nervous system nocardiosis in a bone marrow transplant recipient for acute lymphoblastic leukemia. Exp Clin Transplant. 2009;7:264-6 pubmed
    ..Trimethoprim-sulfamethoxazole was prescribed, and significant improvement was seen after 2 weeks. The patient was discharged. He was subsequently referred after 3 weeks due to graft-versus-host disease and died of pancytopenia. ..
  3. Schmidt U, Cooper P, Essers H, Freeman C, Holland R, Palmer R, et al. Fluvoxamine and graded psychotherapy in the treatment of bulimia nervosa: a randomized, double-blind, placebo-controlled, multicenter study of short-term and long-term pharmacotherapy combined with a stepped care approach to psychotherapy. J Clin Psychopharmacol. 2004;24:549-52 pubmed
  4. Blumenfeld H, Varghese G, Purcaro M, Motelow J, Enev M, McNally K, et al. Cortical and subcortical networks in human secondarily generalized tonic-clonic seizures. Brain. 2009;132:999-1012 pubmed publisher
    ..Understanding the networks involved in generalized tonic-clonic seizures can provide insights into mechanisms of behavioural changes, and may elucidate targets for improved therapies. ..
  5. Lorenz R, Vandenberg A, Canepa E. Serotonergic antidepressants and linezolid: a retrospective chart review and presentation of cases. Int J Psychiatry Med. 2008;38:81-90 pubmed
    ..This retrospective review and subsequent case reports confirm the rare, but serious, potential of serotonin syndrome associated with the combination of linezolid and serotonergic antidepressants. ..
  6. Lu Y, Yu W, Shen D, Wang X. Three new forms of familial epilepsy syndromes in the proposed diagnostic scheme of the ILAE (2001): a clinical experience in Southwest China. Epilepsia. 2008;49:1103 pubmed publisher
  7. Brinar V, Poser C. Disseminated encephalomyelitis in adults. Clin Neurol Neurosurg. 2008;110:913-8 pubmed publisher
  8. Boutin F, Bonnet A, Cros A. [Occurrence of epileptiform crisis in child under sevoflurane anaesthesia]. Ann Fr Anesth Reanim. 2005;24:559-60 pubmed
    ..9% sevoflurane for 45 minutes associated with moderate hyperventilation. Epilepsy was discovered on the EEG, which was performed postoperatively. ..
  9. Ardesch J, Buschman H, van der Burgh P, Wagener Schimmel L, van der Aa H, Hageman G. Cardiac responses of vagus nerve stimulation: intraoperative bradycardia and subsequent chronic stimulation. Clin Neurol Neurosurg. 2007;109:849-52 pubmed
    ..Subsequent chronic stimulation is safe in respect to heart rate. Bradycardia during intraoperative device testing is no reason to abort the operation. ..

More Information


  1. Szawarski P, Dvorkin L, Tam E. Laparotomy for treatment of seizures. Emerg Med J. 2008;25:120 pubmed publisher
  2. Agarwal A, Malhotra H. Camphor ingestion: an unusual cause of seizure. J Assoc Physicians India. 2008;56:123-4 pubmed
    ..These cases highlight the importance of enquiring any intake of material (medicinal or otherwise) in every patient presenting with seizure. ..
  3. Ito M, Okazaki M, Takahashi S, Muramatsu R, Kato M, Onuma T. Subacute postictal aggression in patients with epilepsy. Epilepsy Behav. 2007;10:611-4 pubmed
    ..Epilepsy of prolonged duration and brain dysfunction involving a broad area including the temporal and frontal lobes may be associated with the occurrence of subacute postictal aggression. ..
  4. Pompili M, Girardi P, Lester D, Tatarelli R. Suicide soon after generalized tonic-clonic seizure. A possible peri-ictal phenomenon?. ScientificWorldJournal. 2006;6:356-60 pubmed
    ..After many years free from seizures, she experienced one day a generalized tonic-clonic seizure that required hospitalization and, soon thereafter, she committed suicide. ..
