Order or download our poster on first aid for tonic-clonic seizures. Ideal for surgeries or schools.
Jump straight in
Key points
- Tonic-clonic seizures have two stages. The first is the tonic phase where you go stiff and fall. This is followed by the clonic phase where your limbs jerk quickly and rhythmically
- Some people get an ‘aura’ that can act as a warning before their seizures start. These ‘auras’ are actually focal seizures
- Most tonic-clonic seizures last 1 to 3 minutes. Usually the jerking movements start to slow down within a minute. Seizures lasting over 5 minutes, or longer than normal for that person, are a medical emergency called status epilepticus
- Recovery after a seizure can vary from person to person. You may feel tired, sore and confused. You may also struggle with your memory or want to sleep
- Uncontrolled tonic-clonic seizures increase the risk of Sudden Unexpected Death in Epilepsy (SUDEP)
- Find out about first aid for tonic-clonic seizures
What are tonic-clonic seizures?
Tonic-clonic seizures are the type of seizure most people recognise. They used to be called grand mal seizures.
Tonic-clonic seizures can have a generalised onset. This means they appear to involve both sides of the brain from the start. This is called a ‘generalized tonic-clonic seizure’. Here someone will go straight into a tonic-clonic seizure.
Sometimes a focal seizure can develop into a tonic-clonic seizure. This happens when a seizure starts in one area of the brain, and spreads to both sides. This is called a ‘focal to bilateral tonic–clonic seizure’. In this type of seizure, people experience symptoms of a focal seizure first. For example, déjà vu or jerking in one part of the body. Some people describe this as an aura.
Sometimes it might not be known where the seizure starts if the person cannot recall the onset or there is no witness, and EEG and MRI tests don’t always help. The seizure could be generalized, or it could have started as a focal seizure. This is known as a ‘bilateral tonic–clonic seizure of unknown origin’.
What happens during a tonic-clonic seizure?
There are 2 phases in a tonic-clonic seizure: the ‘tonic’ phase, followed by the ‘clonic’ phase.
During the tonic phase:
- You lose consciousness, so you won’t be aware of what’s happening
- All your muscles go stiff, and if you’re standing you fall to the floor
- Air might push past your voice box, which can make a sound like you’re crying out
- You may bite down on your tongue or inside your mouth
During the clonic phase:
- Your limbs jerk quickly and rhythmically
- You may lose control of your bladder and/or bowels
- Your breathing may be affected, causing a blue tinge around your mouth. Your skin may turn grey if you have black or brown skin. It may be easier to see the discoloration on the lips, gums, inside their eyelids, palms, or the soles of the feet
What is an aura?
A focal to bilateral tonic-clonic seizure is when the seizure starts on one side of the brain and spreads to affect both sides. If you have this type of seizure, you might get the symptoms of a focal seizure immediately before you lose consciousness.
An aura is actually a focal seizure. They can act as a warning that you’re about to have a tonic-clonic seizure. Find out more about auras.
“When I have a tonic clonic… it always starts with aura… my aura is always the same. A bright flash of many colours that blinks rapidly. The feeling of this aura isn’t painful but extremely uncomfortable. Next I feel my face twitch.
Head starts turning towards one side… and then I fall to the floor. That’s when I lose awareness. And my limbs and whole body shake violently. After the ‘shakes’ stop I become fully aware for just a few seconds before I fall into a deep sleep. When I wake up later, it can take me from a few minutes up to several days to remember what happened”
How long do tonic-clonic seizures last?
Most tonic-clonic seizures last between 1 and 3 minutes.
Focal to bilateral tonic-clonic seizures might last slightly longer. One study found that they usually last under 4 minutes.
Status epilepticus is when a tonic-clonic seizure lasts more than 5 minutes. Status epilepticus needs emergency medical treatment.
Find out more about status epilepticus and rescue medicines.
What happens after a tonic-clonic seizure?
The time after a seizure is called the post-ictal phase. People can have different symptoms during this time. They can last minutes or hours, or even days.
