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TYPES OF EPILEPTIC SEIZURES: GRAND MAL SEIZURES (MAJOR GENERALISED SEIZURES)
Grand mal seizures are the commonest type of seizure. About 70 – 80% of children with epilepsy have grand mal fits. A grand mal fit may begin without warning or may be preceded by an aura.
An aura is a sensation which precedes loss of consciousness mid is actually the beginning of the fit. This may be a regular event for some people, but not for others. The nature of the aura will depend on the area of the brain in which the fit begins. Some people may exhibit unusual behaviour or be somewhat out of sorts before an attack. At the start of the fit there is a sudden loss of consciousness. If at that time the patient is standing, he or she will fall to the ground. This is quickly followed by generalised rigidity (stiffening) of the body, called the tonic phase of the fit. This is then followed by a generalised jerking of the body, the clonic phase. During the clonic phase patients may bite their tongue, pass urine or pass a motion. These three events occur less often in children than in adults.
During the tonic phase, when the body is rigid, the face and lips may go blue (cyanosis) as the patient is unable to breathe because of the stiffening of the body. Thereafter, breathing becomes jerky during the clonic phase and the cyanosis (blueness) lessens. The clonic movements then gradually settle down and the patient becomes relaxed and limp. After a grand mal fit the patient may recover rapidly, but if it has been a long fit, they may go into a deep sleep. Associated with recovery there may be feelings of weakness, headache or fatigue and some people may be confused and irritable. In addition, some people may injure themselves during a fit.
When a number of grand mal convulsions follow each other in rapid succession, the situation becomes serious and is called status epilepticus. This implies that the epilepsy is continuous and will not stop spontaneously.
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