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Tonic-Clonic Seizure: What to Do and What Not to Do

dr shukla neurologist tx
Medically reviewed by Dr. Shukla
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dr shukla neurologist tx
Medically reviewed by Dr. Shukla

Knowing how to help a person in such a situation is very important. Several erroneous actions can cause significant harm to the victim. So you should never take them in an attempt to help. Thus, we recommend you further read our article to become more informed. In addition, in some patients, such situations occur several times daily. In such cases, it is enough to know the basic principles of help. And if everything goes without complications, you can cope on your own.

But, in some situations, the help of professionals is vital for an epileptic patient.

This article navigates through the medical aspects. This includes diagnostic approaches and available treatment options. So we shed light on what to do with tonic-clonic seizures.

What is Tonic-Clonic Seizure?

Tonic-clonic seizures are usually mixed paroxysms. Rapid clonic contractions of the skeletal muscles replace prolonged tonic spasms. The causes of generalized seizures are extensive: 

  • epilepsy;
  • organic pathology of the CNS;
  • neuro infections, and other conditions. 

To verify the diagnosis, a comprehensive examination is necessary. It includes:

  • laboratory tests;
  • tomography;
  • neurophysiological techniques. 

Medications are often used to manage and treat seizure syndrome. 

Сonvulsions characterize a tonic-clonic seizure. Then the person’s body tenses up, arms bend, legs, head, and neck extend, and jaws clench sharply. This is the “tonic” phase. So this is important to master the management of tonic-clonic seizures. The person falls to the ground, sometimes letting out a hoarse scream. He also loses consciousness for a few minutes. During this time, the following may occur:

  • breathing becomes labored or stops;
  • the body twitches;
  • saliva may form in the mouth;
  • urinary incontinence may occur. 

This is the “clinical” phase. After a while, the muscle twitching subsides, and consciousness returns. The person feels confused and tired for a while from the strenuous muscle work.

a man lies on the ground with convulsions

Tonic-Clonic Seizure What to Do

These are seizures with bilateral, sustained rhythmic twitching and loss of consciousness. The rhythmicity of the jerks with loss of consciousness distinguishes them from others. Recurrent serial myoclonic seizures go with irregular twitches. They often occur with partial preservation of consciousness. This occurs, for example, in myoclonic status epilepticus.

In generalized seizures with motor onset, asymmetries may be usually observed. This may be a deviation of the head and eyes. But if focal signs persist from seizure to seizure, we should assume:

  • focal bilateral tonic-clonic;
  • focal bilateral motor seizure.

Management of tonic-clonic seizures requires emergency treatment. With the onset of an attack, the patient should always be protected from trauma. Do it by laying on a flat surface with a pillow under the head, providing free air access. In eclampsia, it is important to minimize the effect of external stimuli. The on-call team of specialists can do things like:

  • manage a persistent seizure with anticonvulsant medications;
  • administer oxygen therapy.

Read further about what to do with tonic-clonic seizures.

Stay with the person until the seizure is over

Seizures are unpredictable. Some start with minor symptoms but result in unconsciousness or falls. If a person has an injury during a seizure, they will need help from other people or paramedics. Stay calm and reassure yourself. As tonic-clonic seizures usually go away on their own. They are usually not life-threatening.

Ensure Safety

Quickly scan the area for potential hazards, such as:

  • furniture with sharp corners;
  • hard surfaces;
  • objects that could pose a risk during the seizure.

Gently move objects away from the person’s vicinity to create a safe zone. This reduces the chances of them hitting or stumbling onto anything harmful. If the person is wearing glasses or sunglasses, gently remove them. Use it in generalized tonic-clonic seizure guidelines.

Protect the Head

While assisting them to the ground, avoid forcefully holding their head down. Allow their head to rest on the cushioning to cut any discomfort or unnecessary pressure. After the person is on the ground, gently turn them onto their side. This posture maintains an open airway and prevents any fluid from obstructing breathing. As the seizure unfolds, continue to provide gentle support to the person’s head. Do it by ensuring it remains cushioned and safe from any surrounding objects.

Turn the Person on Their Side

Gently roll the person onto their side. Do it after the intense convulsive phase of the seizure subsides. This change is important. This gives an open airway and prevents saliva or vomiting. Ensure that you set the person’s head slightly lower than their body. It allows any fluids to drain out of the mouth naturally and reduces the risk of choking or aspiration. This management of tonic-clonic seizures promotes effective breathing. It also minimizes the risk of complications related to airway obstruction.