  5. Rosenberg H, Grant M. Ascending tonic-clonic syndrome secondary to intrathecal Omnipaque. J Clin Anesth. 2004;16:299-300 pubmed
    ..Although this syndrome superficially resembles malignant hyperthermia, the pathophysiology is different. Survival depends on prompt recognition and rapid symptomatic treatment. Treatment with dantrolene sodium is not necessary. ..
  6. Scorza F, Albuquerque M, Arida R, Cysneiros R, Henriques T, Scorza C, et al. Seizure occurrence in patients with chronic renal insufficiency in regular hemodialysis program. Arq Neuropsiquiatr. 2005;63:757-60 pubmed
    ..The two other patients had already presented seizures prior the beginning of dialysis. We conclude that seizures in renal failure could be considered as occasional events that do not usually become chronic. ..
  7. Sankar M, Agarwal R, Aggarwal R, Deorari A, Paul V. Seizures in the newborn. Indian J Pediatr. 2008;75:149-55 pubmed
    ..A comprehensive approach for management of neonatal seizures has been described. ..
  8. Ryvlin P, Tomson T, Montavont A. [Excess mortality and sudden unexpected death in epilepsy]. Presse Med. 2009;38:905-10 pubmed publisher
    ..There is yet no consensus regarding the information about SUDEP that should be delivered to patients with epilepsy, but it seems reasonable to individualize this information according to each patient form of epilepsy. ..
  9. Szucs A, Lalit N, Rasonyi G, Barcs G, Bone B, Halasz P, et al. [Sudden death and mortality in epilepsy]. Ideggyogy Sz. 2006;59:321-8 pubmed
  10. Snell D, Bartley C. Osmotic demyelination syndrome following rapid correction of hyponatraemia. Anaesthesia. 2008;63:92-5 pubmed
    ..Continuous veno-venous haemofiltration has been used effectively in this setting...
  11. Chokshi R, Openshaw J, Mehta N, Mohler E. Purple glove syndrome following intravenous phenytoin administration. Vasc Med. 2007;12:29-31 pubmed
    ..Several risk factors have been associated with the development of PGS; however, the etiology remains unknown. We present a case of PGS and briefly review the current understanding of this syndrome...
  12. Braham E, Bellil S, Ben Hamouda K, Bettaieb I, Mekni A, Bellil K, et al. [Chordoid meningioma. Two cases]. Neurochirurgie. 2007;53:39-42 pubmed
    ..Radiological findings were temporoparietal and temporofrontal lesions with intense enhancement after contrast injection. Complete surgical resection was performed. Histopathologic findings were consistent with chordoid meningioma. ..
  13. Werz M. Idiopathic generalized tonic-clonic seizures limited to exercise in a young adult. Epilepsy Behav. 2005;6:98-101 pubmed
    ..This case demonstrates the utility of simultaneous cardiac stress testing with electroencephalography in confirming exercise-related seizures and distinguishing epilepsy from syncope. ..
  14. Santos F, Gonçales C, Rocha J, Nogueira C. 2,3-Dimercaptopropanol, 2,3-dimercaptopropane-1-sulfonic acid and meso-2,3-dimercaptosuccinic acid acute administration diferentially change biochemical parameters in mice. Basic Clin Pharmacol Toxicol. 2005;96:331-4 pubmed
  15. Pushpakumara J, Sivathiran S, Roshan L, Gunatilake S. Bilateral posterior fracture-dislocation of the shoulders following epileptic seizures: a case report and review of the literature. BMC Res Notes. 2015;8:704 pubmed publisher
    ..Forcible restraining of the patient's upper limbs during seizures is the likely cause for the fracture dislocations in our patient and this had not been reported before. ..
  16. Castagna A, Delle Rose G, Borroni M, Markopoulos N, Conti M, Maradei L, et al. Modified MacLaughlin procedure in the treatment of neglected posterior dislocation of the shoulder. Chir Organi Mov. 2009;93 Suppl 1:S1-5 pubmed publisher
    ..Poorer results should be expected in patients with an associated fracture of the proximal humerus. ..
