Table of ContentsView AllTable of ContentsOverview of SeizuresAtonic SeizuresSymptomsCausesDiagnosisTreatmentCoping
Table of ContentsView All
View All
Table of Contents
Overview of Seizures
Atonic Seizures
Symptoms
Causes
Diagnosis
Treatment
Coping
Atonic seizures (also known as drop attacks) are one of several types ofseizuresthat can occur as a result of various underlying causes. “Atonic” means loss of muscle tone. This type of seizure is also known as akinetic or drop seizures.
Atonic seizures oftentimes begin during childhood and are most common in children, although they may continue into adulthood. This type of seizure is often present in people who have other types of seizures as well, such as tonic ormyoclonic seizures.
Atonic seizures are rare in adults.
FatCamera / Getty Images
A seizure is the result of the brain receiving surges of abnormal electrical signals, interrupting normal electrical brain functioning in the nerve cells that control the muscles. Primarily, there are two types of seizures: generalized andfocal. The difference is mainly where they begin in the brain.
Generalized seizures involve the entire brain, and subsequently, affect the entire body. They may also cause convulsions (non-voluntary movements), but some generalized seizures (such as absence seizures) do not cause convulsions.
Types of generalized seizures include:
What Are Atonic Seizures?
Normally, when you sit or stand, your muscles are slightly contracted. That allows the body to stay upright.
In an atonic seizure, a person’s muscles do not clench up as they do in the more well-known types of seizures called tonic-clonic (convulsive or grand mal) type.
In fact, the muscles become so relaxed that the person having atonic seizures often falls forward because the muscles are unable to support the body. If they’re standing, they’ll fall to the ground.
If the person is sitting, an atonic seizure may make their head drop. This is typical of babies who are too young to stand, as well. It can be difficult to spot an atonic seizure in a person who’s lying down except that they become limp and unresponsive.
Atonic seizures are less common than many other types of seizures, but they can occur in conjunction with other types.
An atonic seizure may begin with one or more myoclonic jerks. This type of seizure is usually short in duration, coming on without warning. Recovery is usually within minutes to hours (excluding any injuries that may occur from falling). Falls from atonic seizures often result in injuries to the face and head.
Atonic seizures cause a person’s muscles to suddenly become flaccid.
Understanding Seizures: What They Look Like and How to Respond
Types of Atonic Seizures
Atonic seizures can be categorized as focal seizures (starting in one part of the brain) and cause muscle tone loss in only one part of the body. This is referred to as afocal motor atonic seizure.
When the atonic seizure starts on both sides of the brain, it is referred to as ageneralized onset atonic seizure. Most of the time, atonic seizures are generalized seizures. Generalized atonic seizures start out with a sudden loss of muscle tone in the head, the trunk, or the entire body.
Atonic seizures usually result in loss of consciousness. This type of seizure normally lasts less than 15 seconds but may last up to several minutes. After an atonic seizure, a person will become alert and conscious within minutes, although it may take longer.
Symptoms of atonic seizures may include:
Anything that disrupts the normal nerve transmission in the brain can cause a seizure. This can include:
Common causes of seizures in infants include:
Risk Factors and Triggers
The underlying cause of atonic seizures is often unknown. Changes in the genes may be responsible for an increased risk of having atonic seizures. In fact, researchers have identified nearly a thousand genes that play a role in epilepsy.
Atonic Seizures in Epilepsy
When a person has two or more seizures of any type, they are diagnosed with epilepsy of unknown cause.
Epilepsy affects about 3.4 million people in the United States, according to the Centers for Disease Control and Prevention.It’s one of the most common nervous system disorders.
Atonic seizures are commonly the type of seizure experienced with specific types of epilepsy, such as Lennox-Gastaut syndrome (LGS) and Dravet syndrome (DS).
LGSis a severe childhood form of epilepsy involving:
Atypical absence seizures involve a less abrupt onset type of seizure compared to typical absence seizures, associated with loss of muscle tone in the trunk, limbs, or head and a gradual slump as well as mild myoclonic jerks.
