Section 3 Lecture 6 Flashcards
What does DD stand for:
developmental disability
In order to be classified as a developmental disability in must occur before what age?
22, in NYS
List of DD’s:
autism, ID, CP, epilepsy/seizure disorder, neurological impairment, traumatic brain injury (22 or younger in NYS)
Two causes of DS:
trisomy-21 (all cells w 47 chromosomes) and trisomy mosaic (Some cells have 46 chromosomes, some have 47)
Most children w DS are born to (younger/older) women.
younger
Who is at greater risk for have a child w DS, younger or older women?
older
What % of DS babies result in miscarriage?
75%
How to detect DS:
amniocentesis
Are older dads at a higher risk of having a child w DS?
Yes
DS characteristics:
Higher arched palate, underdeveloped midface, and development of the CNS, face and mouth altered
An ID is clasified as an IQ lower than:
70
T or F? There is a huge range of IQ’s in DS.
T
Which portion of the brain is most affected with DS?
cortex, brain is smaller overall (about 25% smaller?)
Can strabismus be corrected?
yes, by surgically shortening an occular m.
Mx issues that come with DS:
heart surgery, strabismus, myopia, spontaneous nystagmus, short, obese, shorter life expectancy, protruding tongue, hypotonia w delayed M milestones, early onset Alzheimers, cervical spine instability (atlanto-axial subluxation: too much moves at the j bw skull and cord, danger of s.c. injury (positioning in dental chair)
nearsightedness is aka:
myopia
Why are DS and AD connected?
1 of the chromosomes implicated in AD is #21. Extra 21 means more likelihood of developing AD
What is atlanto-axial subluxation?
too much moves at the j bw skull and s.c., danger of s.c. injury in positioning in dental chair. Atlas can project too far anterior when leaning forward
The paralympics is for people w:
physical disability
The special olympics is for people w:
ID/DD
Issues related to DS affecting dental tx:
IS dysfunction, abnormal develop of teeth, incorrect # of teeth, late eruption of baby teeth, inc gum disease, retention of baby teeth, different order of tooth eruption, large/ small tongue, large/small jaw, grooves on tongue, behavioral issues, seizures, position in the dental chair bc of cervical instability, cognitive limitations.
Epilepsy is aka:
seizure disorder
What % of people w seizure disorders can not control the seizures w drugs?
35%
Define intractable:
can not control with drugs
Recurrent, unprovoked seizures:
seizure disorder
What can cause a child to have a seizure if its not due to epilepsy?
High fever
Neurological basis of seizures:
spontaneous, recurrent, simultaneous, massive discharges of neurons (AP’s at the same time)
Cause of seizure disorders:
DD, CP, DS, genetic mutations in genes affecting receptors/ transmitters in the brain, head injury, metabolic disturbances, paraneoplastic syndrome (metabolic effects of cancer on tissue), epilepsy secondary to cancer/tumors, brain tumors, autoimmune epilepsy (ABs to key proeins in neurotransmission), alcohol withdrawal
PET scan measures:
metabolic activity
Epilepsy syndromes:
Lennox-Gastaux syndrome, Benign Rolandic Epilepsy, Landau-Kleffner Syndrome, Rasmussen’s syndrome, Dravet Syndrome, Infalntile spasms
2 major classes of seizures:
partial (localized to a specific region) and generalized (all over brain)
How many types of seizures are there?
40+
What varies w seizure type?
part of CNS involved
2 types of partial (focal) seizures:
simple and complex
The progression of seizure contractions across the body in Jacksonian epilepsy reflects:
the orderly map of the body in MC, the “March of Epilepsy”, consciousness remains during
Movement or sensory experience w no loss of consciousness or postural control:
partial simple seizure
Partial complex seizures originate:
in the temporal lobe
What types of movements are involved with partial complex seizures?
complex moves (lip-smacking)
Are pts conscious or unconscious during partial (focal) seizures?
conscious
Are pts conscious or unconscious during partial complex seizures?
not fully conscious, may not remember the seizure
What type of seizure is often preceded by an “aura?”
Partial complex seizures
Do people fall to the ground immediately with a partial complex seizure?
no, they feel funny prior
How do partial complex seizures begin?
as focal and spread or “generalize”
2 major classes of generalized seizures:
Tonic-clonic (grand mal) and absense (petit mal)
Tonic-clonic seizure:
protective reflexes don’t work, reflexes involving vestibular input don’t work, pt instnatly looses consciousness and falls, initial period of rigidity
What type of seizure results in immediate loss of consciousness and falling?
tonic-clonic
What is the tonic phase?
Full body rigidity
What is the clonic phase?
back and forth moves of all body parts (alternating contraction of agonists and antagonists) (often loss of bladder control)
What type of seizures can have an environmental stimulus?
tonic-clonic
Seizure first aid:
keep person safe, don’t hold down, don’t put anything in the mouth
When are tonic-clonic seizures dangerous?
Status epilepticus: continues for more than 5 minutes, tx with IV drugs and life support (resp compromised)
How long do most seizures last?
a few minutes
What is the period after a seizure called?
Post-ictal period
How long does the post-ictal period last?
few minutes to several hours of deep sleep
Which parts of the brain are involved in absence seizures?
the whole brain (petit mal)
What does a absence seizure look like?
No loss of postural tone, looks like kid is daydreaming, may not be recognized as a seizure
Who are affected by absence seizures?
children, frequently outgrown
EEG are used to:
Record seizure type and look for seizure focus, electrodes on scalp record many neurons
Duration of EEG recording:
less than one hour
What does LTM stand for?
Long-term monitoring, usually w video recording as well
When is a more invasive EEG with electrodes on the dura used?
When there is a seizure focus, to try to localize, PET can help too
How can a seizure focus be localized?
EEG w electrodes on dura or PET
AED drugs stands for:
Anti-Epileptic Drugs
Break-through seizure:
when a pt will has a seizure despite being on medications
Drugs for seizures:
Tegretol, Depakote, Lamictal, Felbamate, Dilantin, Keppra, Neurontin, Onfi, Topamaz, Manzel, Vimpat
T or F? Most people can control their seizures by taking 1 Mx.
F. some take 4-5
How do AED’s work?
dec excitation, inc inhibition by inc GABA, or alter levels or receps
How is the correct dosage of Mx often achieved with AED’s?
blood levels
Side effects of AEDs:
sedation, Vit D metabolism, bone density, triggering of allergic rxn, weight gain/loss, pain mgmt, used in psychiatry
AED’s used in psychiatry:
Tegretol, Depakote, Lamictal
AED’s that can trigger allergic rxns:
Tegretol, Dilanton, phenobarbital
What AED interferes with Vit D metabolism?
Tegretol
What diet helps prevent seizures?
fatty/ketogenic, modified Atkins diet (Johns Hopkins), low glycemic index diet (Mass. General)
What seizure pts will respond well to a high fat diet?
Those w glucose transporter mutation, do genetic test for this
When is surgery useful in seizure mgmt?
“focal cortical dysplasia”, remove seizure focus abnormal structure in restricted region of cortex, cut corpus callosum, prevents spreading, young kids w severe cases, remove an entire hemisphere
VNS stands for:
Vagal neve stimulator
What does a VNS do?
electrical stimulation to brain via CN X by an external magnet, mechanism not understood
T or F? Protective reflexes are still functional during a seizure.
F.
Seizure disorders often accompany:
DD’s, CP, DS
What should you ask a pt known to have seizures?
typical duration? triggers?
Dental side effect of Dilatin:
gingival overgrowth that requires surgery
How are some people with autism treated for dental care?
sedation or general anesthesia in hospital