  17. Ranjbar Omrani G, Zamiri N, Sabayan B, Mohammadzadeh A. Concomitant hypoparathyroidism, sensorineural deafness, and renal agenesis: a case of Barakat syndrome. Arch Iran Med. 2008;11:337-40 pubmed publisher
    ..Different etiologies are described for the syndrome but the definite pathophysiology remains unclear. Hereby, we present a case of Barakat syndrome who was diagnosed on the basis of clinical and molecular data. ..
  18. Schmitt B, Kovacevic Preradovic T, Critelli H, Molinari L. Is ethosuximide a risk factor for generalised tonic-clonic seizures in absence epilepsy?. Neuropediatrics. 2007;38:83-7 pubmed
    ..002) and GTCS during treatment (p=0.02). GTCS are rare in patients with typical AE. Our data do not support the current opinion that ethosuximide is inefficacious on GTCS in AE. ..
  19. Tanriverdi T, Olivier A, Poulin N, Andermann F, Dubeau F. Long-term seizure outcome after corpus callosotomy: a retrospective analysis of 95 patients. J Neurosurg. 2009;110:332-42 pubmed publisher
    ..When considering this procedure, the treating physician must thoroughly assess the expected benefits, limitations, likelihood of residual seizures, and the risks, and explain them to the patient, his or her family, and other caregivers. ..
  20. Kostov H, Larsson P, Røste G. Is vagus nerve stimulation a treatment option for patients with drug-resistant idiopathic generalized epilepsy?. Acta Neurol Scand Suppl. 2007;187:55-8 pubmed
    ..Our results indicate that adjunctive VNS therapy is a favourable treatment option for patients with drug-resistant IGE. Rapid cycling seems worth trying in some of the non-responders. ..
  21. Cervera M, Sanchez S, Molina B, Alcántara M, Del Castillo V, Carnevale A, et al. Trisomy of the short arm of chromosome 5 due to a de novo inversion and duplication (5)(p15.3 p13.3). Am J Med Genet A. 2005;136A:381-5 pubmed
    ..The combined use of conventional and molecular cytogenetics in this case allows a more precise diagnosis and furthers knowledge in phenotype/genotype correlation. ..
  22. Sherman P, Aygun N. Development of a cavum septi pellucidi after Ommaya reservoir placement: report of an unusual complication. Acta Neurochir (Wien). 2006;148:359-62; discussion 362 pubmed
    ..Caution is recommended when injecting a single-hole ventricular catheter if the tip is against the septum pellucidum. ..
  23. Martinez M, Ballesteros S, Segura L, Garcia M. Reporting a fatality during tumescent liposuction. Forensic Sci Int. 2008;178:e11-6 pubmed publisher
    ..The Court of Law ruled the death as an involuntary homicide due to gross negligence. ..
  24. Suryavanshi N, Kashyape S, Kashyape P, Phalke V. Tuberous sclerosis complex. Indian J Pediatr. 2004;71:659 pubmed
  25. Surmeli T, Ertem A. Post WISC-R and TOVA improvement with QEEG guided neurofeedback training in mentally retarded: a clinical case series of behavioral problems. Clin EEG Neurosci. 2010;41:32-41 pubmed
    ..This study provides the first evidence for positive effects of NF treatment in mental retardation. The results of this study encourage further research. ..
  26. Iwama H. A case of normal ropivacaine concentration causing grand mal seizure after epidural injection. Eur J Anaesthesiol. 2005;22:322-3 pubmed
  27. Vinogradova L, Van Rijn C. Anticonvulsive and antiepileptogenic effects of levetiracetam in the audiogenic kindling model. Epilepsia. 2008;49:1160-8 pubmed publisher
    ..To study anticonvulsive and antiepileptogenic effects of singe levetiracetam (LEV) administration in the model of audiogenic kindling...
  28. Dejhalla M, Parton P, Golombek S. Case report of Haddad syndrome in a newborn: congenital central hypoventilation syndrome and Hirschsprung's disease. J Perinatol. 2006;26:259-60 pubmed
    ..Association with Hirschsprung's disease is known as Haddad syndrome. We present a newborn with respiratory distress since birth and Hirschprung's disease subsequently diagnosed with Haddad syndrome. ..