Provide Support After Seizure

As the seizure concludes, stay composed and offer a calm presence to the person. Reassure them that the seizure has passed and that you are there to support them. While the person regains consciousness, be patient and observant. They might initially feel disoriented, confused, or fatigued. Give them time to reorient themselves. Offer water if the person is alert and capable of drinking. Hydration can be helpful, especially if the seizure is longer or more intense. Be patient and understanding as the person’s mental state returns to normal.

Seek Medical Attention

You should pay attention to the following:

  • if the seizure lasts longer than five minutes;
  • if a second seizure follows immediately without the person regaining consciousness.  

This is a medical emergency that requires immediate attention. Sharing information about the seizure with the health care provider can help in:

  • accurate assessment;
  • appropriate recommendations. 

This should include its duration, behavioral patterns, and medical history.

a man is lying on the floor with a seizure, a woman helps him

Tonic-Clonic Seizure What Not to Do

It is not necessary to forcefully restrain the person, try to bring him/her to his/her senses, hit him/her in the face, or shake him/her. This will lead to more traumatization of the patient. If the teeth are clenched, it is not necessary to forcefully unclench the jaw. The muscles are hypertonic, and such actions can:

  • traumatize the teeth, the tongue;
  • block the airway with tooth fragments. 

Also, you can not unclench the cramped jaw with your hands or a hard object. Do not pour water on the patient or perform artificial respiration. Read also more about what not to do with tonic-clonic seizures.

Do Not Panic

Keep your composure and maintain a clear mindset. Panic can hinder your ability to think clearly and respond effectively. Focus on the current situation and actions. After all, you must take them to ensure the safety and well-being of the person. Your calm demeanor will help to reassure the person and those around you. Taking a moment to think through your actions can lead to more effective responses.

Do Not Restrict Movements

During a tonic-clonic seizure, the person’s body will experience involuntary convulsions. It’s important not to restrain their movements. As this could cause injuries or additional distress. Holding the person down to prevent movement might be instinctive. Doing so can result in unintended harm.

Do Not Put Anything in the Mouth

It is one more important thing on what not to do with tonic-clonic seizure. They can get between the teeth or into the patient’s mouth during a seizure. Doing so can lead to injury and pose a choking hazard. Contrary to popular belief, putting objects in the mouth will not prevent a person from swallowing their tongue. The focus should be on creating a safe and supportive environment. It minimizes risks and keeps the person safe without unnecessary interference.

Do Not Leave Alone

Remain with the person who has experienced the tonic-clonic seizure. Your presence offers reassurance and support during the crucial moments following the seizure. If the person experiences prolonged confusion, difficulty regaining consciousness, or any concerning symptoms after the seizure, you will be present to seek medical attention if necessary promptly.

Generalized Tonic-Clonic Seizure Guidelines

After the tonic-clonic seizure is over, the following steps should be taken:

  1. lay the patient on his/her side and let him/her rest for a few minutes;
  2. if the seizure occurs in a crowded place, ask everyone to move away to ensure the psychological comfort of the affected person;
  3. be tactful and ask others to do the same. So they may feel uncomfortable;
  4. offer to stay with the person until they are ready to return to normal activities. Or you can call someone who can stay with them;
  5. after the seizures have stopped, do not let the person get up and walk around immediately, but allow time to recover calmly;
  6. treat injuries with an antiseptic solution;
  7. if the person has involuntarily emptied the bowels or bladder, try to help clean the area and remove dirty clothes;
  8. notify relatives or loved ones, especially if the person is a minor child or elderly.

First aid for epilepsy does not always have to involve doctors. So, you need to know what to do with tonic-clonic seizures. As a rule, seizures are transient. Patients are often fully conscious by the time the ambulance arrives. And they leave the scene of the accident on their own.

Bottom Line

Lone Star Neurology offers comprehensive services for managing tonic-clonic seizures. Our expert team provides specialized care, from accurate diagnosis to tailored treatment plans. With a focus on patient safety and well-being, we offer guidance, medical interventions, and support to enhance the quality of life for individuals experiencing tonic-clonic seizures. Remember also to read our other articles about medicine. They are very meaningful and useful.


How long do tonic-clonic seizures usually last?

Tonic-clonic seizures typically last around 1 to 3 minutes, but the duration can vary.

Are tonic-clonic seizures dangerous?

Yes, tonic-clonic seizures can be dangerous due to the risk of injury during convulsions and potential complications. Seek medical attention if they occur.

Can stress trigger tonic-clonic seizures?

