4: Epilepsy Flashcards
Spasm
sudden involuntary muscular contraction or convulsive movement
Seizure
sudden surge of electrical activity in the brain leading to occurrence of abnormal behaviour
8 triggers for seizures
- recreational drug use
- alcohol (esp withdrawal)
- flickering lights (incl TV and computer screens)
- sleep deprivation
- physical and mental exhaustion
- metabolic disturbances & infections occurring at the same time
- missed doses of anti-epileptic drugs
- uncommon: loud noises, hot baths, music, reading
3 main types of epilepsy
- partial epilepsy
- primary generalised epilepsy (idiopathic)
- secondary generalised epilepsy
partial epilepsy symptoms
- seizures occur usually during sleep and are mild
partial epilepsy epidemiology
occurs in children and usually grow out of it by adulthood
partial epilepsy origins
acquired and congenital
partial epilepsy causes
- tumours
- trauma
- infection (HIV)
- inflammatory (vasculitis)
partial epilepsy brain area affected
disease of the cerebral cortex
primary generalised epilepsy onset
always early (childhood/adolescence)
what’s always common
substantial genetic predisposition
2 main subcategories of primary generalised epilepsy
- petit-mal epilepsy. childhood absence epilepsy; progresses to adult form “grand-mal”
- “grand-mal” - generalized tonic clonic seizure (GTCS)
typical Generalised Tonic Clonic Seizure (GTCS)
- 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
describe Clonic Phase
- generalised convulsions
- frothing of mouth
- bilateral rhythmic jerking of muscles
- followed by drowsiness & confusion/coma for a few hrs
what to do to stop Generalised Tonic Clonic Seizures?
seizures will stop on their own
Secondary Generalised Epilepsy: one cause
may arise from spread of PARTIAL SEIZURES due to structural disease
- CJD
- Alzheimers
- Meningitis
Secondary Generalised Epilepsy: second cause
secondary to drugs OR metabolic disorders
- hypoglacaemia
- hypocalcaemia
- renal/liver failure
- antibiotics (eg metronidazole)
- immunosuppressants
- metals
Secondary Generalised Epilepsy: onset
occurs in adults;
major seizure can occur even without previous history of partial seizures
Secondary Generalised Epilepsy: main cause for it in elderly
cerebrovascular disease
dental implications: instruments
kept at a safer distance from pt
dental implications: pt with infrequent epileptic seizures /learning disability
higher probability of irregular taking of medication thus higher chance of/less controlled seizures
dental implications: oral precaution
strong mouth props to be put in place during tx
dental implications: when is it appropriate to treat
only in a good phase of epilepsy where attacks are WELL CONTROLLED and infrequent
dental implications: type of prosthesis recommended for epileptics
acrylic prosthesis as they’re more resilient than porcelain prosthesis
dental implications: factors that can cause sudden attack
- starvation
- fatigue
- stress
- withdrawal from anticonvulsants
- flickering lights (flashlight photography)
- infection
- EPILEPTOGENIC drugs
epileptogenic drugs
alcohol metronidazole (antibiotic) LIDOCAINE quinolones tricyclic antidepressants chlorPROmazine (dopamine antagonist for schizophrenia)
phenytoin;
CARBAmaZEPINE; dental relevance
used as anticonvulsant in therapy of epilepsy. provokes gingival hyperplasia.
dental implications: after a siezure…
- someone to accompany the pt home (relative)
- assess if pt is conscious after the seizure
- check for injuries in the oral cavity
dduh protocol: during siezure
- 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
dduh protocol: status eplipticus
- 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)
dduh protocol: aftermath
- 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
should one try prevent tongue-biting in epileptic pt
cannot be prevented by observers as happens at onset of seizure; do NOT introduce anything in mouth for this purpose
when to seek urgent medical attention
if convulsions continue 5 mins +
