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BDS3 BAMS > Epilepsy > Flashcards

Epilepsy Flashcards

1
Q

What is Epilepsy?

A
  • Common condition where sudden bursts of electricity activity in brain causes seizures or fits
  • Associated with reduced GABA levels in brain
  • Leads to abnormal cell-cell message propagation
  • Abnormal chain reaction can be set up leading to dysfunction of many neurons in same section
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2
Q

What are the signs and symptoms of Febrile Seizures?

A
  • Fever above 38
  • Face may turn blue or red
  • Eyes rolling upwards
  • Loss of consciousness
  • Muscles and limbs jerk in unnatural movements
  • Likely to have another if have one
  • Most likely occurs in children
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3
Q

How to help prevent a Febrile Seizure in Children?

A
  • Any child with fever above 38 degrees can be at risk of seizure
  • Cool hot children down
  • Paracetamol
  • Ibuprofen
  • Remove clothes
  • Cool sponging
  • Cool bath
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4
Q

What groups can Epilepsy be classified in to?

A

Generalised
- Tonic/clonic
- Absence (petit mal)
- Myoclonic/ atonic

Partial
- Simple partial
- Complex partial
- Simple sensory

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5
Q

What can trigger Epilepsy?

A
  • Idiopathic (cause unknown) and most common
  • Trauma (head injury)
  • CNS disease e.g. tumour/ stroke/ CJD/ meningitis/ Encephalitis
    Social e.g. late nights/ excess tiredness/ excess alcohol/ hypoglycaemia/ flashing lights
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6
Q

What can trigger Epilepsy?

A
  • Idiopathic (cause unknown) and most common
  • Trauma (head injury)
  • CNS disease e.g. tumour/ stroke/ CJD/ meningitis/ Encephalitis
    Social e.g. late nights/ excess tiredness/ excess alcohol/ hypoglycaemia/ flashing lights
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7
Q

What is generalised Epilepsy?

A
  • Central focus releases abnormal electrical activity out to both hemispheres of brain at same time
  • All parts of body involved in seizure
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8
Q

What is partial Epilepsy?

A
  • AKA focal seizures
  • Has a cortical focus that releases abnormal electrical activity and only affects single brain area
  • Temporal lobes most common site
  • Can affect motor/ perception and sensation
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9
Q

How do EEG Electrical changes in generalised seizure change?

A
  • Change from normal to larger and more erratic pattern
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10
Q

What is a Tonic Clonic?

A
  • Type of generalised seizure
  • Patient has prodromal aura (Subtle changes patient is aware of)
  • Lead to loss of consciousness/ continence
  • Initial tonic (stiff) reaction where all voluntary muscles in body contract - puts P on skeleton and spine and can lead to damage
  • Lead to Clonic phase (intermittent contraction/relaxation of muscles- jerking or spasm)
  • Will spontaneously terminate after 1-3min
  • Patient remains drowsy until return to normal
  • Can repeat and this is very dangerous for patient as breathing becomes effected and patient can become hypoxic
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11
Q

What is Petit Mal?

A
  • Type of generalised seizure
  • May not have awareness of changes or even no changes
  • Short lived episodes of 5-15seconds
  • Lead to loss of awareness where eyelids flutter, vacant stare, stops activity, loss of response
  • Usually occurs in Childhood and can be taken for daydreaming
  • Can have multiple attacks in a single day
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12
Q

What are the medical Problems of Tonic-Clonic Seizures?

A

Injury
- Always try and protect where poss
- Remove objects from mouth if poss
- If aware attack is going to happen, control fall to ground

Asphyxia
- No normal breathing taking place during seizure
- Use supplemental oxygen
- Use Guedel airway if possible
- Suction away any secretions

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13
Q

What are the social problems associated with Tonic-Clonic seizures?

A

Hard to get pregnant on medications
- Drug reactions of certain medications means harder to get pregnant
- Metabolism is upset

Sudden death
- Due to Asphyxiation/ aspiration of gastric contents leading to acute lung damage

Social
- Driving (free of seizures for at least a year in order to get a driving license) , employment (no working form heights or drivers)

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14
Q

What are some precipitators for Tonic-Clonic Seizures?

A
  • Mostly idiopathic but
  • Withdrawal/ poor medication compliance
  • Useful to ask do you regularly take the medication you’ve been prescribed

Epileptogenic drugs
- Some GA agents
- Alcohol
- Tricyclics and SSRIs

  • Fatigue/stress
  • Has systemic Infection
  • Menstruation
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15
Q

What occurs during partial seizures affecting motor neurons?

A
  • Motor localised to one region of brain
  • May move/spread to other motor areas
  • Called Jacksonian seizure
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16
Q

What is a sensory partial seizure?

A
  • Affects any sensory modality
  • Visual, auditory, taste, smell
  • Often involve deja vu
17
Q

What is complex partial seizure?

A
  • Focal seizures that start in one hemisphere of brain and associated with impairment of consciousness
  • Automatism occurs where two different movements can be made to happen
  • e.g. repetitive purposeless movements like lip smacking and grimmacing
  • No awareness they are carrying these out
18
Q

How is Epilepsy treated?

A

Preventative treatment of anticonvulsant drugs;

For tonic- clonic use Valproate, Carbamazepine, Phenytoin, Gabapentin, Phenobarbitone, Lamotrigine
For absence use Levitiracetam

19
Q

What is the Emergency treatment for Epilepsy?

A
  • Most require supportive treatment only
  • If unconscious use airway and oxygen to prevent hypoxia
  • If patient undergoing status epilepticus then require Benzodiazepines as more serious
20
Q

What is Status Epilepticus?

A
  • A seizure that lasts longer than 5 mins or having more than one seizure within 5 min period without returning to normal level of consciousness between episodes
21
Q

How do GABA receptor drugs work for Epilepsy?

A
  • Valproate works by acting on Gaba transaminase inhibitor
  • Benzodiazepines works by acting on GABA receptor action on Cl- enhanced
22
Q

How is surgery used to help treat Epileptic patients?

A
  • Removal of focal neurological lesions in benign brain tumours
  • Focal seizures have identifiable point of origin within brain and not well controlled by medication
  • Can do frontal lobectomy/ Functional hemispherectomy
23
Q

What are the dental aspects of Epilepsy?

A

Complication of fits
- Oral soft tissue injury
- Dental injury/fracture

Complications of treatment
- Gingival hyperplasia common from drug phenytoin
- Bleeding tendency (valproate)
- Folate deficiency (rare)

Know emergency care
- Ask what type of epilepsy and how compliant they are with taking them, when last seizure occured etc - full medical history

24
Q

How to assess risk of fit Epilepsy for dental care?

A
  • Good and bad phases
  • Ask when last three fits took place (e.g. if had one 3 months/6months etc then low risk but if happened within the past two weeks then don’t perform)
  • Ask about compliance with medication
  • Ask about changes in medication
  • Treat at times of low risk if poss

BDS3 BAMS (15 decks)

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