4: Epilepsy

Question 1

Spasm

Answer 1

sudden involuntary muscular contraction or convulsive movement

Question 2

Seizure

Answer 2

sudden surge of electrical activity in the brain leading to occurrence of abnormal behaviour

Question 3

8 triggers for seizures

Answer 3

1. recreational drug use
2. alcohol (esp withdrawal)
3. flickering lights (incl TV and computer screens)
4. sleep deprivation
5. physical and mental exhaustion
6. metabolic disturbances & infections occurring at the same time
7. missed doses of anti-epileptic drugs
8. uncommon: loud noises, hot baths, music, reading

Question 4

3 main types of epilepsy

Answer 4

1. partial epilepsy
2. primary generalised epilepsy (idiopathic)
3. secondary generalised epilepsy

Question 5

partial epilepsy symptoms

Answer 5

• seizures occur usually during sleep and are mild

Question 6

partial epilepsy epidemiology

Answer 6

occurs in children and usually grow out of it by adulthood

Question 7

partial epilepsy origins

Answer 7

acquired and congenital

Question 8

partial epilepsy causes

Answer 8

• tumours
• trauma
• infection (HIV)
• inflammatory (vasculitis)

Question 9

partial epilepsy brain area affected

Answer 9

disease of the cerebral cortex

Question 10

primary generalised epilepsy onset

Answer 10

always early (childhood/adolescence)

Question 11

what’s always common

Answer 11

substantial genetic predisposition

Question 12

2 main subcategories of primary generalised epilepsy

Answer 12

1. petit-mal epilepsy. childhood absence epilepsy; progresses to adult form “grand-mal”
2. “grand-mal” - generalized tonic clonic seizure (GTCS)

Question 13

typical Generalised Tonic Clonic Seizure (GTCS)

Answer 13

• The Tonic Phase follows after a vague warning: The Aura Phase
• Tonic Phase = body rigid for up to a min
• pt falls and can bite tongue
• incontinence of faeces or urine may occur
  NEXT FOLLOWS: Clonic Phase

Question 14

describe Clonic Phase

Answer 14

• generalised convulsions
• frothing of mouth
• bilateral rhythmic jerking of muscles
• followed by drowsiness & confusion/coma for a few hrs

Question 15

what to do to stop Generalised Tonic Clonic Seizures?

Answer 15

seizures will stop on their own

Question 16

Secondary Generalised Epilepsy: one cause

Answer 16

may arise from spread of PARTIAL SEIZURES due to structural disease

• CJD
• Alzheimers
• Meningitis

Question 17

Secondary Generalised Epilepsy: second cause

Answer 17

secondary to drugs OR metabolic disorders

• hypoglacaemia
• hypocalcaemia
• renal/liver failure
• antibiotics (eg metronidazole)
• immunosuppressants
• metals

Question 18

Secondary Generalised Epilepsy: onset

Answer 18

occurs in adults;

major seizure can occur even without previous history of partial seizures

Question 19

Secondary Generalised Epilepsy: main cause for it in elderly

Answer 19

cerebrovascular disease

Question 20

dental implications: instruments

Answer 20

kept at a safer distance from pt

Question 21

dental implications: pt with infrequent epileptic seizures /learning disability

Answer 21

higher probability of irregular taking of medication thus higher chance of/less controlled seizures

Question 22

dental implications: oral precaution

Answer 22

strong mouth props to be put in place during tx

Question 23

dental implications: when is it appropriate to treat

Answer 23

only in a good phase of epilepsy where attacks are WELL CONTROLLED and infrequent

Question 24

dental implications: type of prosthesis recommended for epileptics

Answer 24

acrylic prosthesis as they’re more resilient than porcelain prosthesis

Question 25

dental implications: factors that can cause sudden attack

Answer 25

- starvation - fatigue - stress - withdrawal from anticonvulsants - flickering lights (flashlight photography) - infection - EPILEPTOGENIC drugs

Question 26

epileptogenic drugs

Answer 26

``` alcohol metronidazole (antibiotic) LIDOCAINE quinolones tricyclic antidepressants chlorPROmazine (dopamine antagonist for schizophrenia) ```

Question 27

phenytoin; | CARBAmaZEPINE; dental relevance

Answer 27

used as anticonvulsant in therapy of epilepsy. provokes gingival hyperplasia.

Question 28

dental implications: after a siezure...

Answer 28

- someone to accompany the pt home (relative) - assess if pt is conscious after the seizure - check for injuries in the oral cavity

Question 29

dduh protocol: during siezure

Answer 29

- if possible, place on floor, far away from dental unit OR - in a position where seizure can safely run its course - monitor CARDIO-RESPIRATORY function - if convulsion is prolonged and cyanosis occurs, insert SOFT airway if possible NOT FORCIBLY

Question 30

dduh protocol: status eplipticus

Answer 30

- refers to prolonged epileptic seizures - arrange for pt to be transferred to A&E of a nearby hospital - monitor cardiorespiratory function & insert SOFT airway if cyanosis occurs (not forcibly) - give DIAZEPAM 0.1 mg/KG intravenously over 5 mins if seizure is not self-limiting. (best administered by admitting staff at the A&E)

Question 31

dduh protocol: aftermath

Answer 31

- seizure should self-limit in a few mins - incontinence may occur - pulse will be FAST and of GOOD VOLUME - place in recovery position after convulsion stops - pt will be drowsy for up to 1 hr

Question 32

should one try prevent tongue-biting in epileptic pt

Answer 32

cannot be prevented by observers as happens at onset of seizure; do NOT introduce anything in mouth for this purpose

Question 33

when to seek urgent medical attention

Answer 33

if convulsions continue 5 mins +