darryl-epilepsy Flashcards
(23 cards)
Define epilepsy
Recurrent state of seizures
A symptom not a disease
Define seizure
Disorderly discharge of cerebral neurones resulting in a violent spasm or convulsion
Describe diagnosis of epilepsy
- Detailed eye witness account is vital
- Can be difficult
- Misdiagnosis carries a huge cost-side effects of meds, stigmatisation, employment and insurance issues
Describe aetiology of epilepsy
- Largely unknown
- Genetic
- Environmental
- Combination of factors and causes
Describe structural causes of epilepsy/seizures
- cortical scarring (head injury)
- developmental
- space-occupying lesion
- stroke
- hippocampal sclerosis
- vascular malformations
Describe non-epileptic causes of seizures
- Trauma
- Haemmorrhage
- increased ICP
- Alcohol/benzodiazepine withdrawl
- Metabolic disturbances
- Infection
- Drugs
What are some precipitating factors for seizures
- stress
- hyperventilation
- photic stimulation
- alcohol
- drugs
Describe the course of a seizure
- Prodrome
- Aura
- Seizure event proper
- Post-seizure period
Describe the prodrome
waiting at train station
- hrs or days prior
- change in behaviour or mood
Describe aura
hear train coming
- part of seizure
- precedes other manifestations of seizure
- may include strange sensations in gut on limbs, deja vu, strange smells, flashing lights
Describe seizure event
train arrives
- signs and symptoms may vary
- tongue biting very suggestive
- may have incontinence
- abnormal movements
Describe post-seizure events
train passed
- todd’s palsy
- headache
- drowsiness/lethargy
- myalgia
- confusion
What are some commonly prescribed ASMS
- Sodium valproate
- carbamazepine
- lamotrigine
- phenytoin
- gabapentin
- topiramate
Why are ASMS ‘dirty’
hit all sorts of receptors-> more side effects
What are some dental considerations for epileptic/seizure pts
- recognising pt
- recognising medications and side effects (medication induced gingival hyperplasia
- avoid known triggers
- cheek biting, tongue biting, chipped teeth
- must have meticulous oral hygiene
What medications may cause gingival hyperplasia
- phenytoin (dilantin)
- cyclosporin A
- calcium channel blockers: nifedipine, amlodipine
How does medication induced gingival hyperplasia work
- fibroblast stimulation
- inflammatory cytokines (importance of perio health!)
- matrix metalloproteinase
Describe management of medication induced gingival hyperplasia
- recognition
- oral hygiene
- education
- liaison with medical practitioners
- surgery
What to do in a seizure event
- ask how are things to seizure pts to prevent
- have a signal
- down tools
- put pt on ground if practical
- can put chair flat and all the way down onto DA chair for more support
- can protect, do not restrain
- clear area
- call 111 ASAPP (1-111 in dent school)
- Do not put anything in mouth-aspiration
- Airway, Breating, Circulation and post care
describe status epilepticus
- single seizure lasting for more than 5 mins
- 2 or more seizures within 5 mins without regaining consciousness in between
- mortality and risk of brain damage increase with length of attack
What to do if status epilepticus
- Call 111
- General management still same
- Diazepam IV infusion 10mg over 10 mins
- Midazolam titrated to effect, max. 10-15mg IV
- watch for respiratory depression
- benzodiazepines may be given IM
Describe symptoms of alcohol withdrawl
- delirium tremors
- sweats
- hallucinations
- irritability
- labile blood pressure
- tachycardia
- convulsions
What are some education tips for seizure pts
- avoid known triggers
- driving, occupation, hazards
- lifestyle changes esp. alcohol intake
- medications and compliance
- oral health esp. with phenytoin
- normal life is achievable!
