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2TRN B12: Human Disease > 4: Epilepsy > Flashcards

4: Epilepsy Flashcards

1
Q

Spasm

A

sudden involuntary muscular contraction or convulsive movement

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2
Q

Seizure

A

sudden surge of electrical activity in the brain leading to occurrence of abnormal behaviour

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3
Q

8 triggers for seizures

A
  1. recreational drug use
  2. alcohol (esp withdrawal)
  3. flickering lights (incl TV and computer screens)
  4. sleep deprivation
  5. physical and mental exhaustion
  6. metabolic disturbances & infections occurring at the same time
  7. missed doses of anti-epileptic drugs
  8. uncommon: loud noises, hot baths, music, reading
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4
Q

3 main types of epilepsy

A
  1. partial epilepsy
  2. primary generalised epilepsy (idiopathic)
  3. secondary generalised epilepsy
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5
Q

partial epilepsy symptoms

A
  • seizures occur usually during sleep and are mild
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6
Q

partial epilepsy epidemiology

A

occurs in children and usually grow out of it by adulthood

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7
Q

partial epilepsy origins

A

acquired and congenital

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8
Q

partial epilepsy causes

A
  • tumours
  • trauma
  • infection (HIV)
  • inflammatory (vasculitis)
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9
Q

partial epilepsy brain area affected

A

disease of the cerebral cortex

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10
Q

primary generalised epilepsy onset

A

always early (childhood/adolescence)

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11
Q

what’s always common

A

substantial genetic predisposition

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12
Q

2 main subcategories of primary generalised epilepsy

A
  1. petit-mal epilepsy. childhood absence epilepsy; progresses to adult form “grand-mal”
  2. “grand-mal” - generalized tonic clonic seizure (GTCS)
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13
Q

typical Generalised Tonic Clonic Seizure (GTCS)

A
  • The Tonic Phase follows after a vague warning: The Aura Phase
  • Tonic Phase = body rigid for up to a min
  • pt falls and can bite tongue
  • incontinence of faeces or urine may occur
    NEXT FOLLOWS: Clonic Phase
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14
Q

describe Clonic Phase

A
  • generalised convulsions
  • frothing of mouth
  • bilateral rhythmic jerking of muscles
  • followed by drowsiness & confusion/coma for a few hrs
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15
Q

what to do to stop Generalised Tonic Clonic Seizures?

A

seizures will stop on their own

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16
Q

Secondary Generalised Epilepsy: one cause

A

may arise from spread of PARTIAL SEIZURES due to structural disease

  • CJD
  • Alzheimers
  • Meningitis
17
Q

Secondary Generalised Epilepsy: second cause

A

secondary to drugs OR metabolic disorders

  • hypoglacaemia
  • hypocalcaemia
  • renal/liver failure
  • antibiotics (eg metronidazole)
  • immunosuppressants
  • metals
18
Q

Secondary Generalised Epilepsy: onset

A

occurs in adults;

major seizure can occur even without previous history of partial seizures

19
Q

Secondary Generalised Epilepsy: main cause for it in elderly

A

cerebrovascular disease

20
Q

dental implications: instruments

A

kept at a safer distance from pt

21
Q

dental implications: pt with infrequent epileptic seizures /learning disability

A

higher probability of irregular taking of medication thus higher chance of/less controlled seizures

22
Q

dental implications: oral precaution

A

strong mouth props to be put in place during tx

23
Q

dental implications: when is it appropriate to treat

A

only in a good phase of epilepsy where attacks are WELL CONTROLLED and infrequent

24
Q

dental implications: type of prosthesis recommended for epileptics

A

acrylic prosthesis as they’re more resilient than porcelain prosthesis

25
Q

dental implications: factors that can cause sudden attack

A
  • starvation
  • fatigue
  • stress
  • withdrawal from anticonvulsants
  • flickering lights (flashlight photography)
  • infection
  • EPILEPTOGENIC drugs
26
Q

epileptogenic drugs

A 
alcohol
metronidazole (antibiotic)
LIDOCAINE
quinolones
tricyclic antidepressants
chlorPROmazine (dopamine antagonist for schizophrenia)
27
Q

phenytoin;

CARBAmaZEPINE; dental relevance

A

used as anticonvulsant in therapy of epilepsy. provokes gingival hyperplasia.

28
Q

dental implications: after a siezure…

A
  • someone to accompany the pt home (relative)
  • assess if pt is conscious after the seizure
  • check for injuries in the oral cavity
29
Q

dduh protocol: during siezure

A
  • if possible, place on floor, far away from dental unit OR
  • in a position where seizure can safely run its course
  • monitor CARDIO-RESPIRATORY function
  • if convulsion is prolonged and cyanosis occurs, insert SOFT airway if possible NOT FORCIBLY
30
Q

dduh protocol: status eplipticus

A
  • refers to prolonged epileptic seizures
  • arrange for pt to be transferred to A&E of a nearby hospital
  • monitor cardiorespiratory function & insert SOFT airway if cyanosis occurs (not forcibly)
  • give DIAZEPAM 0.1 mg/KG intravenously over 5 mins if seizure is not self-limiting. (best administered by admitting staff at the A&E)
31
Q

dduh protocol: aftermath

A
  • seizure should self-limit in a few mins
  • incontinence may occur
  • pulse will be FAST and of GOOD VOLUME
  • place in recovery position after convulsion stops
  • pt will be drowsy for up to 1 hr
32
Q

should one try prevent tongue-biting in epileptic pt

A

cannot be prevented by observers as happens at onset of seizure; do NOT introduce anything in mouth for this purpose

33
Q

when to seek urgent medical attention

A

if convulsions continue 5 mins +

2TRN B12: Human Disease (7 decks)

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