Epilepsy Flashcards
Epilepsy is associated with reduced levels of what in the brain? What does this lead to?
- Reduced GABA levels (GABA inhibits neurotransmission)
- The reduction leads to abnormal cell-cell message propagation
- Less stimulation is required for a neuron to fire and pass a message onto another cell (abnormal chain reaction)
What are febrile seizures?
-A seizure in kids that has the same symptoms as a tonic clonic seizure but only happens when the child has a fever
(is managed the same way as a tonic clonic but IS NOT a tonic clonic seizure)
Above what temperature is a child at risk of a febrile seizure? How can you cool the chil down?
-above 30 degrees celsius
To cool:
- Paracetamol
- Ibuprofen
- Remove clothes
- Cool sponging
- Cool bath
How can epilepsy be classified?
- Generalised
- Tonic/clonic
- Absence (petit mal)
- myoclonic/atonic
- Partial
- simple partial
- complex partial
- simple sensory
What are some triggers for epilepsy?
- Idiopathic
- Trauma - head injury
- CNS disease
- tumour, stroke
- CJD, meningitis, encephalitis
- Social
- Late nights, alcohol, hypoglycaemia
- flashing lights
Describe how the focus point in the brain for epilepsy changes with primary generalised and partial (focal seizures)
A central focus in generalised that spreads the signal out to all parts of the cortex (so the full body is involved)
In partial it can affect anywhere and will be focused in a particular part of the cortex (so may affect motor, perception, sensation etc)
How do EEG’s appear during a seizure? (electrical changes)
Larger and more eratic waves than normal
Describe what happens before, during and after a tonic clinic seizure. (basic)
- prodromal aura (has an awareness in change in brain function but may not be able to report this)
- loss of consciousness/continence
- initial tonic (stiff) (all voluntary muscles contact together)
- clonic - (contraction/relaxation)
- post-ictal drowsiness
What is status epilepticus?
A seizure lasting more than 5 minutes or recurrent seizures (no full recovery between seizures)
Why is status epilepticus a medical emergency/dangerous?
The normal breathing muscles cant function properly and the patient can become hypoxic if the seizures continue
Describe what happens in petite mal seizures (absences).
- short lived episodes (5-15 seconds)
- loss of awareness – eyelids flutter, vacant stare, stops activity, loss of response
NOTE: normally happens in childhood and can have multiple atacks in one day
What are the medical concerns during a tonic clonic seizure?
- injury from repeatedly hitting themselves off of hard surfaces
- asphyxia
- sudden death from asphyxiation/aspiration
How can you help someone having a tonic clonic seizure to help protect from injury and asphyxia(reduction in O2 due to abnormal breathing)?
- INJURY - protect where possible
- remove objects from the mouth IF POSSIBLE
Asphyxia
- USE SUPPLEMENTAL OXYGEN
- GUEDEL airway IF POSSIBLE
- SUCTION any secretions
What are some social implication of tonic clinic seizures?
Pregnancy
•metabolism upset, Drug reactions
Social
•Driving, employment
What can be precipitators to tonic clonic seizures?
- withdrawal/poor medication compliance (ask P if they actually take their meds properly)
- epileptogenic drugs
- some GA agents
- alcohol
- tricyclics & SSRIs
- fatigue/stress
- Infection
- menstruation
What happens in partial motor seizures?
- localised to one region of the brain
- may move/spread to other motor areas (Jacksonian seizure)
Describe sensory partial seizures.
- •any sensory modality
- •visual, auditory, taste, smell
- •often aura & may involve déja vu
Describe complex partial seizures.
- automatism
- repetitive purposeless movements
- lip smacking, grimmacing
- These are all linked movements and need a bunch of different signals to do this
What preventative treatment is there for epilepsy?
Anticonvulsant drugs
What anticonvulsant drugs are there for tonic-clonic seizures?
•Valproate, Carbamazapine, Phenytoin, Gabapentin, Phenobarbitone, Lamotrigine
What anticonvulsant drugs are there for absence seizures (petite mal)?
Levitiracetam
Describe basic emergency treatment for epilepsy.
- most require supportive treatment ONLY if unconscious (airway and oxygen)
- Status epilepticus requires bensodiazepines
How can you group epilepsy drugs?
- GABA receptor actions
- Sodium channel actions
What epilepsy drugsresult in GABA receptoe actions? Describe these
Valproate = GABA transaminase inhibitor
Benzodiazepines - GABAA receptor action on Cl- enhanced
What epilepsy drugs act on sodium channels and what do they do?
Cabamazepine - stabilises
Phenytoin - unsure of action
What are the surgery options for epilepsy?
- Removal of focal neurological lesions
- Brain tumours (benign)
- Focal seizures
- Identifiable point of origin within the brain
- Not well controlled by medication
- Lobectomy
- Vagus nerve stimulators
What are the dental aspects of epilepsy?
- Complications of fits
- oral soft tissue injury
- dental injury/fracture
- Complications of treatment
- gingival hyperplasia (phenytoin)
- bleeding tendency (valproate)
- folate deficiency (rare)
- KNOW EMERGENCY CARE
What questions should you ask/how should you adapt dental care for a patient with epilepsy?
- •Assess risk of seizure
- 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
