Epilepsy is a feature of several brain diseases. It manifests itself in seizures, and the most common form of these seizures is called a grand mal seizure (grand mal seizure).
What is a grand mal seizure?
The word “epilepsy” comes from the ancient Greek, “epilepsis” meaning attack or assault. This illustrates how suddenly and unpredictably such a seizure happens in the brain and puts sufferers out of action. Science distinguishes between different forms of seizures. They differ on the one hand in which brain region they originate, and on the other hand in their intensity. There are convulsions with no or very brief loss of consciousness (petit mal seizures), with and without twitching of the extremities, and tonic-clonic seizures with profound loss of consciousness, convulsions, and severe convulsions – grand mal seizures.
Causes
The causes of epilepsy vary widely. Brain damage, for example, due to lack of oxygen at birth, is just as possible as malformations of the brain tissue or vessels. But also infectious diseases, inflammatory processes in the brain, poisoning, drug consumption, electric shocks and various metabolic disorders can trigger epilepsy. There are sometimes also very banal triggers if there is a corresponding tendency, for example, twitching lights in a disco, over-loud noises. Excitement, sleep deprivation or breathing too hastily. Sometimes, however, the treating physicians find no clues to the sudden discharges in the brain that lead to seizures of various degrees.
Symptoms, complaints, and signs
As a rule, the grand mal seizure proceeds as follows: In the first phase, affected persons feel a kind of premonitory sensation, a special malaise. Experts call this an aura. In the second, tonic phase, they completely lose control of themselves, stiffen completely and faint. When they can no longer manage to lie down, many sufferers fall and can injure themselves considerably. In the subsequent clonic phase, uncontrollable twitching of the arms and legs occurs, and some sufferers also bite their lips and tongue bloody. In the subsequent recovery phase, sufferers are in a kind of deep sleep. The entire grand mal seizure can last a few seconds, a few minutes, or even hours. Affected persons can influence neither the seizure event nor the seizure duration in any way. However, relatives, friends or people who happen to be present can help during a grand mal seizure. The possibilities for help are limited. Helpers can only try to ensure that the patient does not fall heavily and does not bump into obstacles and objects during the twitching that occurs and injure himself in the process. They should also make sure that he gets enough air during the recovery phase. Therefore, it may be necessary to place him in the recovery position. Anyone who experiences a grand mal seizure in someone they do not know should also always call an emergency physician as a precaution. Relatives can assess whether this is necessary or whether it is sufficient to wait for the seizure to end. There are also some emergency medications that are effective for long-lasting seizures and that relatives can administer to the affected person if they have been instructed to do so by the attending physician. Under no circumstances should sufferers be left alone in this completely helpless situation.
Diagnosis
To diagnose epilepsy, the seizure picture must be analyzed in detail. The information provided by witnesses who witness the seizure is also important, because the affected person usually does not notice the seizure. In addition, a magnetic resonance imaging (MRI) is required. This allows the doctor to determine whether there is a structural change in the brain. A computer tomography and an electroencephalography may also be necessary, and in special cases also magnetic resonance imaging, angiography and cerebrospinal fluid puncture.
Complications
Grand mal seizure results in an epileptic seizure. This can cause extreme sequelae and complications for the patient. These depend thereby strongly on the respective situation and the well-being of the patient. As a rule, the patient feels unwell before the seizure and continues to lose control. The affected person stiffens and in most cases can no longer move. Fainting occurs shortly thereafter.When losing consciousness, the patient may suffer a fall or a blow, with various complications. These can also occur if the affected person is driving a vehicle or working on a dangerous machine at the time of the grand mal seizure. The grand mal seizure itself cannot be treated, so the patient can only be placed in a stable position. In addition, fellow human beings can hold the patient during the fall so that no injuries occur. In most cases there are no complications. Furthermore, the epileptic seizures are limited in time, although no exact prediction can be made as to when the next seizure will occur.
When should you see a doctor?
A grand mal seizure is an epileptic seizure such that affected individuals lose control of their own bodies. However, this clinical picture can occur in varying degrees of severity, so medical treatment is not always immediately necessary. Mild and initial seizures, are usually noticeable by a simple muscle twitch. Immediate treatment by a doctor is not necessary in such a case. However, the uncontrolled muscle twitching should continue to be monitored so that it does not lead to further complications or discomfort. If the epileptic seizures lead to a total loss of control, then a visit to the doctor should not be postponed. Drug treatment is absolutely necessary in such a case, so that serious consequential damage does not occur. In addition, only in this way can a serious underlying disease be diagnosed or ruled out. Thus: A grand mal seizure is a serious clinical picture that should definitely be treated by a doctor. Only if the affected person sees a doctor as soon as possible, possible complications and aggravations can be avoided.