Dravet syndrome (DS) is a severe form of epilepsy that includes symptoms such as:
Dravet Syndrome: What to Know
When to See a Healthcare Provider
The first time anyone has a seizure (of any type) the healthcare provider should be notified immediately and diagnostic steps should be made, including an examination of the medical history and a physical exam.
In someone diagnosed with epilepsy, it’s important to seek immediate medical attention in any of the following scenarios:
Whenever a person has a seizure, it’s imperative that the healthcare provider discern the type of seizure and which area of the brain is involved. This is because the anti-seizure medication regimen is partially based on the type and duration of seizures.
Input from observers (via written descriptions or video recordings) describing the event is an important part of the diagnostic assessment.
An electroencephalogram (EEG) is the primary diagnostic tool used to diagnose seizures. The EEG procedure involves attaching electrodes to the scalp to measure the electrical activity in the brain and reveal abnormal patterns.
Magnetic resonance imaging (MRI) and computed tomography (CT) scans are also used to study important factors such as where the seizure occurs in the brain. These scans are often used to rule out possible causes of seizures such as a stroke.
If a diagnosis isn’t clear and anti-seizure medication isn’t effective, tests may be done to find other origins of the problem that could be causing the falls.
The goal in treating atonic seizures is to control, decrease the frequency of, or stop the seizures without interfering with a person’s normal life activities. The treatment for atonic seizures depends on many factors, including:
Factors that impact treatment options include:
In addition to medication, the healthcare provider will most likely encourage:
Anti-Seizure Medication Administration
The healthcare provider will take several factors into consideration when prescribing anti-seizure medications. These include:
Types of Medication
Anti-epileptic or anti-seizure drugs are the most common form of treatment for seizures; however, it may take the healthcare provider some time to discover the right drug and the best dosage for each person.
Types of anti-seizure medication include:
Taking Anti-Seizure Medicine
Anticipate that several tests will be performed to measure the effectiveness and safety of anti-seizure medications. These tests may include:
Ask your healthcare provider or pharmacist before taking other medications (including over the counter drugs) because they may interfere with the effectiveness of anti-seizure medications or cause harmful side effects.
Drugs don’t work for everyone, so your healthcare provider may recommend other kinds of treatment.
The Ketogenic Diet
The ketogenic diet tricks the body into a state of starvation from the lack of carbohydrates and results in a state of ketosis in the brain. It was identified nearly a century ago, and in the past 30 years, studies have backed up its ability to lessen seizures in kids who don’t respond well to anti-seizure medication.
“The connection between metabolism and epilepsy has been such a puzzle,” said Gary Yellen, Ph.D., professor of neurobiology at Harvard Medical School. He was introduced to the ketogenic diet through his wife, Elizabeth Thiele, MD, Ph.D., HMS professor of neurology, who directs the Pediatric Epilepsy Program at Mass General Hospital for Children.
Surgical Procedures
Surgical options may be right for some people who don’t respond well to medications.
A study published in 2013 discovered that while VNS was effective in lowering the incidence of some types of seizures (tonic-clonic and myoclonic type), it was ineffective at reducing atonic or tonic seizures in children with Lennox-Gastaut or Lennox-like syndrome.
Corpus Callosotomy:A surgical procedure called a corpus callosotomy (CC) is an operation aimed at interrupting the abnormal electrical activity in the brain, which spreads from one hemisphere to the other during a generalized seizure (such as an atonic seizure).
Surgery is not recommended for everyone with atonic seizures, but it may be a good option for some. A 2015 study involving patients with atonic seizures and drop attacks undergoing CC and VNS discovered that 58% of those who had CC performed were free of atonic seizures after the procedure, compared to only 21.1% of the study subjects who had VNS implants.
The prognosis or projected outcome of atonic seizures depends primarily on the cause. Sometimes epilepsy syndromes (epilepsy of unknown cause) will go away once a child grows older.
