Suspect 6: Tonic-Clonic. (A.K.A. the grand mal)

By: Neha Kinariwalla

Before cueing any James Bond music, let’s take a look at the grand mal (equally big and bad)!

Because we often tend to unfairly stigmatize epilepsy it’s worthwhile to explain what the grand mal seizure actually is, as well as the physiology behind it. Let’s start by defining what the term literally means. The grand mal seizure consists of the following two phases; the first being tonic, and the last being clonic.

During the tonic phase, since breathing decreases, a person’s lips, nail beds, and face can turn blue—this usually lasts for a minute or so.

During the clonic phase, there are jerking movements that usually alternate.

Tonic: Commonly thought of as some form of medicine taken to bring feel good, in physiological terms it means “muscular contraction” [2]. When a person has a tonic seizure, their muscles stiffen, their eyes roll to the back of their head, and they lose consciousness. This could be rapidly occurring at first, but will subside gradually. People often think that a person having such a seizure will “swallow their tongue”. Thankfully, that’s physically impossible! Though one should never, under any circumstances attempt to open their tightly clenched jaw as that can be tremendously harmful to the patient experiencing the seizure.

Clonic: I can’t say clonic is commonly used in day-to-day language, but in medical terms it is just simple alternation of contraction and relaxation [2]. So naturally, a clonic seizure is when the individual’s muscles begin to spasm and jerk. Towards the end of this phase, one should look for a deep sigh after which normal breathing will resume.

It’s rare for these two types of seizures to be separate from one another. And when both are experienced at the same time, it’s known as the tonic-clonic seizure. Makes sense, right?

So what should you do? Prevent injury by placing something soft under their head. Loosen tight clothing. Turn a person on their side. Stay with that person and be there for them—physically and emotionally. If lasts longer than 5 minutes, call the doctor.


[1] “Tonic and Clonic Seizures” Johns Hopkins Medicine. Web. 30 Oct. 2013.

[2] Tonic Clonic Seizures. Epilepsy Foundation. Web. 30 Oct 2013.


 Reviewed by Dr. Miller-Horn 

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