After a tonic-clonic seizure, you might:
- Have a headache and feel sore, tired and very unwell
- Feel confused, or have memory problems
- Go into a deep sleep. When you wake up, you might still feel sore or unwell
Your breathing might sound heavy and laboured after a tonic-clonic seizure, with a deep snoring sound.
Some people might feel confused and scared. They may act in unusual ways. It may be helpful to talk to the people around you about this, if it happens to you. This can help them understand how to keep you safe during this phase.
Some people may experience psychosis after a seizure. Find out more about epilepsy and psychosis.
Recovery
How long it takes to recover after a tonic-clonic seizure is different for everyone. Some people feel better after an hour or two, but for some people it can take several days to feel ‘back to normal’.
“I don’t experience aura before a tonic-clonic seizure but after coming out of a seizure I feel confused, nauseous, in pain (from my muscles tensing) and need to sleep. It feels like I’ve done a really intense workout, my whole body aches and I often bite my tongue.
Sleep helps me recover and checking in with me to make sure I’m ok as I feel very unsettled/scared after”
Todd’s Paralysis after a tonic-clonic seizure
Some people have temporary weakness or can’t move part of their body after they have had a seizure. This is called Todd’s Paralysis or Todd’s paresis.
It can last from a few minutes up to 36 hours. It will go away by itself, without treatment. A brain scan (CT or MRI) will usually be done if this happens for the first time. This is to rule out a stroke. You may not need these scans every time if you experience Todd’s Paralysis regularly.
Am I at risk of SUDEP?
SUDEP is sudden unexpected death in epilepsy. SUDEP is rare, affecting around 1 in every 1,000 people with epilepsy each year.
Some things increase your risk of SUDEP. This includes having uncontrolled tonic-clonic seizures. It’s important to be aware of SUDEP and talk with your healthcare professional to understand the risks. Find out more information about SUDEP, including the causes and how you can reduce the risks.
What can I do if I or my child has tonic-clonic seizures?
Having tonic-clonic seizures may cause some anxiety. But there are things you can do to manage your condition.
- Identify and avoid any triggers
- Keeping a seizure diary can help you to understand your seizures better
- Speak to our helpline to find out more about tonic-clonic seizures and how to manage them
- Go to all your medical appointments
- Take your epilepsy medicine as prescribed and do not miss any doses
- Carry a medical ID that lets people know you have epilepsy
- Regularly check that rescue medicine is in date, if you have it
- Try to maintain a healthy lifestyle and look after your general wellbeing and mental health
- Find out more on our pages about safety advice and living with epilepsy
- Explore resources on our Just for Kids page if your child has tonic-clonic seizures
Tonic-clonic seizure first aid: How to help someone
Our CARE video explains what to do if someone is having a tonic-clonic seizure
What to do
- Protect them from injury by removing harmful objects from nearby
- Cushion their head
- Look for an epilepsy identity card or identity jewellery – it may give you information about their seizures and what to do
- Time how long the seizure lasts
- Once the jerking has stopped, help their breathing by gently placing them in the recovery position (see below)
- Stay with the them until they are fully recovered
- Be calm and reassuring
Call for an ambulance if any of these things apply:
- You know it is their first seizure
- The seizure lasts for more than five minutes
- They have one tonic-clonic seizure after another without regaining consciousness between seizures
- They are seriously injured during the seizure
- They have trouble breathing after the seizure has stopped
- They have had three or more seizures in the past 24 hours
Other advice
- Do not hold the person down or put anything in their mouth
- Do not move them, unless they are in danger
- Do not try to bring them round
- Do not give them anything to eat or drink until they are fully recovered
The person having the seizure may wet themselves. You can help give them dignity by putting a light blanket or piece of clothing over their lower body.
It may also help to move any bystanders away.