  29. Carrasco Moro R, García Navarrete E, Pedrosa Sanchez M, Pascual Garvi J, Minervini Marín M, Sola R. [Refractory epilepsy as the presenting symptom of a brucellar brain abscess]. Rev Neurol. 2006;43:729-32 pubmed
    ..Identification of risk factors on the patient record is also a crucial step. ..
  30. Chandrasekar T, Sharan A, Sperling M. Postoperative auras and the risk of recurrent seizures. Epilepsy Res. 2008;78:195-200 pubmed publisher
    ..However, any medication effect appears to be quite small, so we consider it reasonable to advise cessation of AEDs in patients with persistent auras who are otherwise seizure-free. ..
  31. McGregor A, Wheless J. Pediatric experience with sudden unexplained death in epilepsy at a tertiary epilepsy center. J Child Neurol. 2006;21:782-7 pubmed
    ..Sudden unexplained death in epilepsy in children and adolescents is associated with convulsive seizures, and aggressive treatment of nocturnal generalized tonic-clonic seizures might help lower the occurrence. ..
  32. Schnyder Krieg A, Conen D. [Large water intake and its sequelae]. Praxis (Bern 1994). 2006;95:1329-31 pubmed
  33. Compton R, Spiller H, Bosse G. Fatal fluoxetine ingestion with postmortem blood concentrations. Clin Toxicol (Phila). 2005;43:277-9 pubmed
    ..No other drugs were detected. We report an unusual case of massive fluoxetine ingestion resulting in neurological and cardiovascular toxicity resulting in death. ..
  34. Karlov V. [An absence]. Zh Nevrol Psikhiatr Im S S Korsakova. 2005;105:55-60 pubmed
  35. Parney I, Goerss S, MCGEE K, Huston J, Perkins W, Meyer F. Awake craniotomy, electrophysiologic mapping, and tumor resection with high-field intraoperative MRI. World Neurosurg. 2010;73:547-51 pubmed publisher
    ..Standard protocols for positioning and draping in high-field iMRI units make awake craniotomies problematic. This straightforward technique for combined awake EPM and iMRI may facilitate safe removal of large lesions in eloquent cortex. ..
  36. Devinsky O, Davachi L, Santchi C, Quinn B, Staresina B, Thesen T. Hyperfamiliarity for faces. Neurology. 2010;74:970-4 pubmed publisher
    ..Epilepsy and seizures were present in all 9 cases, suggesting a pathophysiologic relationship, which likely varies among cases. Although only reported in 9 patients, HFF is probably much more common than it is diagnosed. ..
  37. Sahin D, Ilbay G, IMAL M, Bozdogan O, Ates N. Vagus nerve stimulation suppresses generalized seizure activity and seizure-triggered postictal cardiac rhythm changes in rats. Physiol Res. 2009;58:345-50 pubmed
    ..However, in the VNS-treated group the seizure scores and cardiac parameter returned to the baseline level. Present results emphasize that VNS effectively reduces seizure severity and suppress the seizure-induced cardiac rhythm changes. ..
  38. Di Mizio G, Gambardella A, Labate A, Perna A, Ricci P, Quattrone A. Hepatonecrosis and cholangitis related to long-term phenobarbital therapy: an autopsy report of two patients. Seizure. 2007;16:653-6 pubmed
    ..For this reason, each clinician should recognize this entity in the differential diagnosis of PB-related asymptomatic chronic hepatic enzyme dysfunction. ..
  39. Beghi M, Beghi E, Cornaggia C, Gobbi G. Idiopathic generalized epilepsies of adolescence. Epilepsia. 2006;47 Suppl 2:107-10 pubmed
    ..Some patients become obstinate and are impressionable. The cognitive and behavioral aspects of these patients suggest an involvement of frontal lobes. ..
  40. Kang T, Sanchez L, Barkin A. A 24-year-old woman with abdominal pain. J Emerg Med. 2008;34:199-201 pubmed publisher
  41. Holtschmidt Taschner B, Soyka M. Hyponatremia-induced seizure during carbamazepine treatment. World J Biol Psychiatry. 2007;8:51-3 pubmed
    ..CCT and ECG were normal. To our knowledge, this is the first description of a seizure related to hyponatremia in an adult carbamazepine-treated patient. ..
