tonicocloniche

Tonicocloniche are a type of generalized seizure characterized by sudden impairment of consciousness accompanied by bilateral motor activity that alternates between tonic stiffening and clonic jerking. They are among the most common seizure types in people with epilepsy and can occur in various etiologies, including genetic generalized epilepsy and structural brain disease.

The onset may include an aura or prodrome; the tonic phase lasts several seconds with stiffening of axial and limb muscles, often causing a fall. This is followed by the clonic phase with rhythmic jerking that typically lasts 1–3 minutes. Common features include impaired awareness, tongue biting, urinary incontinence, and postictal confusion, fatigue, and sleepiness.

Pathophysiology involves widespread, synchronous neuronal discharges across thalamocortical networks, leading to generalized cerebral involvement. In many cases, tonicocloniche arise from primary generalized epilepsy, while in others they represent secondary generalization from focal seizures.

Diagnosis relies on clinical history and eyewitness description; electroencephalography (EEG) may show generalized epileptiform discharges; brain imaging (MRI) may be indicated to exclude structural lesions. Differential diagnoses include syncope (fainting), psychogenic non-epileptic seizures, and sleep disorders.

Management includes safety during seizures, acute treatment with benzodiazepines (e.g., lorazepam), and long-term antiseizure medication to reduce recurrence. Choice of drug depends on age, comorbidity, and epilepsy syndrome. Prognosis varies; some individuals achieve seizure control with treatment, while others have refractory epilepsy. Emergency care is required for status epilepticus or injuries.