HOME PRODUCTS SERVICES COMPANY CONTACT FAQ

Tonic-Clonic Epilepsy (Epilepsy, Tonic Clonic)

Subscribe to New Research on Tonic-Clonic Epilepsy

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: 233 relevant articles (12 outcomes, 12 trials/studies)

Relationship Network

Disease Context: Research Results

Nervous System Diseases: 6158
- Central Nervous System Diseases: 1649
  - Brain Diseases: 2114
    - Epilepsy: 22953
      - Generalized Epilepsy: 1060
        Tonic-Clonic Epilepsy: 233

Related Diseases

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

Experts

1.	Oda, Yutaka: 3 articles (05/2008 - 03/2004)
2.	Asada, Akira: 3 articles (05/2008 - 03/2004)
3.	Tanaka, Katsuaki: 3 articles (05/2008 - 03/2004)
4.	Dhir, Ashish: 2 articles (12/2015 - 08/2007)
5.	Umukoro, Solomon: 2 articles (09/2014 - 01/2013)
6.	Mihály, A: 2 articles (09/2008 - 01/2000)
7.	Takahashi, Ryota: 2 articles (05/2008 - 03/2005)
8.	Funao, Tomoharu: 2 articles (03/2005 - 03/2004)
9.	Kassa, J: 2 articles (09/2001 - 08/2001)
10.	Chopra, Kanwaljit: 1 article (12/2015)

Drugs and Biologics

Drugs and Important Biological Agents (IBA) related to Tonic-Clonic Epilepsy:

