During a generalized tonic-clonic (formerly grand mal) seizure, electric discharges instantaneously involve the entire brain. The person loses consciousness right from the beginning of the seizure.

A tonic-clonic seizure usually lasts one to three minutes, but may last up to five minutes.  If seizures last more than five minutes, or occur one after another without recovery between seizures, the individual may be experiencing a life-threatening medical emergency and requires immediate medical help.

The person will usually emit a short, loud cry as the muscles in the chest contract and the air rushes between the vocal cods, making a sound. This cry does not indicate pain. The muscles will stiffen (tonic phase), causing him/her to fall to the floor. Increased pressure on the bladder and bowel may cause wetting (urinary incontinence) or soiling (fecal incontinence). The child may bite the tongue, which may cause bleeding.

The extremities will then jerk and twitch rhythmically (clonic phase). Saliva that has not bene swallowed during the seizure may froth at the mouth. Breathing may be irregular as the respiratory muscles may be affected. The person will regain consciousness slowly.

The period after the seizure is referred to as the post-ictal state. During this time, the person will need to rest. It may be difficult to wake him/her or get any response from him/her during this time. After a seizure, the person may feel fatigue, confusion and disorientation, which may last from five minutes to several hours or even days. Rarely, this disorientation may last up to two weeks.

The person may fall asleep, or gradually become less confused until full consciousness is regained. S/he may have a headache once s/he regains consciousness. There is no evidence that tonic-clonic seizures cause brain damage.

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