During this type of seizure activity, consciousness is lost suddenly, often preceded by a cry, with immediate loss of posture followed by rhythmic jerking.

• A. focal seizure with impairment of consciousness
• B. Jacksonian seizure
• C. focal seizure that becomes generalized
• D. grand mal seizure

Answer: (D)

This describes a generalized tonic-clonic seizure, also known as a grand mal. The hallmark is sudden loss of consciousness with an abrupt fall, followed by a tonic stiffening phase and then rhythmic jerking. The cry at onset comes from a brief period of forced expiration during the tonic phase. There are no preceding focal symptoms, which distinguishes it from focal-onset seizures. A focal seizure with impairment of consciousness would start with focal signs (auras, unusual sensations, automatisms) before any loss of awareness. A Jacksonian seizure is a focal motor seizure that starts in one area and spreads, again without immediate generalized convulsions. A focal seizure that becomes generalized would show initial focal activity before the generalized convulsions. Hence, the pattern described best fits a grand mal seizure.