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
