epilepsy

Question 1

what condition is associated with reduced GABA levels in the brain?

Answer 1

epilepsy

Question 2

what is GABA?

Answer 2

gamma aminobutyric acid - primary inhibitory neurotransmitter in the brain

Question 3

what are the signs and symptoms of febrile seizures?

Answer 3

fever
blue or red face
eyes roll up
loss of consciousness
muscles or limbs jerking

Question 4

what is a febrile seizure?

Answer 4

febrile means having or showing symptoms of fever - so it is a seizure that can happen when a child has a fever

Question 5

what temperature are children at risk of febrile seizure?

Answer 5

above 38

Question 6

how do you manage a child who has a temperature of 38 degrees and is at risk of febrile seizure?

Answer 6

cool the child down
paracetamol - antipyretic
ibuprofen - antipyretic
remove clothes
cool sponging
cool bath

Question 7

what are the triggers of epilepsy?

Answer 7

idiopathic
trauma - head injury
CNS disease - stroke, meningitis, encephalitis, tumour
social - late nights, alcohol, flashing lights hypoglycaemia

Question 8

what age group is predominantly affected by febrile seizures?

Answer 8

children

Question 9

what are the two classifications of epilepsy?

Answer 9

generalised
partial

Question 10

what are the three main types of generalised epilepsy?

Answer 10

tonic/clonic
absence (petit mal)
myoclonic/atonic

Question 11

what are the three types of partial epilepsy?

Answer 11

simple partial
complex partial
simple sensory

Question 12

which classification of epilepsy is associated with a central focus which spreads signal to all parts of the cortex therefore involving the whole body??

Answer 12

generalised

Question 13

which classification of epilepsy is associated with a cortical focus?

Answer 13

partial

Question 14

what are the characteristics of tonic clonic seizures?

Answer 14

prodromal aura - awareness of change in brain function
loss of consciousness/continence
initial tonic - stiff
clonic - intermittent contration/relaxation (jerks)
post-ictal drowsiness

Question 15

define status epilepticus

Answer 15

recurrent seizures

Question 16

what are the characteristics of petit Mal seizures?

Answer 16

pt may not have obvious changes
short lived episodes 5-15 seconds
loss of awareness - vacant stare, eyelids flutter, stops activity, loss of response
can have multiple attacks in a day
children - thought to be daydreaming

Question 17

what medical risks associated with tonic clonic seizures?

Answer 17

injury - protect patient - clear surroundings and control fall, remove objects from mouth if possible
asphyxia - use supplemental oxygen, airway
sudden death - asphyxiation or aspiration of reflux contents

Question 18

what social risks are associated with tonic clonic seizures?

Answer 18

pregnancy - epilepsy medicines harmful, small risk to baby on meds vs risk to mother and baby if meds stopped

sudden death - due to asphyxiation or aspiration

driving and employment restrictions

Question 19

what may precipitate tonic clonic seizures?

Answer 19

withdrawal or poor medication compliance

patient does not like side effects of epileptogenic drugs - poor compliance

fatigue/stress
infection
menstruation

Question 20

which seizure type is localised to one region of the brain?

Answer 20

partial

Question 21

what is Jacksonian seizure?

Answer 21

a motor partial seizure which may spread or move to other motor areas of the brain

Question 22

what will a sensory partial seizure affect?

Answer 22

any sensory modality - taste smell hearing visual
often aura and may involve deja vu

Question 23

what is a complex partial seizure

Answer 23

different areas of the brain are affected and produce connected movements
automatic repetitive purposeless movements - lip smacking e.g. grimacing

Question 24

what drugs might you use as a preventative treatment for tonic clonic seizures?

Answer 24

anticonvulsant drugs
e.g. carbamazepine and valproate

Question 25

what drugs might you use as a preventative treatment for absence seizures?

Answer 25

anticonvulsant drugs
levetiracetam

Question 26

how to you manage a seizure in an emergency?

Answer 26

supportive treatment if unconscious
airway and oxygen
status epilepticus is continuous and requires benxodiazepines

Question 27

what drug is used to terminate status epilepticus?

Answer 27

benzodiazepines

Question 28

what receptors to benzodiazepines act on?

Answer 28

GABA receptor

Question 29

what receptors do valproate act on?

Answer 29

GABA receptor - GABA transaminase inhibitor

Question 30

which channels do carbamazepine act on?

Answer 30

sodium channels

Question 31

when is surgery possible for epilepsy?

Answer 31

focal seizures where there is a single focus that is identifiable and poorly controlled by medication

Question 32

what are the dental impacts of seizures?

Answer 32

oral soft tissue injury or dental fractures
complications of treatment - if seize in chair sharps injuries
gingival hyperplasia
bleeding tendency
KNOW EMERGENCY CARE

Question 33

if a patient tells you they take seizures, what should you then ask?

Answer 33

what type of seizure
what medication and do they take it
how often do they seize
when their last seizure was
what time suits best for appointment

Question 34

which drug used in epilepsy treatment can cause gingival hyperplasia?

Answer 34

phenytoin

Question 35

which drug used in treatment of epilepsy can cause bleeding tendency?

Answer 35

valproate

Question 36

if a patient tells you they take seizures, what should you then ask?

Answer 36

what type of seizure
what medication and do they take it
changes in medication
when their last 3 seizures were
what time suits best for appointment as they have good and bad phases
treat at times of low risk