epilepsy Flashcards
what condition is associated with reduced GABA levels in the brain?
epilepsy
what is GABA?
gamma aminobutyric acid - primary inhibitory neurotransmitter in the brain
what are the signs and symptoms of febrile seizures?
fever
blue or red face
eyes roll up
loss of consciousness
muscles or limbs jerking
what is a febrile seizure?
febrile means having or showing symptoms of fever - so it is a seizure that can happen when a child has a fever
what temperature are children at risk of febrile seizure?
above 38
how do you manage a child who has a temperature of 38 degrees and is at risk of febrile seizure?
cool the child down
paracetamol - antipyretic
ibuprofen - antipyretic
remove clothes
cool sponging
cool bath
what are the triggers of epilepsy?
idiopathic
trauma - head injury
CNS disease - stroke, meningitis, encephalitis, tumour
social - late nights, alcohol, flashing lights hypoglycaemia
what age group is predominantly affected by febrile seizures?
children
what are the two classifications of epilepsy?
generalised
partial
what are the three main types of generalised epilepsy?
tonic/clonic
absence (petit mal)
myoclonic/atonic
what are the three types of partial epilepsy?
simple partial
complex partial
simple sensory
which classification of epilepsy is associated with a central focus which spreads signal to all parts of the cortex therefore involving the whole body??
generalised
which classification of epilepsy is associated with a cortical focus?
partial
what are the characteristics of tonic clonic seizures?
prodromal aura - awareness of change in brain function
loss of consciousness/continence
initial tonic - stiff
clonic - intermittent contration/relaxation (jerks)
post-ictal drowsiness
define status epilepticus
recurrent seizures
what are the characteristics of petit Mal seizures?
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
what medical risks associated with tonic clonic seizures?
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
what social risks are associated with tonic clonic seizures?
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
what may precipitate tonic clonic seizures?
withdrawal or poor medication compliance
patient does not like side effects of epileptogenic drugs - poor compliance
fatigue/stress
infection
menstruation
which seizure type is localised to one region of the brain?
partial
what is Jacksonian seizure?
a motor partial seizure which may spread or move to other motor areas of the brain
what will a sensory partial seizure affect?
any sensory modality - taste smell hearing visual
often aura and may involve deja vu
what is a complex partial seizure
different areas of the brain are affected and produce connected movements
automatic repetitive purposeless movements - lip smacking e.g. grimacing
what drugs might you use as a preventative treatment for tonic clonic seizures?
anticonvulsant drugs
e.g. carbamazepine and valproate
what drugs might you use as a preventative treatment for absence seizures?
anticonvulsant drugs
levetiracetam
how to you manage a seizure in an emergency?
supportive treatment if unconscious
airway and oxygen
status epilepticus is continuous and requires benxodiazepines
what drug is used to terminate status epilepticus?
benzodiazepines
what receptors to benzodiazepines act on?
GABA receptor
what receptors do valproate act on?
GABA receptor - GABA transaminase inhibitor
which channels do carbamazepine act on?
sodium channels
when is surgery possible for epilepsy?
focal seizures where there is a single focus that is identifiable and poorly controlled by medication
what are the dental impacts of seizures?
oral soft tissue injury or dental fractures
complications of treatment - if seize in chair sharps injuries
gingival hyperplasia
bleeding tendency
KNOW EMERGENCY CARE
if a patient tells you they take seizures, what should you then ask?
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
which drug used in epilepsy treatment can cause gingival hyperplasia?
phenytoin
which drug used in treatment of epilepsy can cause bleeding tendency?
valproate
if a patient tells you they take seizures, what should you then ask?
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