1.	Diazepam (Valium)FDA LinkGeneric 01/01/1992 - "Moreover, only 1 out of the 5 monkeys which received diazepam treatment suffered tonic-clonic convulsions; in contrast all 5 monkeys which did not receive diazepam treatment experienced severe convulsive episodes. " 11/21/1983 - "Diazepam remained protective against tonic-clonic convulsions (but not against myoclonus) induced by threshold doses of PTZ for 30 days in all 3 strains." 01/01/1983 - "Diazepam retained its protective effects against tonic-clonic convulsions induced by PTZ (90 and 60 mg/kg) for 45 days, but the incidence of myoclonic jerks revealed tolerance after 5 days." 01/01/1983 - "Considering the incidence of tonic-clonic convulsions, tolerance to the protective effects of diazepam was evident by day 5 if the mice were challenged with PTZ (120 mg/kg), by day 10 if the challenge was picrotoxin (8 mg/kg) and by day 20 if the challenge was PTZ (105 mg/kg). " 01/01/2008 - "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. "
2.	ParaldehydeIBA 09/01/2009 - "This study provides unique evidence that rectal paraldehyde is effective and safe in treating acute prolonged tonic-clonic convulsions. " 09/01/2009 - "Review of the efficacy of rectal paraldehyde in the management of acute and prolonged tonic-clonic convulsions." 09/01/2009 - "Information was collected on each dose of paraldehyde used for the treatment of a tonic-clonic convulsion over 1 year. " 09/01/2009 - "The aim of this prospective audit was to assess the effectiveness and safety of rectal paraldehyde in the management of acute, including prolonged, tonic-clonic convulsions. " 09/01/2009 - "This would appear to confirm that paraldehyde should remain a treatment for the management of prolonged tonic-clonic convulsions, including convulsive status epilepticus."
3.	Anticonvulsants (Antiepileptic Drugs)IBA 06/01/2012 - "We used maintenance ECT to treat an 18-year-old man with a long-standing generalized tonic-clonic seizure disorder who had shown poor response to several antiepileptic drugs administered in combination with antiepileptic medication compliance confirmed through drug level monitoring. " 06/01/2004 - "He had been institutionalized at the age of 10 years and had received anticonvulsant drugs since he was diagnosed with tonic-clonic epilepsy 20 years ago. " 03/01/2003 - "Careful clinical history revealed Grand Mal epilepsy during infancy that was well controlled by antiepileptic drugs. " 01/01/1982 - "This patient, a 29 year old male, suffered from grand mal epilepsy for about 12 years, and he had been treated with anticonvulsive drugs. " 01/01/2008 - "Randomized and quasi-randomized controlled trials comparing any anticonvulsant drugs used for the treatment of an acute tonic-clonic convulsion including convulsive status epilepticus in children. "
4.	Pentylenetetrazole (Metrazol)IBA 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. " 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. " 02/01/1999 - "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). " 01/01/1988 - "Minimal seizures with a motor pattern identical to minimal metrazol seizures were observed in all the age groups and so were generalized tonic-clonic convulsions, which appeared after large doses of KA. "
5.	PicrotoxinIBA 01/01/1983 - "Considering the incidence of tonic-clonic convulsions, tolerance to the protective effects of diazepam was evident by day 5 if the mice were challenged with PTZ (120 mg/kg), by day 10 if the challenge was picrotoxin (8 mg/kg) and by day 20 if the challenge was PTZ (105 mg/kg). " 09/01/2014 - "MJ (50-400 mg/kg) did not protect the mice against tonic-clonic convulsions induced by picrotoxin (10 mg/kg, i.p.) or strychnine (3 mg/kg, i.p.). " 06/12/1999 - "The total dose of drug infused prior to either electrical seizures (lidocaine, PTZ, and picrotoxin) or tonic-clonic convulsions (all drugs) were noted. " 08/01/2007 - "However, cefazolin (500 or 1000 mg/kg, i.v.) when administered before different doses of pentylenetetrazol (PTZ; 40 or 60 mg/kg, i.p.) or picrotoxin (PTX; 4 or 8 mg/kg, i.p.), it produced severe tonic-clonic convulsions in mice. " 01/01/2013 - "However, it did not did not offer any protection against seizure episodes, as it failed to prevent the animals, from exhibiting tonic-clonic convulsions caused by pentylenetetrazole (85 mg/kg, i.p.), strychnine (2 mg/kg) or picrotoxin (6 mg/kg, i.p.). "
6.	Phenobarbital (Luminal)FDA Link 01/03/1998 - "The acceptability and efficacy of phenobarbital treatment for childhood epilepsy was evaluated in 94 children from rural India with partial and generalized tonic-clonic epilepsy. " 03/01/1994 - "This study showed that in Port Moresby acute meningitis is a significant cause of epilepsy in young children, the majority of whom present with grand mal epilepsy, which is usually controlled by phenobarbitone, a readily available and cheap drug and still a useful anticonvulsant in the developing world." 10/01/1986 - "[Hereditary coproporphyria with grand mal epilepsy, glucose-6-phosphate dehydrogenase deficiency and phenobarbital tolerance]." 08/01/1980 - "Phenobarbital vs. phenytoin for grand mal epilepsy." 07/01/1996 - "To compare the efficacy and side effects of phenobarbitone (PB), phenytoin (PHT) and sodium valproate (SVP) in controlling generalized tonic-clonic convulsions (GTC). "
7.	Lorazepam (Ativan)FDA LinkGeneric 01/01/2008 - "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. " 03/01/1993 - "Four-year-old, 20-kg girl, diagnosed with idiopathic tonic-clonic epilepsy, who developed AHS to phenobarbital and phenytoin and status epilepticus unresponsive to lorazepam. "
8.	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. " 01/01/2008 - "Four trials involving 383 participants were included.(1) Intravenous lorazepam is as effective as intravenous diazepam in the treatment of acute tonic clonic convulsions, 19/27 (70%) versus 22/34 (65%), RR 1.09 (95% CI 0.77 to 1.54), has fewer adverse events and rectal lorazepam may be more effective than rectal diazepam, 6/6 versus 6/19 (31%), RR 3.17 (95% CI 1.63 to 6.14)(2) Buccal midazolam controlled seizures in 61/109 (56%) compared with 30/110 (27%) of rectal diazepam treated episodes with acute tonic-clonic convulsions, RR 2.05 ( 95% CI 1.45 to 2.91)(3) Intranasal midazolam is as effective as intravenous diazepam in the treatment of prolonged febrile convulsions, 23/26 (88%) versus 24/26 (92%), RR 0.96 (95% CI 0.8 to 1.14)(4) There is moderate evidence that intranasal lorazepam is more effective than intramuscular paraldehyde for acute tonic-clonic convulsions and patients treated with intranasal lorazepam are significantly less likely to require further anticonvulsants to control continuing seizures, 8/80 (10%) versus 21/80 (26%), RR 0.58 (95% CI 0.42 to 0.79). " 01/01/2008 - "To review the evidence comparing the efficacy and safety of midazolam, diazepam, lorazepam, phenobarbitone, phenytoin and paraldehyde in treating acute tonic-clonic convulsions and convulsive status epilepticus in children treated in hospital. "
9.	topiramate (Topamax)FDA LinkGeneric 10/01/1999 - " (2) The efficacy of topiramate was established in two double-blind, placebo-controlled trials in patients with generalised tonic-clonic epilepsy, and in a double-blind, placebo-controlled trial in patients with partial epilepsy. " 10/01/1999 - "(1) The licensed indications of topiramate have been extended to cover treatment (in combination with an inadequately effective ongoing treatment) of generalised tonic-clonic epilepsy in adults and children over four years, and partial epilepsy in children over four. " 12/01/1998 - "In cases of poor response to the monotherapy recommended above, the following combinations may be indicated: in primary generalized tonic-clonic epilepsy, valproate and oxcarbazepine/ carbamazepine, or valproate and lamotrigine; in typical absences, valproate and lamotrigine, or valproate and ethosuximide; in juvenile myolonic epilepsy, valproate and lamotrigine, or valproate and clonazepam; and in partial epilepsies, add to the monotherapy one of the following drugs, vigabatrin, lamotrigine, gabapentin, tiagabine, topiramate, zonisamide or clobazam. "
10.	Valproic Acid (Valproate, Semisodium)FDA LinkGeneric 01/01/1987 - "Valproic acid is also effective against generalized tonic-clonic epilepsy. " 07/01/1992 - "Generalized tonic clonic convulsions had appeared from six months after birth and were treated with valproic acid. " 02/01/1990 - "A nine year old boy had been treated with valproic acid during one and a half years because of a grand mal epilepsy. " 04/01/2012 - "We hereby report a rare case of 17-year-old woman suffering from generalized tonic clonic epilepsy with comorbid bipolar affective disorder, who was initially treated with sodium valproate with partial improvement. " 03/09/1992 - "She was handicapped with arthrogryposis multiplex and she was treated with valproate for grand mal epilepsy. "