Here’s a reminder of the steps to put someone in the recovery position
- Lay the arm nearest to you out to the side and flat on the floor so it is at a right angle to the body
- Bring the other arm across the person’s chest and tuck their hand under their cheek
- Bring the knee furthest away from you into a right angle, so the foot is flat on the floor
- Pull on the knee, rolling the person towards you onto their side, whilst protecting their head with the other hand
- Adjust the top leg so that it’s at a right angle and the person can’t roll onto their back
- Tilt their head back slightly to keep their airway open
- Stay with them until they are fully recovered
There is more information on the recovery position on the NHS website.
St John’s Ambulance has information on how to put a baby into the recovery position.
There’s more information on our diagnosis page about the support and tests that someone might have after a first seizure.
-
Sources
Kodankandath, T.V., Theodore, D. and Samanta, D. (2023) ‘Generalized Tonic-Clonic Seizure’, in StatPearls [Internet]. StatPearls Publishing. Available at: https://www.ncbi.nlm.nih.gov/books/NBK554496/ (Accessed: 12 January 2026).
Beniczky, S. et al. (2025) ‘Updated classification of epileptic seizures: Position paper of the International League Against Epilepsy’, Epilepsia, 66(6), pp. 1804–1823. Available at: https://doi.org/10.1111/epi.18338.
Shorvon, S (2010) Handbook of Epilepsy Treatment, 3rd edition. Oxford: Blackwell Publishing Ltd
Ighodaro ET., et al., (2023), StatPearls Focal Onset Seizure, Available at: https://www.ncbi.nlm.nih.gov/books/NBK500005/, (Accessed: 13 August 2025)
Larsen, PG, et al., (2022), Duration of epileptic seizure types: A data-driven approach. Epilepsia, Vol 64 (2), pp: 469-478, Available at: https://onlinelibrary.wiley.com/doi/full/10.1111/epi.17492
NHS (2025) Epilepsy. Available at: https://www.nhs.uk/conditions/epilepsy/ (Accessed: 16 January 2026).
Pottkämper, J.C.M. et al. (2020) ‘The postictal state — What do we know?’, Epilepsia, 61(6), pp. 1045–1061. Available at: https://doi.org/10.1111/epi.16519.
Carmenate, Y.I. et al. (2020) ‘Postictal stertor: Associations with focal and bilateral seizure types’, Epilepsy & Behavior, 110. Available at: https://doi.org/10.1016/j.yebeh.2020.107103.
Clancy, M.J. et al. (2014) ‘The prevalence of psychosis in epilepsy; a systematic review and meta-analysis’, BMC Psychiatry, 14(1), p. 75. Available at: https://doi.org/10.1186/1471-244X-14-75.
Mastriana, J. et al. (2023) ‘Todd Paresis’, in StatPearls [Internet]. StatPearls Publishing. Available at: https://www.ncbi.nlm.nih.gov/books/NBK532238/ (Accessed: 16 January 2026).
International League Against Epilepsy (no date), SUDEP (Sudden Unexpected Death in Epilepsy), Available at: https://www.ilae.org/patient-care/sudep, Accessed on: 18 March
Pottkämper, J.C.M. et al. (2020) ‘The postictal state — What do we know?’, Epilepsia, 61(6), pp. 1045–1061. Available at: https://doi.org/10.1111/epi.16519.
NHS (2023) What to do if someone has a seizure (fit). Available at: https://www.nhs.uk/symptoms/what-to-do-if-someone-has-a-seizure-fit/ (Accessed: 16 January 2026).
NICE CKS (2025) Scenario: Managing an epileptic seizure | Management | Epilepsy. Available at: https://cks.nice.org.uk/topics/epilepsy/management/managing-an-epileptic-seizure/ (Accessed: 16 January 2026).
We're here to help
Got more questions?
Our expert team is here to help with any questions you have. They can also tell you about the different services we offer to help navigate life with epilepsy.
This information has been produced under the terms of the PIF TICK. The PIF TICK is the UK-wide Quality Mark for Health Information. Please contact website@epilepsy.org.uk if you would like a reference list for this information.
Was this article helpful?