(1) Prodromal phase. In this phase, 50 percent of the patients experience
an aura, that is a particular sensation described as an odd or unpleasant sensation
rising from the stomach toward the chest and throat; that is a kind of premonition before
the seizure occurs. The individual cries out (a respiratory muscle has a spasm) and
loses consciousness, falling to the ground. NOTE: Some patients experience the same
aura before each seizure. The aura may cause numbness or motor activity such as
turning the head and eyes or the spasm of a limb. The aura may be a peculiar sound or
baste or a memory from the past.
(2) Tonic phase. This phase is characterized by continuous body tension.
There is a sustained contraction of all muscles in the body; the body is rigid with fixed
jaws, hands clenched, and legs extended. The person's face may be red or cyanotic
due to a spasm of the respiratory muscle. His pupils are dilated, corneal and deep
tendon reflexes are absent, and the Babinski sign is positive.
(3) Clonic phase. The person's muscles alternately contract and then relax
rapidly. The phase follows the tonic phase in less than a minute. The individual's jerky
movements are caused by the alternating contractions and relaxation of his muscles
(myoclonic jerking of arms and legs and/or the body trunk). Frothing at the mouth, loss
of bladder and bowel control, tongue biting, bruises, and contusions commonly occur
during this phase.
(4) Postictal phase. The clonic convulsive phase gradually subsides. The
fourth phase characterized by a deep sleep with gradual recovery. When the person
awakens, he may be confused, tired, have muscle soreness, and a headache.
Encourage him to rest because activity could bring about another attack.
d. Status Epilepticus. Status epilepticus is a medical emergency and is a
series of seizures that occur in rapid succession with no intervening periods of
consciousness. A grand mal status epilepticus may persist for hours or days resulting
in a coma. The coma may be fatal due to hyperthermia (very high body temperature)
and exhaustion. If any seizure lasts over ten minutes, the seizure is considered status
epilepticus and, therefore, a medical emergency. The cause of status epilepticus is
often the result of improper drug therapy for epilepsy. This condition can also occur
e. Psychomotor Seizures. These are seizures that do not adhere to the
classic criteria of the grand mal, focal, or petit mal seizures. Characteristics of
psychomotor seizures include the following:
The individual loses contact with his environment for one to two minutes.
(2) He does not fall, but he may stagger around performing automatic
purposeless movements. Also, he may utter unintelligible sounds, turn his head or
eyes, smack his lips, rub his hair, or rub his face.