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Tonic-Clonic Epilepsy (Epilepsy, Tonic Clonic)

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)
Also Known As:
Epilepsy, Tonic Clonic; Major Epilepsy; Epilepsy, Tonic-Clonic; Convulsions, Grand Mal; Cryptogenic Tonic-Clonic Epilepsy; Epilepsy, Tonic-Clonic, Cryptogenic; Epilepsy, Tonic-Clonic, Familial; Epilepsy, Tonic-Clonic, Symptomatic; Familial Tonic-Clonic Epilepsy; Seizure Disorder, Grand Mal; Seizure Disorder, Major Motor; Symptomatic Tonic-Clonic Epilepsy; Tonic Clonic Convulsions; Tonic-Clonic Convulsion Disorder; Tonic-Clonic Convulsion Syndrome; Tonic-Clonic Seizure Disorder; Tonic-Clonic Seizure Syndrome; Convulsion Disorder, Tonic-Clonic; Convulsion Disorders, Tonic-Clonic; Convulsion Syndrome, Tonic-Clonic; Convulsion Syndromes, Tonic-Clonic; Convulsion, Grand Mal; Convulsion, Tonic Clonic; Convulsions, Tonic Clonic; Cryptogenic Tonic Clonic Epilepsy; Cryptogenic Tonic-Clonic Epilepsies; Disorder, Tonic-Clonic Convulsion; Disorder, Tonic-Clonic Seizure; Disorders, Tonic-Clonic Convulsion; Disorders, Tonic-Clonic Seizure; Epilepsies, Cryptogenic Tonic-Clonic; Epilepsies, Familial Tonic-Clonic; Epilepsies, Symptomatic Tonic-Clonic; Epilepsies, Tonic-Clonic; Epilepsy, Cryptogenic Tonic-Clonic; Epilepsy, Familial Tonic-Clonic; Epilepsy, Symptomatic Tonic-Clonic; Familial Tonic Clonic Epilepsy; Familial Tonic-Clonic Epilepsies; Grand Mal Convulsion; Grand Mal Convulsions; Grand Mal Epilepsy; Major Epilepsies; Seizure Disorder, Tonic-Clonic; Seizure Disorders, Tonic-Clonic; Seizure Syndrome, Tonic-Clonic; Seizure Syndromes, Tonic-Clonic; Symptomatic Tonic Clonic Epilepsy; Symptomatic Tonic-Clonic Epilepsies; Syndrome, Tonic-Clonic Convulsion; Syndrome, Tonic-Clonic Seizure; Syndromes, Tonic-Clonic Convulsion; Syndromes, Tonic-Clonic Seizure; Tonic Clonic Convulsion; Tonic Clonic Convulsion Disorder; Tonic Clonic Convulsion Syndrome; Tonic Clonic Seizure Disorder; Tonic Clonic Seizure Syndrome; Tonic-Clonic Convulsion Disorders; Tonic-Clonic Convulsion Syndromes; Tonic-Clonic Epilepsies; Tonic-Clonic Epilepsies, Cryptogenic; Tonic-Clonic Epilepsies, Familial; Tonic-Clonic Epilepsies, Symptomatic; Tonic-Clonic Epilepsy, Cryptogenic; Tonic-Clonic Epilepsy, Familial; Tonic-Clonic Epilepsy, Symptomatic; Tonic-Clonic Seizure Disorders; Tonic-Clonic Seizure Syndromes; Epilepsy, Grand Mal; Epilepsy, Major; Grand Mal Seizure Disorder; Major Motor Seizure Disorder; Seizure Disorder, Tonic Clonic
Networked: 285 relevant articles (20 outcomes, 20 trials/studies)

Relationship Network

Disease Context: Research Results

Related Diseases

1. Seizures (Absence Seizure)
2. Myoclonus (Nocturnal Myoclonus)
3. Epilepsy (Aura)
4. Partial Epilepsies (Epilepsy, Partial)
5. Stroke (Strokes)

Experts

1. Asada, Akira: 3 articles (05/2008 - 03/2004)
2. Oda, Yutaka: 3 articles (05/2008 - 03/2004)
3. Tanaka, Katsuaki: 3 articles (05/2008 - 03/2004)
4. Appleton, Richard: 2 articles (10/2018 - 07/2008)
5. Martland, Timothy: 2 articles (10/2018 - 07/2008)
6. Goel, Rajesh Kumar: 2 articles (06/2017 - 01/2015)
7. Mishra, Awanish: 2 articles (06/2017 - 01/2015)
8. Dhir, Ashish: 2 articles (12/2015 - 08/2007)
9. Umukoro, Solomon: 2 articles (07/2014 - 01/2013)
10. Myhrer, Trond: 2 articles (12/2010 - 02/2008)

