epilepsy Flashcards
what is epilepsy
Epilepsy is associated with reduced GABA levels in the brain
abnormal discharge of neurons
it causes less requirements to fire a message through
This leads to abnormal cell-cell message propogation
it can set a reaction where too many neurons are fired
signs and symptoms of febrile seizure
fever
face may turn blue or red
eyes rolling upwards
loss of consciousness
muscles and limbs jerk in unnatural movements
often in children
Cool hot children – above 38 degrees at risk of seizure
Paracetamol
Ibuprofen
Remove clothes
Cool sponging
Cool bath
classification of epilepsy
Generalised
Tonic/clonic
Absence (petit mal)
myoclonic/atonic
Partial
simple partial
complex partial
simple sensory
epilepsy triggers
Idiopathic
Trauma - head injury
CNS disease
tumour, stroke
CJD, meningitis, encephalitis
Social
Late nights, alcohol, hypoglycaemia
flashing lights
generalised seizures
the signal spreads from central focus tp all parts
Tonic Clonic =
prodromal aura
loss of consciousness/continence
initial tonic (stiff)
clonic - (contraction/relaxation)
post-ictal drowsiness
WILL BECOME HYPOXIC
Status epilepticus - recurrent seizures
Petit Mal (absence) =
short lived episodes (5-15 seconds)
loss of awareness – eyelids flutter, vacant stare, stops activity, loss of response
CHILDHOOD usually
Can be multiple attacks in a single day
tonic-clonic seizures
Medical
INJURY - protect where possible
remove objects from the mouth IF POSSIBLE
Asphyxia
USE SUPPLEMENTAL OXYGEN
GUEDEL airway IF POSSIBLE
SUCTION any secretions
Social
Pregnancy
metabolism upset, Drug reactions
Sudden Death
asphyxiation/aspiration
Social
Driving, employment = need to be a year free
partial seizures
Motor localised to ONE region of the brain
may move/spread to other motor areas
Jacksonian seizure
Sensory
any sensory modality
visual, auditory, taste, smell
often aura & may involve déja vu
Complex Partial Seizures
automatism
repetitive purposeless movements
lip smacking, grimmacing
treatment epilepsy
Preventative
Anticonvulsant drugs
Tonic –clonic = Valproate, Carbamazapine, Phenytoin, Gabapentin, Phenobarbitone, Lamotrigine
Absence = Levitiracetam
Emergency
most require SUPPORTIVE treatment ONLY if UNCONSCIOUS - Airway & Oxygen
Status epilepticus requires BENZODIAZEPINES
epilepsy drugs
GABA receptor actions
Valproate
Gaba transaminase inhibitor
Benzodiazepines
GABAA receptor action on Cl- enhanced
Sodium Channel actions
Carbamazepine
Stabilises
Phenytoin
? Unsure of action
surgery for epilepsy
Removal of focal neurological lesions
Brain tumours (benign)
Focal seizures
Identifiable point of origin within the brain
Not well controlled by medication
epilepsy dental aspects
Complications of fits
oral soft tissue injury
dental injury/fracture
ASK WHAT SEIZURES AND HOW WELL CONTROLLED IT IS
Complications of treatment
gingival hyperplasia (phenytoin)
bleeding tendency (valproate)
folate deficiency (rare)
know emergency care
epilepsy dental care
Assess risk of fit
good & bad phases
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