Yes, stress can be a trigger for tonic-clonic seizures in some individuals with epilepsy. Stress management is important in seizure management.

Can tonic-clonic seizures be prevented?

Tonic-clonic seizures can be managed with medications, lifestyle adjustments, and sometimes surgery. While prevention is not always possible, appropriate care can reduce seizure frequency and intensity.

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Edward Medina
Edward Medina
15:34 30 Jun 22
Just such an amazing staff that makes you feel like part of their family. I’ve been going there for over 5 years now... and each visit I get the very best care and treatments that I have ever received in the 20+ years that I’ve been dealing with severe debilitating migraines. Since i started seeing them the number of my migraines has dropped from 15-20 a month to 2-3 every 3 month. I highly recommend them …they will change your life!read more
Daneisha Johnson
Daneisha Johnson
22:20 19 May 22
Dr. Askari was very kind and explained everything so I could understand. The other staff were nice as well. I would... have gave 5 stars but I was a little taken aback when I checked in and had to pay 600.00 upfront. I think that should have been discussed in a appointment confirmation call or email just so I could have been more
Jean Cooper
Jean Cooper
16:54 29 Apr 22
I love the office staff they are friendly and very helpful. Dr. JODIE is very caring and understanding to your needs... and wants to help you. I will go back. would recommend Dr. Dr. Jodie to other Patients in a heart beat. The team works well more
Linda M
Linda M
19:40 02 Apr 22
I was obviously stressed, needing to see a neurologist. The staff was so patient and Dr. Ansari was so kind. At one... point he told me to relax, we have time, when I was relaying my history of my condition. That helped ease my stress. I have seen 3 other neurologists and he was the only one who performed any assessment tests on my cognitive and physical skills. At one point I couldn't complete two assessments and got upset and cried. I was told, it's OK. That's why you're here. I was truly impressed, and super pleased with the whole experience!read more
Leslie Durham
Leslie Durham
15:05 01 Apr 22
I've been coming here for about 5 years. The staff are ALWAYS friendly and knowledgeable. The Doctors are the absolute... best!! Jodie Moore is always in such a great mood which is a plus when you are already stressed. Highly recommendedread more
Monica Del Bosque
Monica Del Bosque
14:13 25 Mar 22
Since my first post my thoughts have changed here. It's unfortunate. My doctor and PA were great, but the office staff... is horrible. They never call you back when they say they will, they misinform you, they cause you too much stress wondering what's going on, they don't keep you posted. They never answer the phone. At this point I've left four messages in the last week, and I have sent three messages. Twice from their portal and one direct email. No response. My appointment is on Monday morning at 8:30am, no confirmation on my insurance and what's going on. What the heck is going on, this is ridiculous!I've given up... the stress her office staff has put me through is just not worth it. You can do so much better, please clean house, either change out your office staff, or find a way for them to be more efficient please. You have to do something. This is not how you want to run your practice. It leaves a very bad impression on your more
Ron Buckholz
Ron Buckholz
23:32 23 Mar 22
I was actually pleasantly surprised with this visit! It took me a long time to get the appointment scheduled because no... one answers your phones EVER! After a month, I finally got in, and your staff was warm, friendly, and I was totally impressed! I feel like you will take care of my needs!read more
Steve Nabavi
Steve Nabavi
16:28 16 Mar 22
It was a nice visit. Happy staff doing all they can do to comfort the patients in a very calming environment. You ask... me they are earned a big gold star on the fridge. My only complaint they didn't give me any more
Katie Lewis
Katie Lewis
16:10 10 Feb 22
Had very positive appointments with Jodie and Dr. Sheth for my migraine care. Jodie was so fast with the injections and... has so much valuable info. I started to feel light headed during checkout and the staff was SO helpful—giving me a chair, water, and taking me into a private room until I felt better. Highly recommend this practice for migraine patients, they know what they’re doing!!read more
Joshua Martinez
Joshua Martinez
16:02 10 Dec 21
I was scheduled to be checked and just want to say that the staff was fantastic. They were kind and helpful. I was... asked many questions related to what was going on and not once did I feel as though I was being brushed off. The front desk staff was especially great in assisting me. I'm scheduled to go back for a mri and am glad that I'll be going more
Isabel Ivy
Isabel Ivy
21:42 03 Nov 21
