Epilepsy Flashcards
Provide a brief description of what epilepsy is
- abnormal discharge of neutrons in the brain
- associated with reduced GABA levels
- abnormal cell-cell message propagation
- less stimulation required for neutron firing
- abnormal chain reaction set up
What are the signs and symptoms of febrile seizures?
- fever (>38 degrees)
- face turning red or blue
- eyes rolling upwards
- loss of consciousness
- unnatural jerking limb movements
Who experiences febrile seizures?
- children
- children who have previously had febrile seizures
- not necessarily epileptic
How are febrile seizures managed?
managed in the same was as tonic clonic seizures
- cool children to reduce seizure risk
- antipyretics (paracetamol, ibuprofen)
- removal of clothes
- cool sponging
- cool bath
What are the ways in which epilepsy is classified?
- generalised
- tonic/clonic
- petit mal (absence)
- myoclonic/atonic
- partial
- simple partial
- complex partial
- simple sensory
Provide examples of epilepsy triggers
- idiopathic
- unsure of cause
- trauma
- severe head injury
- CNS disease
- tumour
- stroke
- degenerative brain disease
- CJD
- meningitis
- encephalitis
- social (environmental)
- late nights
- alcohol
- hypoglycaemia (can be as result of alcohol)
- flashing lights
Provide examples of epilepsy triggers
- idiopathic
- unsure of cause
- trauma
- severe head injury
- CNS disease
- tumour
- stroke
- degenerative brain disease
- CJD
- meningitis
- encephalitis
- social (environmental)
- late nights
- alcohol
- hypoglycaemia (can be as result of alcohol)
- flashing lights
What determines whether epilepsy is generalised or partial?
The nature of the epileptic focus
- generalised
- central focus
- spreads signal to all parts of cortex
- all parts of the body involved in seizure
- partial
- focus in cortex
- only affects body part controlled by that area
- can affect any neural modality (motor is most common)
- can be perception and sensation (symptoms with no obvious cause)
What is seen on an EEG during a seizure?
erratic electrical activity in the region of the brain affected
Describe the features of tonic clonic seizures
- generalised
- prodromal aura
- patient awareness of change in function
- loss of consciousness/continence
- initial tonic phase
- stiff
- voluntary muscles contract
- followed by clonic phase
- intermittent contraction and relaxation
- results in jerking/spasming
- spontaneously terminates
- 1-3 minutes after it begins - post-ictal drowsiness
- status epilepticus
- recurrent seizures
- tonic clonic -> post-octal drowsiness -> tonic clonic
- voluntary breathing muscles cannot coordinate
- high risk of hypoxia
Describe the features of petit mal seizures
- short lived episodes
- 5-15 seconds
- loss of awareness
- eyelids flutter
- vacant stare
- stops activity
- lack of response
- childhood
- most commonly children
- multiple attacks in a day
- can be mistaken for daydreaming
- may not notice unless watching
- patient may not realise
What are the risks of tonic clonic seizures?
MEDICAL
- injury
- contraction of muscles puts strain on skeleton
- spine particularly at risk of damage
- uncontrolled falling in tonic phase
- injury due to spasming in clonic phase
- asphyxia
- normal breathing not occurring
- provide supplemental oxygen
- use guedel airway if possible
- suction away secretions
SOCIAL
- pregnancy
- medications can be harmful to foetus
- weigh up risk/benefits (usually keep medication)
- metabolism upset/drug reactions
- sudden death
- asphyxiation/aspiration
- aspiration of gastric contents
- epilepsy diagnosis = reduced life expectancy
- social
- must be seizure free for a year before driving
- limited employment (e.g. HGV, construction, etc.)
What are precipitators for tonic-clonic seizures?
- withdrawal/poor medication compliance
- physician stops medication prior to new one
- unpleasant side effects
- epileptogenic drugs
- precipitate seizures
- some GA agents
- alcohol
- tricyclics, selective serotonin re-uptake inhibitors
- fatigue/stress
- infection
- particularly systemic
- menstruation
What are partial seizures?
- seizures affecting motor localised to one region of the brain
- can spread and move to other areas
- e.g. Jacksonian seizure
- tremor experienced at limb extremity
- tremor moves up limb towards neck
- e.g. Jacksonian seizure
What are the effects of simple sensory partial seizures?
- can affect any sensory modality
- visual and auditory hallucinations
- experience strong tastes/smells
- aura
- prodromal aura
- may involve deja vu
What are the effects of complex partial seizures?
- automatism
- repetitive purposeless movements
- lip smacking, grimacing
- different areas of the brain are affected
- connective movements produced
- patient not aware of actions
- actions stop when seizure stops
What can be used for preventative epilepsy treatment?
anticonvulsant drugs are used as preventative measures
- tonic-clonic
- valproate
- carbamazepine
- phenytoin
- gabapentin
- phenobarbitone
- lamotrigine (increasingly used)
- absence
- levetiracetam
What is the emergency treatment of seizures?
- supportive treatment while unconscious
- seizures tend to terminate after 1-3 minutes
- airway management and oxygen delivery
- reduced hypoxia risk
- delivery of benzodiazepines
- for status epilepticus
- prolonged seizures
What drugs can be used for epilepsy management and what is their method of action?
- GABA receptor actions
- valproate
- GABA transaminase inhibitor - benzodiazepines
- GABA (A) receptor action on Cl- enhanced
- valproate
- sodium channel actions
- carbamazepine
- stabilisation of sodium channels - phenytoin
- unsure of action
- carbamazepine
drugs can be used in combination when a patient is struggling to control symptoms due to the fact they work on different aspects of systems
What is the alternative to drugs for treating epilepsy?
- surgery
- removal of focal neurological lesions
- stereotactic surgery (removal through craniotomy)
- benign brain tumours
What kind of seizures can be treated with surgery?
- focal seizures
- identifiable point of origin within the brain
- single area causing symptoms
- not usually well controlled by medication
What are the dental implications of epilepsy?
- medical history
- what type of epilepsy
- what medication is taken
- compliance with medication
- normal management of seizures
- complications of fits
- oral and soft tissue injury
- dental injury/fracture
- complications of epilepsy treatment
- gingival hyperplasia (phenytoin)
- bleeding tendency (valproate)
- folate deficiency (rare)
- timings of dental treatment
- assess risk of fit
- ask when last three fits occurred (assess intervals)
- ask about medication compliance
- ask about medication changes
- treat at low risk times if possible
