6 - Epilepsy Flashcards
What is epilepsy?
- associated with reduced GABA levels which leads to abnormal cell communication
- less stimulation is required for neurones to fire
What is a febrile seizure?
- children who have a fever
- managed acutely
- presents with fever, eyes rolling upwards, loss of consciousness, jerky movements, face may turn red or blue
What is the management of febrile seizures?
- cool hot children who are above 38 degrees
- paracetamol and ibuprofen
- remove clothes
- cool sponging or bath
What are the different types of generalised epilepsy?
- tonic/clonic
- petit mal (absence)
- myoclonic/atonic
What are the different types of partial epilepsy?
- simple partial
- complex partial
- simple sensory
What are the triggers of epilepsy?
- idiopathic
- trauma (head injury)
- CNS disease eg tumour or stroke, meningitis, encephalitis
- social (alcohol, hypoglycaemia, flashing lights)
How does the epileptic focus affect presentation?
- central focus causes primary generalised epilepsy
- cortical focus causes partial epilepsy
- can present by seeing/hearing something that isn’t there, is generated by seizure
Describe a tonic clonic seizure.
- prodromal aura (awareness of onset)
- loss of consciousness and continence
- tonic = contraction of voluntary muscle
- clonic = contraction and relaxation of muscles, spasm
- post-ictal drowsiness last 1-3 mins
What is status epilepticus?
- recurrent seizures
- very dangerous as breathing muscles are voluntary and do not function during seizure
- can result in hypoxia
Describe a petit mal seizure.
- absence seizure
- short lived episodes of 5-15 seconds
- loss of awareness (eyelids flutter, vacant stare, stop activity, loss of response)
- common in childhood
What are the effects of tonic clonic seizures?
- injury from fall or spasms
- asphyxia
- sudden death
What are risk factors for tonic clonic epilepsy?
- poor medication compliance
- alcohol
- GA agents
- tricyclics (antidepressants)
- stress and fatigue
- infection
- menstruation
Describe a motor partial seizure.
- motor seizure localised to one region of body
- can spread eg move up arm (known as Jacksonian seizure)
Describe a sensory partial seizure.
- can be visual, auditory, taste, smell changes that are not caused by external stimuli
- hallucinations
- can cause deja vu
Describe a complex partial seizure.
- automatism
- unaware of movement occurring
- repetitive purposeless movement including lip smacking and grimacing
What drugs are used in the prevention of tonic clonic epilepsy?
- valproate
- carbamazepine
- phenytoin
What drugs are used in the prevention of petit mal epilepsy?
Levitiracetam
What is the emergency management of epilepsy?
- supportive treatment only is unconscious eg airway and oxygen
- status epilepticus requires benzodiazepines
How does valproate treat epilepsy?
GABA transaminase inhibitor (prevents breakdown of GABA)
How do benzodiazepines treat epilepsy?
GABA receptor action is enhanced
How does carbamazepine treat epilepsy?
Stabilises sodium channels
What surgical options are there for epilepsy?
- removal of focal neurological lesions eg tumours
- partial lobectomy if uncontrollable with medication
How does epilepsy affect dentistry?
- complication of fits (soft tissue injury, dental fracture)
- gingival hyperplasia (phenytoin)
- bleeding tendency (valproate)
- folate deficiency
- treat at low risk times
How do you assess if a patient is at risk of seizures?
- ask when last 3 fits took place
- ask about compliance with medication
- ask about changes in medication