Treatment and therapy
One cannot actually speak of a cure for epilepsy. However, according to in-depth studies, between 50 and about 80 percent of all sufferers regain complete seizure freedom, or at least freedom that lasts for many years. Whether epilepsy will disappear again cannot be predicted with certainty, because too little is known about the triggers. Nevertheless, both patients and their doctors can do a lot to reduce the frequency of epileptic seizures and sometimes even to make them disappear altogether. Even abstaining from drugs and alcohol, getting enough sleep, learning relaxation techniques, eating a certain way, and generally leading a healthy lifestyle can be helpful. Doctors can also initiate drug therapy. There are several types of so-called seizure blockers available today. However, their effect is imprecise and they sometimes have very unpleasant side effects. Such medication must therefore be given with a precise risk/benefit assessment and the most accurate dosage. In case of very frequent and long-lasting seizures and a very severe impairment of the quality of life, there may also be the possibility of electrical stimulation of the vagus nerve. It transmits excitations to the brain and can thus mitigate certain types of seizures or at least reduce their frequency. In some cases, there is also the possibility of surgical intervention. However, this is only possible if there is brain or vascular damage that can be precisely localized. In addition, such an operation is very risky.
Outlook and prognosis
The prognosis of a grand mal seizure depends on the circumstances and environment in which it occurs. Therefore, various complications can occur, which in the worst case can lead to death. The risk of falling with subsequent serious bodily injuries in the form of bone fractures is increased. Seizures during pregnancy are dangerous for both mother and child, and certain antiepileptic drugs increase the risk of birth defects. People with grand mal seizures are more likely to have psychological problems such as depression and anxiety. These problems can also be the result of complications related to the condition itself and side effects from medication. The prognosis is more favorable the earlier medical treatment is initiated. The shorter the duration between the first seizure and adequate drug treatment, the better the prognosis. The classification made here with its subgroups is equally decisive.Children between one and fourteen years of age show the best chance of success for almost perfect rehabilitation. Here, too, the classification of the different gradations as well as the frequency of the seizures is important. Mere mental absences, called absences, disappear completely as the child grows up. The relapse rate in children with grand mal seizures is approximately 12%, provided that at least the third year of life has passed.
Prevention
Epilepsy, and especially the occurrence of grand mal seizures, is a serious condition and can significantly reduce the quality of life of those affected. However, it is not a fatal disease and with the necessary knowledge and support and understanding of the environment, one can live relatively normally with it.
Aftercare
After the first grand mal seizure, intensive follow-up care is mandatory in any case. As soon as the initial medical treatment has been completed and the affected person’s condition has stabilized, intensive examinations are first necessary for precise epilepsy diagnostics. These can sometimes last several days and are usually accompanied by inpatient hospitalization. Lifelong follow-up is necessary to adjust to optimal drug treatment of the underlying form of epilepsy. Initially, follow-up examinations take place within very short intervals several times a month. Over time, they usually become less frequent depending on the success of drug therapy. If further grand mal seizures or other physical complaints occur, even more intensive follow-up is necessary. In general, it is advisable to attend all follow-up and control examinations. In addition, further examinations can be performed at the request of the patient to be on the safe side. If the patient remains seizure-free for a longer period of time, the intervals for medical check-ups can be reduced. However, it is essential to clarify this with the attending physician. For affected persons with a known diagnosis of epilepsy who suffer a grand mal seizure for the second time, several medical check-ups are also advisable after initial medical treatment.
What you can do yourself
The disturbance of both hemispheres of the brain trigger generalized seizures in epileptics. The development phase is accompanied by precursors of a seizure. The patient is irritable, disgruntled, and suffers from headaches. Other physical signs include tingling in the hands and legs and limitation of hearing. Perception and classification of symptoms is important for epileptics. Triggering a grand mal seizure is individual to each patient. Seizure self-monitoring provides patients with information about their own disease progression. Epileptics who actively deal with their disease learn to avoid seizure situations. Stress is known to be a recurring seizure trigger. Recognizing it as a trigger makes it possible to take effective countermeasures. Active relaxation exercises break the progression to the seizure. Seizure self-control can be learned and is performed over a longer period of time. The duration depends on the rhythm of the occurring seizures. Prerequisite is a good body awareness. Self-monitoring is a supplement to drug treatment. For chronic epileptics, communication with the social environment is important. A grand mal seizure is difficult to assess and frightening for relatives. Information about the phases of a seizure and what actions to take will help those affected.