Epilepsy

Question 1

What is epilepsy?

Answer 1

Reduced GABA levels in the brain leading to abnormal cell-cell message propagation

Question 2

What are the signs and symptoms of a febrile seizure?

Answer 2

Fever
Face may turn red or blue
Eyes rolling upwards
Loss of consciousness
Muscles and limbs jerk in unnatural movements

Question 3

How are febrile seizures treated?

Answer 3

Paracetamol and ibuprofen
Remove clothes
Cool sponging
Cool bath

Question 4

How is epilepsy classified?

Answer 4

Generalised - tonic/clonic, absence (petit mal), myoclonic/atonic
Partial - simple partial, complex partial, simple sensory

Question 5

What are common triggers of epilepsy?

Answer 5

Idiopathic
Trauma - head injury
CNS disease - tumour, stroke
Social - late nights, alcohol, flashing lights

Question 6

Describe tonic clonic seizures

Answer 6

Prodromal aura - patient has awareness in change of brain function
Loss of consciousness/continence
Initial tonic (stiff) reaction
Then clonic phase (intermittent contraction and relaxation of muscles)
Patient will remain drowsy until they return to full consciousness

Question 7

Describe Petit Mal (absence) seizures

Answer 7

Short episodes - 5-15 seconds
Loss of awareness - eyelids flutter, vacant stare, loss of response
Occurs in childhood usually
Can have multiple attacks in a day

Question 8

What are the medical problems with tonic clonic seizures?

Answer 8

Injury - remove objects from the mouth if possible
Asphyxia - use supplemental oxygen and suction any secretions

Question 9

What are the social problems of tonic clonic seizures?

Answer 9

Pregnancy - upset metabolism, drug reactions
Sudden death - asphyxationaspiration
Driving
Employment

Question 10

What can commonly precipitate tonic clonic seizures?

Answer 10

Withdrawal/poor medication compliance
Epileptogenic drugs
Alcohol
Fatigue/stress
Infection
Menstruation

Question 11

What are partial seizures?

Answer 11

The focus is localised to one region of the brain
May be sensory or motor
If sensory can affect vision, hearing, taste and smell

Question 12

What are the different treatment forms for epilepsy?

Answer 12

Preventative drugs
Emergency
Surgery

Question 13

What drugs can be used to treat epilepsy?

Answer 13

Tonic Clonic:
Valproate - GABA transaminase inhibitor
Carbamazapine - stabilises Na channels
Phenytoin
Absence:
Levitiracetam

Question 14

Describe emergency epilepsy treatment

Answer 14

Most require supportive treatment only if unconscious - airway and oxygen
Status epilépticos requires benzodiazepines

Question 15

How is surgery used to treat epilepsy?

Answer 15

Removal of focal neurological lesions (benign brain tumours)

Question 16

What are the dental aspects of epilepsy?

Answer 16

Complications of fits - can cause oral soft tissue injury and dental injuries
Gingival hyperplasia from phenytoin
Bleeding tendency from valproate

Question 17

How should epilepsy be assessed in dental care?

Answer 17

Assess risk of fit
Ask when last three fits took place
Ask about compliance with medication
Ask about changes in medication
Treat at times of low risk if possible