Tonic-Clonic Seizures: What They Are and How to Handle Them

If you've ever heard someone talk about a "grand mal" seizure, they're usually describing a tonic‑clonic seizure. It’s the type most people picture when they think of epilepsy—muscles stiffen (tonic phase), then start jerking wildly (clonic phase). These episodes can last from a few seconds to a couple of minutes and often end with confusion or fatigue.

Why do they happen? In simple terms, the brain's electrical activity goes haywire. Triggers vary: lack of sleep, flashing lights, alcohol withdrawal, or even sudden stress. Some people have an underlying condition like epilepsy that makes them more prone, while others might experience a first‑time seizure after a head injury or fever.

How to Recognize a Tonic-Clonic Seizure

The tell‑tale signs are pretty clear. First, the person may lose consciousness and fall. Their body goes rigid for about 10–20 seconds (the tonic part). Then the muscles start to contract rhythmically, causing full‑body convulsions that can look frightening but usually stop on their own. You might also notice a frothy mouth, tongue biting, or loss of bladder control. After the shaking stops, there’s often a period of confusion—called the postictal phase—that can last minutes or longer.

What to Do When Someone Is Having One

Stay calm and act fast. Clear anything dangerous out of their way—move chairs, sharp objects, or hot liquids. Don’t try to hold them down; they need space to breathe. Gently roll them onto their side once the convulsions end; this helps keep the airway clear. Time the seizure if you can—most stop within two minutes. If it goes longer than five minutes, call emergency services immediately.

Never put anything in their mouth. The myth about preventing tongue biting by forcing a spoon or hand is false and can cause injury. Instead, focus on protecting their head with a soft pillow or folded jacket.

After the seizure, stay with them until they’re fully alert. Offer reassurance—most people feel disoriented and scared after an episode. If you know they have a prescribed rescue medication (like midazolam), follow the doctor’s instructions on when to give it.

Long‑term management involves working with a neurologist. Anti‑seizure medications are the mainstay, and finding the right one can take trial and error. Lifestyle tweaks also help: regular sleep, stress reduction, limiting alcohol, and avoiding known triggers like flickering lights.

If you or someone you love has been diagnosed with tonic‑clonic seizures, keep a seizure diary. Note when they happen, how long they last, what you ate, your stress level, and any meds taken. This record is gold for doctors trying to adjust treatment.

Remember, while the sight of a convulsion can be scary, most tonic‑clonic seizures are self‑limiting and don’t cause permanent damage. Knowing the signs and having a clear plan makes the experience less frightening for everyone involved.