  42. Singh N, Rai A, Selhorst J, Acharya J. Ondansetron and seizures. Epilepsia. 2009;50:2663-6 pubmed publisher
    ..The temporal relationship between ondansetron administration and seizures, lack of EEG or MRI abnormalities, and absence of seizure recurrence suggest that the seizures were causally related to ondansetron in our patients. ..
  43. Aleman M, Gray L, Williams D, Holliday T, Madigan J, LeCouteur R, et al. Juvenile idiopathic epilepsy in Egyptian Arabian foals: 22 cases (1985-2005). J Vet Intern Med. 2006;20:1443-9 pubmed
    ..Juvenile idiopathic epilepsy of Egyptian Arabian foals has an early clinical onset but appears to be self-limiting. Information obtained from this study strongly suggests a heritable condition that merits further investigation. ..
  44. Pfütze M, Reis J, Haag A, John D, Hattemer K, Oertel W, et al. Lack of differences of motorcortical excitability in the morning as compared to the evening in juvenile myoclonic epilepsy--a study using transcranial magnetic stimulation. Epilepsy Res. 2007;74:239-42 pubmed
    ..The expected rise of the resting motor thresholds (RMT) in JME-patients taking anticonvulsants could not be detected which may indicate a decreased RMT in JME-patients. ..
  45. Eom K, Lim C, Gu S, Kang B, Kim Y, Jang D, et al. Positron emission tomography features of canine necrotizing meningoencephalitis. Vet Radiol Ultrasound. 2008;49:595-9 pubmed
    ..FDG-PET has the potential to provide valuable diagnostic information in dogs with suspected necrotizing encephalitis. ..
  46. Long T, Hein B, Brown M, Rydberg C, Wass C. Posterior reversible encephalopathy syndrome during pregnancy: seizures in a previously healthy parturient. J Clin Anesth. 2007;19:145-8 pubmed
    ..Prompt recognition and treatment of this potentially catastrophic disease may avert injury to the patient and neonate. ..
  47. Mares P, Haugvicova R, Kasal A. Action of two neuroactive steroids against motor seizures induced by pentetrazol in rats during ontogeny. Physiol Res. 2006;55:437-44 pubmed
    ..Both drugs exhibited an anticonvulsant action in developing rats but, unfortunately, their effect was only shortlasting. ..
  48. Nogueira R, Sheth K, Duffy F, Helmers S, Bromfield E. Bilateral tonic-clonic seizures with temporal onset and preservation of consciousness. Neurology. 2008;70:2188-90 pubmed publisher
  49. Begum T, Ikeda A, Takahashi J, Tomimoto H, Shimohama S, Satow T, et al. Clinical outcome of patients with SREDA (subclinical rhythmic EEG discharge of adults). Intern Med. 2006;45:141-4 pubmed
    ..Being different from the previous reports suggesting the relation with cardiogenic insults or persistent ischemic abnormality, SREDA can occur in patients with various acute brain dysfunctions followed by a favorable clinical outcome. ..
  50. Oh J, Park K, Cho H, Choi K, Jung S. Spasmodic dysphonia induced by valproic acid. Epilepsia. 2004;45:880-1 pubmed
  51. Smigielska Kuzia J, Sobaniec W, Kułak W, Bockowski L. Clinical and EEG features of epilepsy in children and adolescents in Down syndrome. J Child Neurol. 2009;24:416-20 pubmed publisher
    ..Quantitative electroencephalography analysis revealed significant differences between children with Down syndrome and the control groups in the alpha, delta, and beta rhythms. Our findings are in accordance with other reports. ..
  52. Uusimaa J, Hinttala R, Rantala H, Päivärinta M, Herva R, Roytta M, et al. Homozygous W748S mutation in the POLG1 gene in patients with juvenile-onset Alpers syndrome and status epilepticus. Epilepsia. 2008;49:1038-45 pubmed publisher
    ..Here we studied the molecular etiology of juvenile-onset AHS manifesting with status epilepticus and liver disease in three teenagers...
  53. Sethi P, Sethi N, Torgovnick J. Mobile phone artifact. Clin Neurophysiol. 2006;117:1876-8 pubmed