Therapies and Procedures

1.	Hemispherectomy 08/01/1999 - "This study retrospectively reviews the histopathologic findings in 37 cases of functional hemispherectomy performed between 1990 and 1998 at a major epilepsy center. "
2.	Therapeutics 12/15/2015 - "Allopregnanolone is protective in animal models of neonatal status epilepticus and generalized tonic-clonic convulsions and further clinical studies are required to establish its use in therapeutics."
3.	Anesthesia 06/10/2008 - "According to one witness, around 30 min after anesthesia administration, the victim suffered an episode of tonic-clonic convulsion. " 10/01/2001 - "PLP induced barrel turning, running fits and tonic-clonic convulsions, which started 5-10 min after recovery from the anesthesia (halothane), peaked at 20 min and disappeared at about 50 min. These symptoms were accompanied by frequent high amplitude EEG spike burst discharges. " 07/01/1992 - "After surgical preparation and recovery from anesthesia, all groups received a continuous IV infusion of lidocaine (15 mg/mL) at a rate of 4 mg.kg-1.min-1 until tonic/clonic convulsions occurred. " 05/01/1984 - "Immediate and delayed postoperative generalized tonic-clonic convulsions have also been reported after enflurane anesthesia. "
4.	Subcutaneous Injections 08/01/1984 - "Subcutaneous injection of 1.0 mg/kg of the compound induced a generalized tonic-clonic convulsion. " 03/01/2011 - "Our patient was subjected to subcutaneous injection of one ml normal saline, which caused asystole leading to hypoxia and consequently a typical tonic-clonic convulsion. "
5.	Injections 12/01/2008 - "A healthy 18-yr-old male (weight 60 kg, height 167 cm), with a history of febrile convulsions in childhood, developed a grand mal convulsion 10 min after the second of two injections of ropivacaine 150 mg, both given incrementally 15 min apart (total 300 mg), for combined axillary/interscalene brachial plexus block. " 01/01/2000 - "Systemic injections of 4-aminopyridine precipitate epileptiform generalized seizures characterized mainly by shivering of the body, tail movements and tonic-clonic convulsions in rats and mice. "