Tonic-clonic seizure
(Grand mal)

Begin with abrupt loss of consciousness, usually no warning or aura

Attack last 60 to 90 seconds.

Tonic phase

• Patient suddenly becomes rigid, trunk and extremities are extended, and the patient falls to the ground.
• Patient is often apnoeic during this period (may be cyanotic)
• Often urinate and/or vomit.

Clonic phase

• Coarse trembling evolving into a symmetrical rhythmic jerking of the trunk and extremities

After the attack

• Flaccid, unconscious
• Often deep rapid breathing
• Consciousness returns gradually
• Post-ictal confusion and fatigue may persist for several hours.