Neurology - Epilepsy Flashcards
What is epilepsy
it is associated with reduced GABA levels in the brain leading to abnormal cell to cell message propagation
What are the signs and symptoms of a febrile seizure
fever face may turn blue or red eyes rolling upward loss of consciousness muscles and limbs jerk in unnatural movements
Who is at risk of febrile seizures
> 38 degrees childen
How do we cool febrile seizures
paracetamol ibuprofen remove clothes cool sponging cool bath
What is the classification of epilepsy
split into generalized and partial
What can generalized epilepsy be split into
tonic/clonic
absence
myoclonic/atonic
What can partial epilepsy be split into
simple partial
complex partial
simple sensory
What are epilepsy triggers
idiopathic
trauma
CNS disease
social
What trauma can trigger epilepsy
head injury
What Cns diseases can trigger epilepsy
tumor, stroke
CJD, meningitis encephalitis
What social aspects can cause epilepsy
late nights, alcohol, hypoglycemia
flashing lights
What are tonic clonic seizures
prodromal aura loss of consciousness/continence initial tonic (stiff) clonic (contraction/relaxation) post-ictal drowsiness
What is Petit Mal seizures
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 single day
What are medical risks of tonic clonic seizures
injury
asphyxia
How can we try to minimize injury from tonic clonic seizures
protect where possible
remove objects from the mouth if possible
How can we try to reduce the impact of asphyxia
use supplemental oxygen
guedel airway if possible
suction secretions
What are social risks
pregnancy
sudden death
social
What is the risk with pregnancy
metabolism upset and drug reactions
risk to unborn child
Why may sudden death occur in tonic clonic seizures
asphyxiation or aspiration
What are social issues with sonic clonic seizures
certain occupations can’t be done
can’t drive
What are precipitators for tonic/clonic seizures
withdrawal/poor medication compliance
epileptogenic drugs
fatigue/stress
infection
menstruation
What are epileptogenic drugs
some GA agents
alcohol
tricyclics
What are partial seizure
motor localized to one region of brain
may move/spread to other motor areas (jacksonian seizure)
What are the changes that can occur in partial seizures
sensory
may effect visual, auditory, taste, smell
What is complex partial seizures result in
automatism - repetitive purposeless movements
lip smacking and grimacing
How do complex partial seizures occur
When diff areas of the brain are effected to produce connective movements
What is the preventative treatment for epilepsy
anticonvulsant drugs
What are the anticonvulsant drugs for tonic-clonic seizures
gabapentin, phenobarbitone, lamotrigine
What drug is used for absence seizures
levitiracetam
What is the treatment for emergency in epilepsy
most require supportive tx ONLY if UNCONSCIOUS - airway and oxygen
status epileptics requires benzodiazepines
What are the drugs used for epilepsy
gaba receptor actions
sodium channel actions
What are the gala receptor action drugs
valproate - gaba transaminase inhibitor
benzodiazepines - gaba receptor action on CL- enhanced
What are the sodium channel action drugs
carbamazepine - stbailises
phenytoin
What are the surgeries for epilepsy
removal of focal neurological lesions - brain tumours (benign)
What are focal seizures
identifiable point of origin within the brain
not well controlled by meds
What are dental aspects of epilepsy
complications of fits
complications of treatment
know emergency care
What are the complications of fits dentally
oral soft tissue injury
dental injury/fracture
What are the complications of tx dentally
gingival hyperplasia (phenytoin) bleeding tendency (valproate) folate deficiency (rare)
how do we assess risk of fit
good and bad phases ask when last 3 fits took place ask about compliance with medcaiton ask about changes in medication treat at times of low risk