I had such a good experience with Lone Star Neurology, Brent my MRI Tech was so awesome and made sure I was very... comfortable during the appointment. He gave me ear plugs, a pillow, leg support and blanket, easiest MRI ever lol 🤣 My 72 hour EEG nurse Amanda was also so awesome. She made sure I was take care of over the 3 days and took her time with the electrodes to make sure it was comfortable for me! Paige was also a huge help in answering all my questions when it came to my test results, and letting me know her honest opinions about how I should go forth with my more
Leslie Luce
Leslie Luce
17:37 20 Oct 21
The professionalism and want to help attitude of this office was present from the moment I contacted them. The follow... up and follow through as well as their willingness to find a way to schedule my dad was above and beyond. We visited two offices in the same day with the same experience. I am appreciative of this—we spend a lot of time with doctors and this was top notch start to more
robert Parker
robert Parker
16:38 16 Apr 21
I love going to this office. The staff is friendly and helpful. The doctor is great. I am getting the best... neurological tests and treatment I have ever had. The only reason I did not give them a 5 star rating is because it is impossible to reach a live person at the office to reschedule appointments. Every time I have tried to get through to the office it says all people are busy and I am sent to a voicemail. If they could get their phone answering fixed, I would give them a strong 5 more
MaryAnn Hornbaker
MaryAnn Hornbaker
00:26 25 Feb 21
Dr. Harney is an excellent Dr. I found him friendly , personable and thorough. I evidently am an unusual case. ... Therefore he spent a Hugh amount of time educating me. He even gave me literature to further explain my condition and how to follow up. This is something you rarely get from your doctors. So I am more than please with my doctor and his more
Roger Arguello
Roger Arguello
03:05 29 Jan 21
Always courteous, professional. The staff is very friendly and always work with you to find the best appointment time.... The care team has been great. Always taking the time to listen to your concerns and to find the best more
Margaret Rowland
Margaret Rowland
01:12 27 Jan 21
I have been a patient at Lone Star Neurology for several years. Now both my adult daughters also are patients there. I... love Jodie. She is always so prompt whether it is a teleamed call are a visit in the office. She takes the time to explain everything to me and answers all my questions. I am so blessed to have Jodie as my more
Susan Miller
Susan Miller
03:01 13 Jan 21
My husband had an accident 5 years ago and Lone Star Neurology has been such a blessing to us with my husbands care.... Jodie Moore is his provider and she is amazing! Jodie is very knowledgeable, caring, and thorough. She takes her time with you, making sure your needs are met and she is happy to answer any questions you may have. Lone Star Neurology’s patients are very lucky to have Jodie providing their care. Thank you Lone Star Neurology and especially Jodie for everything you have done for us. Jodie, you are the best!read more
Windalyn C
Windalyn C
01:32 09 Jan 21
Jodie is wonderful. She is very caring and knowledgeable. I have been to over a dozen neurologists, and none were able... to help me as much as they have here. Thanks!read more
Katie Kordel
Katie Kordel
00:40 09 Jan 21
Jodi Moore, nurse practitioner, is amazing. I have suffered from frequent, debilitating headaches for almost 20 years.... She has provided the best proactive and responsive care I have ever received. My quality of life has been greatly improved by her caring approach and tenacity in finding more
Ellie Natsis
Ellie Natsis
15:41 07 Jan 21
I have had the best experience at this neurologist's office! For over a year I have been receiving iv treatments here... each month and my nurse, Bobbie is beyond wonderful!! She's so attentive, knowledgeable, caring, and detail oriented. She makes an otherwise uncomfortable experience much more pleasant and definitely puts me at ease! She also helps me with my insurance,ordering this specialty medication and dealing with the ordering process which is no easy feat.Needless to say, she goes above a beyond in every way and I'm so grateful to this office and to Bobbie for all they do for me!read more
Matt Morris
Matt Morris
15:39 07 Jan 21
Let me start by saying that I have been coming here for years. Due to my autoimmune disease, I am in this office... once every three weeks for multiple hours at a time. The office is very clean and the staff very friendly. My only complaint would be there communication via phone. They aren't the best at responding if you leave a voicemail and expect a call back. I understand that this is prob just due to the sheer number of alls they receive daily. What I can say I like the best about the office are the people. Bobby who handles my infusions is great. I never have any issues with her setting up my infusions. She is very quick to reply to messages sent via text and if she were to leave then my whole opinion of the office may change. I also enjoy people like Matt, Lauren, and Jodi. I appreciate all that they do for me and without this team I'm not sure I would be as happy as I am to visit the office as frequently as I have to. Please ensure that these folks are recognized as they are what makes my visit to this office so tolerable :).read more
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