Drugs and Biologics

Drugs and Important Biological Agents (IBA) related to Tonic-Clonic Epilepsy:
1. Diazepam (Valium)FDA LinkGeneric
2. Anticonvulsants (Antiepileptic Drugs)IBA
3. Pentylenetetrazole (Metrazol)IBA
05/01/2009 - "AND administered intraperitoneally exhibited dose-dependent protection against tonic-clonic convulsions caused by maximal electroshock (MES) with ED(50) (effective dose(50)) of 227 mg/kg. The compound also inhibited the convulsive action of pentylenetetrazole (PTZ), increasing its CD(50) (convulsive dose(50)) for clonic convulsions from 77.2 (PTZ + saline) to 93.9 (p < 0.05) for PTZ + AND 40 mg/kg and 113.9 mg/kg (p < 0.001) for PTZ + AND 60 mg/kg. In mice pretreated with 60 mg/kg AND, the CD(50) for PTZ-induced tonic convulsions increased from 102 to 127.6 mg/kg (p < 0.01). "
04/01/2006 - "Pentylenetetrazol (PTZ)-induced seizure in rats, a relevant model of human absence and of generalized tonic-clonic epilepsy, was used to stimulate seizure activity within 30 s of administration while collecting continuous, high-resolution, multislice images at subsecond intervals. "
02/28/2000 - "Generalized tonic-clonic convulsions were induced on 2 consecutive days by pentylenetetrazol (PTZ) in immature rats (postnatal days 10 and 20), and hippocampal slices were prepared at different intervals post-injection. "
02/01/1999 - "Following the transection 58% of GEPR-9s displayed a sound-induced tonic-clonic convulsion and the remaining 42% exhibited a sound-induced seizure when subjected to stimulation 5 min after a subconvulsant dose of pentylenetetrazol (PTZ). "
06/01/2017 - "Except naive, animals were challenged with pentylenetetrazole subconvulsive dose (35 mg/kg, i.p.) on every 5th day to determine convulsion severity score, latency to first myoclonic jerk, latency to first tonic-clonic convulsions and numbers of tonic-clonic convulsions. "
4. ParaldehydeIBA
5. PicrotoxinIBA
6. Lorazepam (Ativan)FDA LinkGeneric
07/16/2008 - "The conclusions of this update have changed to suggest that intravenous lorazepam is at least as effective as intravenous diazepam and is associated with fewer adverse events in the treatment of acute tonic-clonic convulsions. "
01/01/2002 - "There was some evidence from this review that rectal lorazepam may be more effective and safer than rectal diazepam, but the data were insufficient to indicate that lorazepam should replace diazepam as the first choice rectal drug in treating acute tonic-clonic convulsions and convulsive status epilepticus."
01/01/2002 - "This review provides no evidence to suggest that intravenous lorazepam should be preferred to diazepam as the first-line drug in treating acute tonic-clonic convulsions including convulsive status epilepticus in children. "
09/01/1983 - "The two abstinence syndromes had many signs in common, including tremor, hot foot walking, rigidity and decreased food intake, but the lorazepam withdrawal abstinence syndrome was much less intense and had a shorter latency to onset than the diazepam abstinence syndrome, which also included clonic and tonic-clonic convulsions and was lethal in two dogs. "
10/01/2018 - "In general, intravenously-administered anticonvulsants led to more rapid seizure cessation but this was usually compromised by the time taken to establish intravenous access.(5) There is limited evidence from a single trial to suggest that intranasal lorazepam may be more effective than intramuscular paraldehyde in stopping acute tonic-clonic convulsions (RR 1.22, 95% CI 0.99 to 1.52; 160 children; moderate-quality evidence).(6) Adverse side effects were observed and reported very infrequently in the included studies. "
7. Midazolam (Versed)FDA LinkGeneric
05/01/2006 - "On admission to the hospital, 6 hours after the ingestion, she was stuporous and had 3 short, generalized tonic-clonic convulsions that were controlled with a single dose of midazolam. "
10/01/2018 - "We have made many comparisons of drugs and of routes of administration of drugs in this review; our key findings are as follows:(1) This review provides only low- to very low-quality evidence comparing buccal midazolam with rectal diazepam for the treatment of acute tonic-clonic convulsions (risk ratio (RR) for seizure cessation 1.25, 95% confidence interval (CI) 1.13 to 1.38; 4 trials; 690 children). "
01/01/2022 - "During recovery from anaesthesia, the patient developed tonic-clonic convulsions which did not improve after two IV doses of midazolam but showed an improvement after a dose of propofol. "
10/01/2018 - "intranasal lorazepam appears to be as effective as intravenous lorazepam (RR 0.96, 95% CI 0.82 to 1.13; 1 trial; 141 children; high-quality evidence) and intranasal midazolam was equivalent to intravenous diazepam (RR 0.98, 95% CI 0.91 to 1.06; 2 trials; 122 children; moderate-quality evidence).(3) Intramuscular midazolam also showed a similar rate of seizure cessation to intravenous diazepam (RR 0.97, 95% CI 0.87 to 1.09; 2 trials; 105 children; low-quality evidence).(4) For intravenous routes of administration, lorazepam appears to be as effective as diazepam in stopping acute tonic clonic convulsions: RR 1.04, 95% CI 0.94 to 1.16; 3 trials; 414 children; low-quality evidence. "
10/01/2018 - "In the absence of intravenous access, buccal midazolam or rectal diazepam are therefore acceptable first-line anticonvulsants for the treatment of an acute tonic-clonic convulsion that has lasted at least five minutes. "
8. Valproic Acid (Depakote)FDA LinkGeneric
9. Phenobarbital (Luminal)FDA Link
10. Topiramate (Topamax)FDA LinkGeneric

Therapies and Procedures

1. Therapeutics
2. Vagus Nerve Stimulation
3. Stroke Rehabilitation
4. Transcranial Direct Current Stimulation
5. Hemispherectomy