Usually, a child must be seizure-free for one or two years before the option to stop anti-seizure medication is considered.Adults typically have to be seizure-free for longer before healthcare providers recommend stopping medication. According to a 2019 study, the recommendation is at least two years.
In other instances, a child with atonic seizures may end up needing to take anti-epileptic medications for the rest of their life. Be sure you’re making this decision with guidance from your healthcare provider so you’re not taking undue risks with your health.
An Overview of Status Epilepticus
19 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Baraldi S, Farrell F, Benson J, Diehl B, Wehner T, Kovac S.Drop attacks, falls and atonic seizures in the Video-EEG monitoring unit.Seizure. 2015;32:4-8. doi:10.1016/j.seizure.2015.08.001Johns Hopkins.Generalized seizures.Centers for Disease Control and Prevention.Types of seizures.Epilepsy Foundation.Atonic Seizures.Cedars-Sinai.Atonic Seizures.Stanford Children’s Health, Lucile Packard Children’s Hospital.Epilepsy and Seizures in Children.Merck Manual.Seizures in Children.Epilepsy Action/British Epilepsy Association.Epilepsy in babies.Wang J, Lin ZJ, Liu L, et al.Epilepsy-associated genes.Seizure. 2017;44:11-20. doi:10.1016/j.seizure.2016.11.030Centers for Disease Control and Prevention.Epilepsy Data and Statistics.Dravet Syndrome Foundation.What is Dravet Syndrome?Liu G, Slater N, Perkins A.Epilepsy: treatment options.afp. 2017;96(2):87-96.Epilepsy Foundation.Ethosuximide.D’Andrea Meira I, Romao TT, Pires do Prado JH, et al.Ketogenic diet and epilepsy: What we know so far.Front Neurosci. 2019;13:5. doi:10.3389/fnins.2019.00005Poorshiri B, Barzegar M, Tahmasebi S, et al.The efficacy comparison of classic ketogenic diet and modified Atkins diet in children with refractory epilepsy: a clinical trial.Acta Neurol Belg. 2019. doi:10.1007/s13760-019-01225-0Cukiert A, Cukiert CM, Burattini JA, et al.A prospective long-term study on the outcome after vagus nerve stimulation at maximally tolerated current intensity in a cohort of children with refractory secondary generalized epilepsy.Neuromodulation. 2013;16(6):551-6. doi:10.1111/j.1525-1403.2012.00522.xRolston JD, Englot DJ, Wang DD, Garcia PA, Chang EF.Corpus callosotomy versus fabus nerve stimulation for atonic seizures and drop attacks: A systematic review.Epilepsy Behav. 2015;51:13-7. doi:10.1016/j.yebeh.2015.06.001Hixson JD.Stopping antiepileptic drugs: when and why?Curr Treat Options Neurol. 2010;12(5):434-42. doi:10.1007/s11940-010-0083-8Lossius MI, Alfstad KA, Aaberg KM, Nakken KO.Discontinuation of antiepileptic drugs in seizure-free patients - when and how?Tidsskr Nor Laegeforen. 2017;137(6):451-454. doi:10.4045/tidsskr.16.0957Additional ReadingCedars-Sinai.Atonic Seizures.Dana Farber CancerInstitute.Reverse Engineering Epilepsy’s Miracle Diet.Epilepsy Queensland.Generalized Seizures.
