The most dramatic and most widely recognized form, the grand mal or generalized tonic-clonic seizure, involves a period of muscle rigidity followed by rhythmic convulsions, often accompanied by loss of consciousness, loss of bowel or bladder control, and finally a period of deep unconsciousness known as the post-ictal state.

The post-ictal state following a major seizure can be profound.

The patient may be completely unresponsive for minutes to hours.

Their breathing may be shallow and irregular.

Their skin may be pale or cyanotic (bluish) from the oxygen depletion of the seizure.

Their muscle tone may be so relaxed as to produce a floppy, limp appearance.

Their eyes may be open but unfocused, or may be closed with the pupils dilated.

Their pulse, while typically present, may be difficult to detect without careful examination.