Epilepsy: Generalized Seizures and Status Epilepticus
Primary
generalized seizures, the most common type being generalized tonicclonic
(grand mal) seizures, involve both cerebral hemispheres. The seizure begins
with tonic stiffening of the limbs in an extended position, with arching of the
back, followed by synchronous clonic jerks of muscles of the limbs, body, and
head. The tongue may be bitten, and incontinence may occur. A period of
postictal lethargy, confusion, and disorientation follows the seizure. An
unbroken cycle of seizures—termed status epilepticus—can develop. Generalized tonicclonic status epilepticus
is a lifethreatening emergency and almost always requires intravenous
medication for seizure control. Drugs for tonicclonic (and partial) seizures
include carbamazepine, phenytoin, valproic acid, and primidone; those for
status epilepticus include diazepam and lorazepam. Adverse effects such as
sedation, confusion, and hepatic toxicity and drug interactions occur.
