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.