WordNet

relating to or being the keynote of a major or minor scale; "tonic harmony"
a medicine that strengthens and invigorates (同)restorative
(music) the first note of a diatonic scale (同)keynote
lime- or lemon-flavored carbonated water containing quinine (同)tonic_water, quinine water
used of syllables; "a tonic syllables carries the main stress in a word" (同)accented
employing variations in pitch to distinguish meanings of otherwise similar words; "Chinese is a tonal language" (同)tonal
of or relating to or producing normal tone or tonus in muscles or tissue; "a tonic reflex"; "tonic muscle contraction"
of or relating to abnormal neuromuscular activity characterized by rapidly alternating muscle contraction and relaxation; "clonic spasm"

PrepTutorEJDIC

強壮剤;養毛剤,ヘアトニック / (精神的に)元気付けるもの / =tonic water / 主音(音階の中心となる第1音) / 強壮にする,元気付ける / 音調の / (音楽で)主音の
(重量単位の)『トン』 / (容積単位の)トン(物によって異なり,木材では40立方フィート,小麦では20立方フィート) / 《話》大量(の…),多数(の…)《+of+名》

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/05/07 13:10:21」(JST)

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Tonic–clonic seizures (formerly known as grand mal seizures) are a type of generalized seizure that affects the entire brain. Tonic–clonic seizures are the seizure type most commonly associated with epilepsy and seizures in general, though it is a misconception that they are the only type.

Tonic–clonic seizures can be induced deliberately in electroconvulsive therapy.

Pathophysiology

The vast majority of generalized seizures are idiopathic.^[1] However, some generalized seizures start as a smaller seizure such as a simple partial seizure or a complex partial seizure and then spread to both hemispheres of the brain. This is called a secondary generalization.^[2] Factors could include chemical and neurotransmitter imbalances and a genetically determined seizure threshold, both of which have been implicated. The seizure threshold can be altered by fatigue, malnutrition, lack of sleep or rest, hypertension, stress, diabetes, the presence of neon or xenon strobe-flashes, fluorescent lighting, rapid motion or flight, blood sugar imbalances, anxiety, antihistamines and other factors.^[3]

In the case of symptomatic epilepsy, it is often determined by MRI or other neuroimaging techniques that there is some degree of damage to a large number of neurons.^[4] The lesions (i.e., scar tissue) caused by the loss of these neurons can result in groups of neurons episodically firing abnormally, creating a seizure.

Phases

The seizures are divided into two phases, the tonic phase and the clonic phase, hence the name of the seizure.

Tonic phase: The patient will quickly lose consciousness, and the skeletal muscles will suddenly tense, often causing the extremities to be pulled towards the body or rigidly pushed away from it, which will cause the patient to fall if standing or sitting. The tonic phase is usually the shortest part of the seizure, usually lasting only a few seconds. The patient may also express brief vocalizations like a loud moan or scream during the tonic stage, due to air forcefully expelled from the lungs.

Clonic phase: The patient's muscles will start to contract and relax rapidly, causing convulsions. These may range from exaggerated twitches of the limbs to violent shaking or vibrating of the stiffened extremities. The patient may roll and stretch as the seizure spreads. The eyes typically roll back or close and the tongue often suffers bruising or lacerations sustained by strong jaw contractions. The lips or extremities may turn slightly bluish (cyanosis) and incontinence is seen in some cases.

Due to physical and nervous exhaustion, postictal sleep with stertorous breathing invariably follows a tonic–clonic seizure. Confusion and complete amnesia upon regaining consciousness is usually experienced and slowly wears off as the patient becomes gradually aware that a seizure occurred..

References

^ David Y Ko (5 April 2007). "Tonic–Clonic Seizures". eMedicine. Retrieved 2008-03-19.
^ "Epilepsy Action: Simple Partial Seizures". Epilepsy Action. British Epilepsy Association. 19 February 2008. Retrieved 2008-03-19.
^ "Seizure Mechanisms and Threshold". Epilepsy Foundation. Retrieved 2008-03-19.
^ Ruben Kuzniecky, M.D. (16 April 2004). "Looking at the Brain". epilepsy.com. Epilepsy Therapy Project. Retrieved 2008-03-19.

