Grand mal seizures (tonic-clonic seizures) are the most common form found in epilepsy. They can also be brought on by cerebrovascular accidents, meningitis, encephalitis, drug withdrawal, photic stimulation, fatigue and intoxicants. The entire seizure may be broken down into prodromal, preictal, itcal and post-itcal phases which last no more than 5 to 15 minutes. However, it may take up to 2 hours for normal, preictal cerebral function to return. A grand mal seizure that lasts for hours or days is termed status epilepticus and can lead to death if not managed.
In the prodromal phase the patient may exhibit changes that may be evident only to a relative, such as increased anxiety or depression. A patient with a history of seizures may recognize the development of an “aura” consisting of olfactory, visual, gustatory or auditory changes. If the aura is noted by the patient or the dental staff, treatment should be terminated immediately before it progresses to the preictal phase.
The preictal phase is clinically manifested by:
The ictal phase (tonic component) is clinically manifested by:
The postictal phase is clinically manifested by:
Should a patient exhibit a grand mal seizure, the following steps should be taken:
PRODROMAL AND PREICTAL PHASE
If the seizure lasts more than 15 minutes:
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