Seizure Disorder Exam 5 Flashcards
What is a seizures?
Sudden paroxysmal electrical
discharge of neurons in the brain
Other terms: Convulsion, fit, spell, ictus
What are the general characteristics?
- Unprovoked, unpredictable, involuntary
- Begins abruptly
- Progresses with possible loss of consciousness, tonic and/or clonic movements
- Duration uncontrollable
What are the Primary causes of a seizure?
(idiopathic)
▪ Genetic predisposition
▪ Neurologic abnormalities
What are the secondary causes of a seizure?
Secondary (symptomatic)
▪ Examples:
▪ Perinatal injuries
▪ Brain tumor
▪ CVD
▪ Trauma
▪ Infection
▪ Complication of cancer
How do you diagnosis seizures?
- Clinical signs and symptoms
▪ History
▪ Electroencephalography (EEG)
▪ Functional neuroimaging
What are the classification for seizures?
- Age-related onset
- Symptoms
- Anatomic localization in the brain
What are the types of seizures?
Generalized
Partial
What is generalized seizures ?
Affects entire brain
- Nonconvulsive
▪ 4 sub-types
Absence (petit mal)
Atypical absence
Myoclonic
Atonic
- Convulsive
▪ 3 sub-types
Tonic-clonic (grand mal)
Tonic
Cloni
What is partial seizures?
- Involves only part of the brain
- -Simple
No loss of consciousness
Staring
Jerking of mouth muscles - -Complex
Varying level of consciousness
Staring with confusion
Purposeless movements or actions
The most common type of generalized seizures?
Non Convulsive- Absence (petit mal)
Convulsive- Tonic Clonic (grand mal)
What is the absence (petit mal) seizure?
Begins: Loss of consciousness 5-30 secs
▪ Blank stare, posture fixed
▪ Rhythmic twitching- Eyelids, eyebrows, head, chewing
▪ Ends: Fully alert, conscious; unaware of seizure
What is tonic clonic (Grand Mal) seizures?
Loss of consciousness sudden and complete
Muscle contraction and relaxation
Shallow or no breathing → pale, bluish color
Tongue bitten, foamy saliva
1-3 minutes duration
Longer → status epilepticus
Phases
Preictal, ictal, postictal
What are the clinical manifestations of seizures?
- Precipitating Factors: Psychological stress
Fatigue
Sensory stimuli
Flashing lights, noises, peculiar odors
Use or withdrawal of addictive drugs (i.e. alcohol) - Aura: Warning before a seizure
Warning → preparation
What are the Medical Treatment when it comes to medications?
- Medications- Antiepileptic
Phenytoin
Clonazepam
Dilantin
Depakote
Klonopin
Luminal
Neurotin
Lamictal
Topamax
What are the side effects of the antiepileptic medications?
- Allergic reaction
- Liver damage
- Delayed healing and infection
- ↑ bleeding
- Gingival hyperplasia → common with phenytoin
- Drug interactions: Acetaminophen, NSAIDs, Erythromycins, Oral Contraceptives, Herbal supplements
What are the medical treatment?
- Surgery= refractory epilepsy
1. Multple Subpial transections
2. Gamma-Knife Radiosurgery - Vagus nerve stimulation
- Ketogenic Diet- mainly fat and low protein, low to no crabs
What are the prognosis of seizures?
Good control
75% seizure-free
Stable, do not worsen
What are the Implications?
Career
License
Independent Living
What are the oral manifestations ?
- Scars
Oral tissues bitten
Differentiate cause - Fractured Teeth
Bruxism, clenching
Sharp → lacerate tissue
Extends into pulp → RCT or EXT
What are the oral manifestations with hyperplasia within seizures?
- Gingival Hyperplasia
-25-50% using phenytoin
-Dilantin hyperplasia, phenytoin-induced hyperplasia
What are the mechanism of oral manifestions with a patient with seizures?
Fibroblasts and osteoblast deposit excessive extracellular matrix
▪ Normal color, texture; lobular shape
▪ Local irritants → more excessive
▪ OH reduce occurrence and severity
When is the occurance of the oral manifestations w/ hyperplasia ?
Younger
▪ Few weeks to years
▪ Dose and length ≠ incidence
▪ Gingiva affected: Anterior, Maxillary, Facial, proximal
What are the effects?
Biofilm control and removal
Mastication, tooth eruption, speech
Esthetic concerns
What are the tissues characteristics?
▪ Early
-Fibrotic, pink, stippled, cauliflower-like
▪ Advanced- Size ↑, cleft-like grooves
▪ Severe
- Wedge teeth apart, interferes with mastication
What does it look like microscopicly?
▪ Fibroblasts and collagen ↑ in CT
▪ Thick stratified squamous epithelium
▪ Inflammatory cells greatest at pocket base
What are some complicating factors?
Dental Biofilm
What are some contributing factors?
▪ Mouth breathing
▪ Overhangs, defective restorations
▪ Large carious lesions
▪ Calculus
By removing what factors will help to treat hyperlasia?
Complicating and contributing factors
What are the treatment for oral manifiestations of hyperplasia?
▪ Change in Drug Prescription → lower incidence
▪ Non-surgical
Scaling calculus & biofilm control
Strict OH program
Fibrotic ≠ shrinkage
Chlorhexidine gluconate rinses
Surgical
▪ Gingivectomy
▪ Periodontal flap
What are the dental management?
Patient History
▪ Last physical exam, MD name & contact info
▪ Emergency contact name & number
Treatment
▪ Medications, surgery, diet?
▪ Interactions of dental treatment and side effects
▪ Level of control (meds)
What are other differential diagnosis?
- Syncope
▪ Migraine headache
▪ Transient ischemic attack
▪ CVA, stroke
▪ Narcolepsy
▪ Hypoglycemia or insulin overdose
▪ Hyperventilation
What is the emergency procedure for a patient with seizure?
- Do not stop convulsion or restrain patient
- Stop procedure; call for assistance
- Protect patient from injury
- Lower chair, tilt to supine, raise feet
Keep patient from falling out of chair
Move equipment, sharp objects
Loosen tight belt, collar, necktie
Do not put anything between teeth
Provide ABCs if necessary
Monitor vitals
Stay with patient
Check level of consciousness
5 MINUTES = call 911, EMS
After the seizure occur what happens in the postictal phase?
Complete record of emergency
▪ Allow patient to rest
▪ Low, reassuring tone
▪ Check oral cavity for trauma
▪ Broken tooth: determine if aspirated
▪ Contact family / friend if requested
What is status epilepticus?
One or more seizures lasting longer than 30 minutes
Seizure > 5 minutes equals what?
→ status epilepticus unless emergency intervention taken
Call 911 if longer than 5 minutes
Brain injury; long-term morbidity or death
Hospital: BLS, IV lorazepam or diazepam