19 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Baraldi S, Farrell F, Benson J, Diehl B, Wehner T, Kovac S.Drop attacks, falls and atonic seizures in the Video-EEG monitoring unit.Seizure. 2015;32:4-8. doi:10.1016/j.seizure.2015.08.001Johns Hopkins.Generalized seizures.Centers for Disease Control and Prevention.Types of seizures.Epilepsy Foundation.Atonic Seizures.Cedars-Sinai.Atonic Seizures.Stanford Children’s Health, Lucile Packard Children’s Hospital.Epilepsy and Seizures in Children.Merck Manual.Seizures in Children.Epilepsy Action/British Epilepsy Association.Epilepsy in babies.Wang J, Lin ZJ, Liu L, et al.Epilepsy-associated genes.Seizure. 2017;44:11-20. doi:10.1016/j.seizure.2016.11.030Centers for Disease Control and Prevention.Epilepsy Data and Statistics.Dravet Syndrome Foundation.What is Dravet Syndrome?Liu G, Slater N, Perkins A.Epilepsy: treatment options.afp. 2017;96(2):87-96.Epilepsy Foundation.Ethosuximide.D’Andrea Meira I, Romao TT, Pires do Prado JH, et al.Ketogenic diet and epilepsy: What we know so far.Front Neurosci. 2019;13:5. doi:10.3389/fnins.2019.00005Poorshiri B, Barzegar M, Tahmasebi S, et al.The efficacy comparison of classic ketogenic diet and modified Atkins diet in children with refractory epilepsy: a clinical trial.Acta Neurol Belg. 2019. doi:10.1007/s13760-019-01225-0Cukiert A, Cukiert CM, Burattini JA, et al.A prospective long-term study on the outcome after vagus nerve stimulation at maximally tolerated current intensity in a cohort of children with refractory secondary generalized epilepsy.Neuromodulation. 2013;16(6):551-6. doi:10.1111/j.1525-1403.2012.00522.xRolston JD, Englot DJ, Wang DD, Garcia PA, Chang EF.Corpus callosotomy versus fabus nerve stimulation for atonic seizures and drop attacks: A systematic review.Epilepsy Behav. 2015;51:13-7. doi:10.1016/j.yebeh.2015.06.001Hixson JD.Stopping antiepileptic drugs: when and why?Curr Treat Options Neurol. 2010;12(5):434-42. doi:10.1007/s11940-010-0083-8Lossius MI, Alfstad KA, Aaberg KM, Nakken KO.Discontinuation of antiepileptic drugs in seizure-free patients - when and how?Tidsskr Nor Laegeforen. 2017;137(6):451-454. doi:10.4045/tidsskr.16.0957Additional ReadingCedars-Sinai.Atonic Seizures.Dana Farber CancerInstitute.Reverse Engineering Epilepsy’s Miracle Diet.Epilepsy Queensland.Generalized Seizures.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Baraldi S, Farrell F, Benson J, Diehl B, Wehner T, Kovac S.Drop attacks, falls and atonic seizures in the Video-EEG monitoring unit.Seizure. 2015;32:4-8. doi:10.1016/j.seizure.2015.08.001Johns Hopkins.Generalized seizures.Centers for Disease Control and Prevention.Types of seizures.Epilepsy Foundation.Atonic Seizures.Cedars-Sinai.Atonic Seizures.Stanford Children’s Health, Lucile Packard Children’s Hospital.Epilepsy and Seizures in Children.Merck Manual.Seizures in Children.Epilepsy Action/British Epilepsy Association.Epilepsy in babies.Wang J, Lin ZJ, Liu L, et al.Epilepsy-associated genes.Seizure. 2017;44:11-20. doi:10.1016/j.seizure.2016.11.030Centers for Disease Control and Prevention.Epilepsy Data and Statistics.Dravet Syndrome Foundation.What is Dravet Syndrome?Liu G, Slater N, Perkins A.Epilepsy: treatment options.afp. 2017;96(2):87-96.Epilepsy Foundation.Ethosuximide.D’Andrea Meira I, Romao TT, Pires do Prado JH, et al.Ketogenic diet and epilepsy: What we know so far.Front Neurosci. 