External links

Tonic–clonic seizure at DMOZ

UpToDate Contents

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1. 成人におけるてんかん重積状態 status epilepticus in adults
2. 成人における初回痙攣発作の評価 evaluation of the first seizure in adults
3. 小児痙攣およびてんかんの分類、病因、および臨床的特徴の概要 overview of the classification etiology and clinical features of pediatric seizures and epilepsy
4. 成人におけるてんかんの初期治療 initial treatment of epilepsy in adults
5. ミオクローヌスの分類および評価 classification and evaluation of myoclonus

English Journal

Treatment of pediatric epilepsy in Poland.

Dunin-Wąsowicz D1, Mazurkiewicz-Bełdzińska M2, Steinborn B3, Wheless J4, Jóźwiak S5.
European journal of paediatric neurology : EJPN : official journal of the European Paediatric Neurology Society.Eur J Paediatr Neurol.2015 May;19(3):320-6. doi: 10.1016/j.ejpn.2014.12.023. Epub 2015 Jan 17.
BACKGROUND: The many types of childhood epilepsies make the diagnosis and treatment difficult and the outcomes frequently poor. Furthermore, there are few clinical trials in pediatric epilepsy that provide useful results to guide daily practice. Therefore for pediatric neurologists expert opinion ma
PMID 25682573

Importance of cardiological evaluation for first seizures.

Choong H1, Hanna I1, Beran R1.
World journal of clinical cases.World J Clin Cases.2015 Apr 16;3(4):381-4. doi: 10.12998/wjcc.v3.i4.381.
This paper reports two cases of long QT syndrome (LQTS) which presented with seizures as their initial feature. Case 1, AB was seen in emergency department with post-partum seizure, discharged and re-presented following cardiac arrest associated with LQTS. Case 2, CD presented initially with tonic-c
PMID 25879012

Time to prerandomization monthly seizure count in perampanel trials: A novel epilepsy endpoint.

French JA1, Gil-Nagel A2, Malerba S2, Kramer L2, Kumar D2, Bagiella E2.
Neurology.Neurology.2015 Apr 15. pii: 10.1212/WNL.0000000000001585. [Epub ahead of print]
OBJECTIVE: To determine whether a novel endpoint of time to prerandomization monthly seizure count could be used to differentiate efficacious and nonefficacious therapies in clinical trials of new add-on antiepileptic drugs (AEDs).METHODS: This analysis used data from 3 randomized, double-blind, pla
PMID 25878175

Japanese Journal

Long-term follow-up of cortical hyperexcitability in Japanese Unverricht-Lundborg disease.

Kobayashi Katsuya,Hitomi Takefumi,Matsumoto Riki,Kondo Takayuki,Kawamata Jun,Matsuhashi Masao,Hashimoto Shuji,Ikeda Hitoshi,Koide Yasumichi,Inoue Yushi,Takahashi Ryosuke,Ikeda Akio
Seizure 23(9), 746-750, 2014-10
… [Results]Their clinical course was almost stable during the follow-up period, namely cessation of generalized tonic-clonic seizures and little or no progression of myoclonus. …
NAID 120005512264

Advances on Genetic Rat Models of Epilepsy

SERIKAWA Tadao,MASHIMO Tomoji,KURAMOTO Takashi,VOIGT Birger,OHNO Yukihiro,SASA Masashi
Experimental Animals, 2014
… So far, the absence seizure models GAERS and WAG/Rij, audiogenic seizure models GEPR-3 and GEPR-9, generalized tonic-clonic seizure models IER, NER and WER, and Canavan-disease related epileptic models TRM and SER have been established. …
NAID 130004694009

Errata: Interictal Electrocardiographic and Echocardiographic Changes in Patients With Generalized Tonic-Clonic Seizures

M. Ramadan Mahmoud,El-Shahat Nader,A. Omar Ashraf,Gomaa Mohamed,Belal Tamer,A. Sakr Sherif,Abu-Hegazy Mohammad,Hakim Hazem,A. Selim Heba,A. Omar Sabry
International Heart Journal 55(6), 564-564, 2014
… An error appeared in the article titled "Interictal Electrocardiographic and Echocardiographic Changes in Patients With Generalized Tonic-Clonic Seizures" by Mahmoud M. …
NAID 130004690990