Epilepsy

Question 1

What causes epilepsy?

What are the two types of seizures and their presentations?

Answer 1

Epilepsy is caused by excessive electrical discharges in the brain

• focal seizures - partial - presentation depends on part of brain affected
• generalised seizures - whole brain affected - whole body presentation

Question 2

What are the types of focal seizures?

Answer 2

Simple: motor cortex - shaking on one side

Complex partial: temporal lobe

• Aura - olfactory (rarely visual) hallucinations (smell something weird)
• Followed by odd behaviour e.g. automatisms - lip-smacking, odd posture, staring

Question 3

List some signs and symptoms of focal seizures:

Answer 3

• may be a brief warning
• sudden loss of consciousness, pt becomes rigid, falls, may give a cry and becomes cyanotic (tonic phase)
• after 30 seconds, jerking movements of limbs, tongue may be bitten (clonic phase)
• frothing from mouth and urinary incontinence

Seizures typically last a few minutes, pt may then become flaccid but remain unconscious. After a variable time, pt regains unconscious but may remain confused for a while (post ictal)

Question 4

What are the generalised seizures we may witness in children?

Adults?

Answer 4

Children: absence seizure

Adults: tonic-clonic seizure (formerly ‘Grand Mal’)

• loss of consciousness
• limbs stiffen - tonic phase
• limbs shake - clonic phase
• may be incontinence, tongue biting, cyanosis
• headache, drowsy afterwards - post ictal

Question 5

How is suspected epilepsy investigated?

How is epilepsy treated?

Answer 5

Investigations:

• blood tests
• brain imaging (MRI)
• electroencephalogram - EEG - reading of brain movements

Treatment:

Drugs - older: phenytoin (risk of gingival hypertrophy), carbamazepine, sodium valproate, phenobarbital

Newer: levetiracetam, lamotrigine, zonisamide, gabapentin, pregabalin

Surgery - if focal area is epileptogenic

Question 6

How should generalised seizures be managed?

When should you seek medical attention?

When should medication be administered and how?

Answer 6

• try to ensure pt is not at risk of injury
• don’t put anything in mouth
• give oxygen 15L/min
• do not attempt to restrain movements
• after movements have subsided, place in recovery position and check airway
• pt may be confused –> need support, sympathy, don’t send home until fully recovered

Seek medical attention/transfer to hospital if first episode of epilepsy or convulsion was atypical, prolonged or injury occured

• medication only administered after seizure lasting 5mins or more, or repeated rapidly (midazolam)

Midazolam oromucosal solution can be used by buccal route in adults as a single 10mg dose

Question 7

How should focal seizures be managed?

What are the childrens doses of Midazolam?

Answer 7

Focal seizures - very little acute management, remove risk of injury and monitor until fully recovered

Childrens doses of Midazolam:

6-11 months: 2.5mg

1-4 years: 5mg

5-9 years: 7.5mg

10-17 years: 10mg

Question 8

List some dental aspects of epilepsy:

Answer 8

• recognise how well controlled epilepsy is, avoid treatment if epilepsy is poorly controlled
• know how to manage seizures
• check drug side effects in BNF