MCC Paramedic Education

Types of Seizures

Absence (formerly petite mal) Typically lasts less than one minute,  usually do not fall or become incontinent, appear to be day-dreaming, often go unrecognized. A patient is never disoriented afterwards, and  rarely if ever, are ambulances called for this problem. 

Tonic  Sudden contractions of a muscle group that last for 10 to 15 seconds. Usually occurs with the upper extremities. Does not cause a loss of consciousness. Has a poor prognosis as it is usually due to a structural anomaly.

Clonic Jerking motions of the muscles, usually in a 30/70 ratio. 30 percent of the time in contraction, 70 percent of the time in relaxation. Can occur alone but are usually part of the Tonic-clonic seizure. History from bystanders will help differentiate between these two.

Tonic-Clonic (formerly grand mal) Patient may have an aura (visual, auditory, olfactory, somatic) They may yell out, suddenly stiffen and fall (tonic phase) which lasts for 20 seconds to 60 seconds and then becomes jerky (clonic phase) The muscle contractions are typically in a 30/70 ratio and the head and eyes typically deviate to one side or the other. Bubbly salivation and grunting vocalizations are common as are incontinence of urine and less commonly, stool.. "Non-electric" seizures rarely have these findings. Can occur as a result of rapid change in temperature,  past head injury, brain tumor or stroke. When no identifiable cause can be found, it is termed idiopathic seizure or epilepsy. When the seizure lasts more than 10 minutes, or multiple seizures occur in succession without regaining cx, you have the diagnosis of status epileptics which can be treated with Valium or Versed.  

Myotonic Sudden muscle contractions occurring in groups of 2-5 usually occurring in the morning hours or upon waking. There is a genetic trait that can be passed along family lines that causes myotonic seizures.

Atonic (drop attacks) Patients without warning will suddenly lose all muscle tone and collapse. Due to the weight of the head and upper torso,  the patient usually falls head first and should be regarded as a C-Spine injury until proven other wise. Patients usually regain cx fairly quickly unless an associated head injury occurs. The differential diagnosis of Stokes-Adams must be also considered as a possibility. Often, these patient wear helmets for protection. 

Jacksonian (marching seizures) A clonic seizure that begins in one area of the body (typically the hand or foot) and moves progressively towards the other side of the body. It can be limited to one extremity but can also become grand-mal. It is very very important to identify the exact location the seizure began i.e. right hand. If the seizure is limited to only part of the body, cx  may be intact.