[Grand mal status and grand mal series--causes, therapy and course]

This retrospective study includes 15 patients with grand-mal status and 17 patients with a series of grand-mal seizures. 8 patients with a grand-mal status never had seizures before. Encephalitis was the most common cause of a grand-mal status in our patients. As a rule, duration of a grand-mal status was less than 10 hours and comprised 8 seizures on average with seizure intervals less than one hour. The initial treatment of the grand-mal status consisted above all of phenytoin, diazepam or phenobarbital, or a combination of these drugs. 3 patients died within 2 months after the beginning of the status. Series of grand-mal seizures were observed mainly in patients with a preexistent seizure disorder; brain damage of early childhood was the most common cause which could be detected. The duration of a series of grand-mal seizures was 13 hours on the average, comprising 4 seizures with an interval of more than 1 hour. Phenytoin and/or diazepam proved to be an efficient initial medication. One of 17 patients died. The most common provoking factor in case of status and series were medication mistakes. The preferential drugs in the initial treatment of status and series of tonic-clonic seizures are the benzodiazepines (above all, clonazepam and diazepam) and phenytoin. The referral to an intensive-care unit is highly recommended. If seizures persist, treatment is continued with barbiturates (phenobarbital, thiopental).