2019;13:5. doi:10.3389/fnins.2019.00005Poorshiri B, Barzegar M, Tahmasebi S, et al.The efficacy comparison of classic ketogenic diet and modified Atkins diet in children with refractory epilepsy: a clinical trial.Acta Neurol Belg. 2019. doi:10.1007/s13760-019-01225-0Cukiert A, Cukiert CM, Burattini JA, et al.A prospective long-term study on the outcome after vagus nerve stimulation at maximally tolerated current intensity in a cohort of children with refractory secondary generalized epilepsy.Neuromodulation. 2013;16(6):551-6. doi:10.1111/j.1525-1403.2012.00522.xRolston JD, Englot DJ, Wang DD, Garcia PA, Chang EF.Corpus callosotomy versus fabus nerve stimulation for atonic seizures and drop attacks: A systematic review.Epilepsy Behav. 2015;51:13-7. doi:10.1016/j.yebeh.2015.06.001Hixson JD.Stopping antiepileptic drugs: when and why?Curr Treat Options Neurol. 2010;12(5):434-42. doi:10.1007/s11940-010-0083-8Lossius MI, Alfstad KA, Aaberg KM, Nakken KO.Discontinuation of antiepileptic drugs in seizure-free patients - when and how?Tidsskr Nor Laegeforen. 2017;137(6):451-454. doi:10.4045/tidsskr.16.0957
Baraldi S, Farrell F, Benson J, Diehl B, Wehner T, Kovac S.Drop attacks, falls and atonic seizures in the Video-EEG monitoring unit.Seizure. 2015;32:4-8. doi:10.1016/j.seizure.2015.08.001
Johns Hopkins.Generalized seizures.
Centers for Disease Control and Prevention.Types of seizures.
Epilepsy Foundation.Atonic Seizures.
Cedars-Sinai.Atonic Seizures.
Stanford Children’s Health, Lucile Packard Children’s Hospital.Epilepsy and Seizures in Children.
Merck Manual.Seizures in Children.
Epilepsy Action/British Epilepsy Association.Epilepsy in babies.
Wang J, Lin ZJ, Liu L, et al.Epilepsy-associated genes.Seizure. 2017;44:11-20. doi:10.1016/j.seizure.2016.11.030
Centers for Disease Control and Prevention.Epilepsy Data and Statistics.
Dravet Syndrome Foundation.What is Dravet Syndrome?
Liu G, Slater N, Perkins A.Epilepsy: treatment options.afp. 2017;96(2):87-96.
Epilepsy Foundation.Ethosuximide.
D’Andrea Meira I, Romao TT, Pires do Prado JH, et al.Ketogenic diet and epilepsy: What we know so far.Front Neurosci. 2019;13:5. doi:10.3389/fnins.2019.00005
Poorshiri B, Barzegar M, Tahmasebi S, et al.The efficacy comparison of classic ketogenic diet and modified Atkins diet in children with refractory epilepsy: a clinical trial.Acta Neurol Belg. 2019. doi:10.1007/s13760-019-01225-0
Cukiert A, Cukiert CM, Burattini JA, et al.A prospective long-term study on the outcome after vagus nerve stimulation at maximally tolerated current intensity in a cohort of children with refractory secondary generalized epilepsy.Neuromodulation. 2013;16(6):551-6. doi:10.1111/j.1525-1403.2012.00522.x
Rolston JD, Englot DJ, Wang DD, Garcia PA, Chang EF.Corpus callosotomy versus fabus nerve stimulation for atonic seizures and drop attacks: A systematic review.Epilepsy Behav. 2015;51:13-7. doi:10.1016/j.yebeh.2015.06.001
Hixson JD.Stopping antiepileptic drugs: when and why?Curr Treat Options Neurol. 2010;12(5):434-42. doi:10.1007/s11940-010-0083-8
Lossius MI, Alfstad KA, Aaberg KM, Nakken KO.Discontinuation of antiepileptic drugs in seizure-free patients - when and how?Tidsskr Nor Laegeforen. 2017;137(6):451-454. doi:10.4045/tidsskr.16.0957
Cedars-Sinai.Atonic Seizures.Dana Farber CancerInstitute.Reverse Engineering Epilepsy’s Miracle Diet.Epilepsy Queensland.Generalized Seizures.
Dana Farber CancerInstitute.Reverse Engineering Epilepsy’s Miracle Diet.
Epilepsy Queensland.Generalized Seizures.
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