GENERALIZED TONIC-CLONIC SEIZURES (GRAND MAL)

Generalized tonic-clonic seizures occur when epileptic activity spreads throughout the entire brain. The child is unconscious from the start, and will have a major convulsion with both a tonic (stiffening) and a clonic (jerking) phase. After the seizure, the children are unconscious and then groggy for a while. They may want to sleep. There will be no memory of what went on during the seizure.

The seizure usually begins with a fall, possibly accompanied by a sudden cry. The body stiffens (tonus), and then, after a while, begins to jerk (clonus). There may be shallow breathing or temporarily suspended breathing, with bluish skin or lips. (note that children do not stop breathing long enough to hurt themselves.) There may be a loss of bladder or bowel control. Toward the end of the seizure, children may salivate profusely.

Tonic-clonic seizures usually last 1 to 3 minutes, seldom longer.

Tonic-clonic seizures are not

Do NOT

SOME MEDICATIONS USED FOR TONIC-CLONIC SEIZURES

DEPAKENE® / EPIVAL® (VALPROATE / DIVALPROEX SODIUM) 

Depakene® / Epival® is the drug of choice for children with absence seizures who are also prone to tonic-clonic seizures. Often used for children who have seizures that are induced by flashing lights (photosensitivity). 

Can cause

Less Common Side-Effects

If individuals experience vomiting and nausea, it usually happens at the initiation of the treatment, then wears off.

The uncommon side effect most people are concerned about is hepatic (liver) failure (jaundice). The possibility of this is very slight. The deaths due to liver failure from this drug have almost always occurred in children under 2 years of age, and many of these children have had severe health problems along with epilepsy and been on multiple anti-epileptic medications. It is highly unlikely that your child will develop liver problems. If you see a loss of appetite and weight, however, or a yellow colour in the child's skin, you should call your doctor immediately.

Ask your doctor about getting regular Valproic acid levels taken (blood test).

DILANTIN  ® (PHENYTOIN)

Rarely used in children

Can cause:

FRISIUM ® (CLOBAZAM)

Used in combination with another anticonvulsant medication. A useful addition to the anti-epileptic medications for people with refractory or difficult to control seizures.

Can cause:

Less Common Side-Effects

Tolerance may develop after 1-6 months of administration and some patients cease to respond to the drug.

LAMICTAL ® (LAMOTRIGINE)

Broad-spectrum anti-convulsant

Can cause:

Less Common Side Effects:

***Labeling suggests this medication not to be used in children under the age of 18***

MYSOLINE ® (PRIMIDONE)

Less Common Side-Effects

Since Mysoline is partially changed to Phenobarbital in the body, it is not usually prescribed in conjunction with Phenobarbital.

NEURONTIN ® (GABAPENTIN)

Safety and efficacy in children are still under investigation

Can cause:

PHENOBARBITAL

Oldest established anti-epileptic medication

Can cause:

Less Common Side Effects

Children who show the sedative side effects of Phenobarbital may experience memory and cognitive problems. The abrupt discontinuation of Phenobarbital may lead to a sudden increase in seizures.

TEGRETOL ® (CARBAMAZEPINE)

Can cause

nausea/vomiting

Less Common Side Effects

With regular Tegretol ®, a wide daily fluctuation in blood levels of the drug is seen in some children. For this reason, it may be difficult to get the right dosage. The Tegretol-CR ® (controlled release) formulation, however, provides steady blood levels and many people find that the side effects are not as prevalent.  Tegretol ® is also available in a liquid (Tegretol ® Suspension) and in a chewable formulation (Chewtabs ­® - must be chewed completely to be effective).

July 4, 2002