Introduction
Tonic-clonic seizures are pretty common in epilepsy. Triggers and risk factors for each patient are individual. However, quantitative research in this area helps to reduce the impact of the most common ones. The type of seizures and their accompanying characteristics enable healthcare providers to respond quickly, manage them, and select the optimal treatment for the patient. Therefore, this paper will analyze quantitative studies regarding tonic-clonic seizures.
Background
The most common cause of generalized tonic-clonic seizures is epilepsy. Attacks occur in two stages, and their duration is individual, depending on the patient’s condition. During the tonic phase, the person’s body tenses up, arms bend, the legs, head, and neck stretch, and the jaws tighten sharply (Tonic-clonic seizures, n.d.). During this, the person falls to the ground, sometimes lets out a hoarse cry, and loses consciousness for several minutes.
After muscle tension, a sharp contraction occurs, which is characteristic of the clonic phase. During this time, breathing seems complicated or stops, the body twitches, and saliva may form in the mouth, possibly with blood (Tonic-clonic seizures, n.d.). After a while, the muscles twitching subsides, and consciousness returns. During episodes, the greatest danger to patients is a sudden fall with the loss of consciousness, which entails injuries with a potential threat to life.
Quantitative research aims to identify and classify the most common manifestations of tonic-clonic seizures. Additional education on this issue helps to quickly determine the type of seizure and respond to its management and control. Therefore, the overall goal of this research is to improve the quality of care for patients with epilepsy and to create a theoretical basis for choosing the optimal treatment method.
Tonic-Clonic Seizures Research
Research into tonic-clonic seizures is part of epilepsy research, focusing on the causes of attacks and identifying risk groups. According to Kodankandath et al. (2022), the main reason for these episodes is an “imbalance between excitation and inhibition of neurons” (para. 9). Healthcare workers must be able to distinguish between types of tonic-clonic seizures to be able to provide the necessary assistance to the patient quickly. A study by Senevirante et al. (2022) showed that focal-onset bilateral tonic-clonic seizures (FBTCS) have a greater duration and number of manifestations that require additional intervention by healthcare providers for their management. In addition, research is helping to set goals in patient education for seizure prevention, including diet, alcohol avoidance, and moderate exercise.
Moreover, studies are establishing risk factors that may be the cause or consequence of tonic-clonic seizures. According to Kennedy et al. (2019), epilepsy in patients is often associated with musculoskeletal dysfunction because of muscle tension and headaches that appear before or after a seizure. The consequences of epileptic episodes determine not only the management of the seizure itself but also the treatment of the patient in the long term.
Methods of Studies
Kennedy et al. (2019) conducted an online survey regarding musculoskeletal symptoms during seizures, which was sent to members of the Australian Epilepsy Research Register. A total of 256 responses were received, with answers regarding children from parents or guardians not considered in data analysis. This method has advantages, such as its convenience and data collection speed. Nevertheless, the 256 samples used in the study may not represent the global situation with tonic-clonic seizures.
Senevirante et al. (2022) chose video-EEG data of recorded patient episodes as the study material. The study’s main objective was to establish the difference between generalized-onset bilateral tonic-clonic seizures (GBTCS) and FBTCS. Sixty video recordings were used (FBTCS – 41, GBTCS – 19), and researchers established 12 focal signs and the duration of seizures. On the one hand, this method allows one to see the course of episodes. However, the information may be incomplete due to the lack of other signs recorded on video.
Results
The survey by Kennedy et al. (2019) found that 66.53% (n = 165) of respondents are “suffering from generalized tonic-clonic seizures” (p. 32). In 12.84% of cases, episodes occurred at least once in the last 12 months; 9.46% reported two seizures, 11.49% reported three seizures, and 66.21% reported having had four or more seizures in the past year. Thus, tonic-clonic seizures are a common problem among patients with epilepsy.
In addition, the study showed a trend toward an increase in the frequency of episodes among 40.41% of the respondents. As triggers, 80.61% of participants indicated sleep deprivation; 23.19% reported stress, 16.84% reported dehydration, and 11.73% reported muscular tension (Kennedy et al., 2019, p. 23). Establishing risk factors helps healthcare providers develop the steps needed to prevent seizures.
Moreover, the result showed that 56.54% experienced muscular pain, and 72.15% reported headaches. At the same time, in most cases, 51.49%, these symptoms were observed after an epileptic episode. Given the frequency of seizures, it can be assumed that these consequences may lead to musculoskeletal dysfunction in the long term.
Senevirante et al. (2022) found that the “median duration of a GBTCS was 67 seconds and for FBTCS it was 118 s” (p. 2). In addition, the most common cause of FBTCS and GBTCS (47.4%) is Temporal lobe epilepsy. FBTCS, in most cases, is accompanied by head version (82.9%), mouth deviation (73.1%), preceding automatisms (53.6%), unilateral facial clonic activity (46.3%), figure-4 sign (41.4%), eye version (34.1%), and asymmetric termination (31.7%).
At the same time, signs of GBTCS were mouth deviation (31.6%), head version (21.1%), figure-4 sign (15.8%), and asymmetric seizure termination (10.5%). From this, it follows that FBTCS is characterized by more signs, which can help nurses determine the type of seizure. However, some manifestations, like the eye version, were not captured in the analyzed videos, so they cannot be excluded from GBTCS.
These studies contribute to expanding knowledge about tonic-clonic seizures, which helps choose the most appropriate type of treatment. Treatment may be medical or surgical, depending on the patient’s condition, the type and frequency of seizures, and the factors that can trigger their occurrence. At the same time, surgical treatment is used only in severe cases of FBTCS (Kodankandath et al., 2022). Thus, the analyzed quantitative studies help to determine the type of seizure and risk factors, including musculoskeletal dysfunction, to determine the subsequent treatment for the patient.
Ethical Considerations
Both research groups received approval from the hospital’s Human Research Ethics Committee to quantify tonic-clonic seizures. Survey Respondent Participation by Kennedy et al. (2019) was voluntary, as evidenced by 256 responses received out of 625 questionnaires sent. Both research groups received informed consent from participants and maintained confidentiality and anonymity. In addition, studies do not have the potential for harm since they were conducted through a survey and analysis of video materials.
Conclusion
Thus, the analyzed quantitative studies of tonic-clonic seizures contain statistical information that can be used to improve care for epileptic patients. In particular, the results include information about the frequency and duration of different episodes, their signs, triggers, and possible adverse outcomes for patients. This information may be used to develop a strategy for healthcare providers to manage seizures and eliminate patient hazards. In addition, the results of the studies can be used to make decisions regarding the further treatment of patients with epilepsy.
References
Kennedy, S., Carroll, Z., Merrett, T., & Grace, S. (2019). Epilepsy and its association with musculoskeletal dysfunction: A survey of adult epilepsy sufferers. Journal of the Australian Traditional-Medicine Society, 25(1), 30-34.
Kodankandath, V., Danny, T., & Debopam, S. (2022). Generalized Tonic-Clonic Seizure. National Library of Medicine
Seneviratne, U., Christie, H., D’Souza, W., & Cook, M. (2022). Semiologic differences between bilateral tonic-clonicseizures of focal onset and generalized onset. Epilepsy & Behavior, 134, 108837.
Tonic-clonic seizures (n.d.). Epilepsy Foundation.