Seizures

Question 1

Differentiate between an atonic seizure and a tonic seizure:

Answer 1

An atonic (drop attack) seizure would occur when a child (begins in childhood) loses muscle tone abruptly while they remain conscious for 15 seconds and may get injured. In a tonic seizure, the body stiffens on one or both sides for 20 seconds while the person remains conscious; they might have several in a row and are tired and confused after.

Question 2

Differentiate between a tonic-clonic (grand mal) seizure and an absence (petite mal) seizure:

Answer 2

A tonic-clonic (most common seizure disorder) seizure is precipitated by a neurologic disorder or a systemic, metabolic or toxic disturbance and lasts 1-3 minutes. An absence seizure begins and terminates abruptly lasting 5 to 30 seconds occurring frequently throughout the day, usually shortly after waking up or in the ‘absence’ of inactivity, so you should exercise if you have absence seizures!

Question 3

Differentiate between a clonic and myoclonic seizure:

Answer 3

A clonic seizure can be any age characterized by rhythmic jerking of arms and legs from seconds to a minute, and after the seizure they continue what they were doing. During a myoclonic seizure, there are shock like jerks of muscles for 1 to 2 seconds, and they could have several within a short time.

Question 4

What are the four types of simple partial seizures (focal w/ out impairment), and what are the general characteristics of simple partial seizures?

Answer 4

1. Motor 2. Sensory 3. Autonomic 4. Psychic The person is alert and remembers what happens when they exist these seizures around the 2 minute mark. They might continue what they were doing, or if they had an aura they will have a stronger seizure.

Question 5

Tell me three things about a motor simple partial seizure:

Answer 5

-muscle jerking or stiffening -movements spread or march -coordinated; laughter or hand movements

Question 6

Tell me two things about a sensory simple partial seizure:

Answer 6

1. any of senses 2. “pins and needles” or numbness

Question 7

Tell me three things about an autonomic simple partial seizure:

Answer 7

-strange, unpleasant sensations to stomach, chest, head -change in HR or breathing -sweating and piloerection

Question 8

Give me a run down of a psychic simple partial seizure:

Answer 8

-problems with memory, garbled speech, written or spoken language -sudden emotions for no reason -feel outside of body; deja vu or jamais vu

Question 9

Give me a quick run down of complex partial (focal w/ impairment) seizures:

Answer 9

-temporal or frontal lobe then traveling to areas of alertness and awareness -mistaken for daydreaming (30 sec to 2 mins) -move mouth, pick at air or clothing, fumbling of hands and purposeless actions; dangerous or embarrassing actions -repeat words, scream, laugh, cry

Question 10

Tell me about status epilepticus:

Answer 10

-seizures lasting more than 30 mins or repeated seizure beginning before recovery of initial episode -precipitating factor is failure to take anti epileptic drugs -mortality rate of 10-20%

Question 11

What causes primary epilepsy?

Answer 11

1. Idiopathic or genetic etiology 2. Relatives with increase incidence rate

Question 12

Give me congenital abnormalities, perinatal injuries, metabolic disorders, and drugs that would cause secondary epilepsy:

Answer 12

congenital: maternal infection
perinatal: trauma or hypoxia during delivery

metabolic disorders: hypocalcemia or hypoglycemia

drugs: penicillin, local anesthetics, withdrawal

Question 13

When would a head trauma manifest itself as secondary epilepsy?

Answer 13

2 years; 5-15% of acquired epileptics

Question 14

Throw down 5 more causes of secondary seizures:

Answer 14

1. Tumors- initial symptom of a tumor 2. Vascular disease like cerebral ischemia 3. Bacterial meningitis or viral encephalitis 4. exposure to flickering lights 5. febrile conditions; 102 or greater

Question 15

What are the most likely causes of seizures that we will see in the dental office?

Answer 15

1. epilepsy 2. hypoglycemia 3. hypoxia secondary to syncope 4. local anesthetic overdose

Question 16

Your patient is having a seizure which came on abruptly. They are immobile and staring at you, then begin blinking, mouthing movements and motioning hand gestures. Their seizure ends and they act like nothing has happened. What kind of seizure is this?

Answer 16

Absence

Question 17

What would you see in the prodromal phase of a generalized tonic clonic seizure?

Answer 17

The patient had a recent and sudden change in emotions, but just immediately to the seizure they had an aura. This seizure could be olfactory, gustatory, or auditory.

Question 18

The generalized tonic clonic seizure patient has already experienced the prodromal phase of their generalized tonic clonic seizure. What phase do they enter and what is this phase called?

Answer 18

Preictal phase. -lost consciousness after the aura and fell -myoclonic jerks for several seconds with epileptic cry -increased HR and BP, increased bladder pressure, piloerection, glandular hyper secretion, superior ocular deviation, mydriasis, apnea.

Question 19

The GTCS patient enters the ictal phase of their seizure. What two components will you see and tell me about them.

Answer 19

Tonic and clonic.

Tonic -muscle contractions (10 to 20 sec), flexion first then extensor -dyspnea and cyanosis

Clonic (2 to 5 mins) -heavy, snoring type, but exit ictal phase when breathing returns to normal -alternating relaxation and violent flexion; these become less frequent with a final flexor jerk -froth at mouth, blood in mouth from trauma

Question 20

Now that you know EVERYTHING about GTCS, tell me about the post ictal phase:

Answer 20

-muscular flaccidity (looseness) (fecal incontinence) -deep sleep -regain consciousness slowly with disorientation -amnesia -headache and soreness

Question 21

What occurs during status epilepticus?

Answer 21

• hyperthermia
• tachycardia, dysrhythmias, elevated BP
• brain damage, death

Question 22

If your patient is undergoing a petit mal or partial seizure, what is protocol?

Answer 22

Terminate procedure; there’s not time to alter position; reassure patient that you have some idea wth just went on and discharge them with escort

Question 24

What do you do during a preictal phase of GTCS?

Answer 24

Terminate procedure and move instruments away from patient.

Question 25

What do you do during the ictal phase of GTCS?

Answer 25

1. P: place on floor, or if in dental chair place in supine position
2. ACTIVATE EMS
3. CAB: suction oral cavity
4. D: gently refrain arms and legs from gross movements; put cushion under head; remove headrest donut to prevent flexion; person at chest and feet to prevent injury; loosen clothing
5. give O2 and monitor vitals

Question 26

What do you do during the post ictal phase of GTCS?

Answer 26

P: supine

CAB: usually require airway maintenance

D: administer O2; monitor vitals; discharge as per paramedic protocol

Question 27

How do you manage a patient with status epilepticus?

Answer 27

1. same as initial for GTCS
2. Continue BLS until medical assistance available
3. IV or IM of 2.5 mg of Versed; repeat 2-3 minutes or IV of 10 mg of Valium over 2 minutes repeated every 10

Give IV of 50% dextrose IV to rule out hypoglycemia