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DH 2 > Seizure Disorder Exam 5 > Flashcards

Seizure Disorder Exam 5 Flashcards

1
Q

What is a seizures?

A

Sudden paroxysmal electrical
discharge of neurons in the brain
Other terms: Convulsion, fit, spell, ictus

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2
Q

What are the general characteristics?

A
  • Unprovoked, unpredictable, involuntary
  • Begins abruptly
  • Progresses with possible loss of consciousness, tonic and/or clonic movements
  • Duration uncontrollable
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3
Q

What are the Primary causes of a seizure?

A

(idiopathic)
▪ Genetic predisposition
▪ Neurologic abnormalities

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4
Q

What are the secondary causes of a seizure?

A

Secondary (symptomatic)
▪ Examples:
▪ Perinatal injuries
▪ Brain tumor
▪ CVD
▪ Trauma
▪ Infection
▪ Complication of cancer

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5
Q

How do you diagnosis seizures?

A
  • Clinical signs and symptoms
    ▪ History
    ▪ Electroencephalography (EEG)
    ▪ Functional neuroimaging
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6
Q

What are the classification for seizures?

A
  • Age-related onset
  • Symptoms
  • Anatomic localization in the brain
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7
Q

What are the types of seizures?

A

Generalized
Partial

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8
Q

What is generalized seizures ?

A

Affects entire brain
- Nonconvulsive
▪ 4 sub-types
Absence (petit mal)
Atypical absence
Myoclonic
Atonic
- Convulsive
▪ 3 sub-types
Tonic-clonic (grand mal)
Tonic
Cloni

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9
Q

What is partial seizures?

A
  • 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
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10
Q

The most common type of generalized seizures?

A

Non Convulsive- Absence (petit mal)
Convulsive- Tonic Clonic (grand mal)

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11
Q

What is the absence (petit mal) seizure?

A

Begins: Loss of consciousness 5-30 secs
▪ Blank stare, posture fixed
▪ Rhythmic twitching- Eyelids, eyebrows, head, chewing
▪ Ends: Fully alert, conscious; unaware of seizure

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12
Q

What is tonic clonic (Grand Mal) seizures?

A

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

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13
Q

What are the clinical manifestations of seizures?

A
  • 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
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14
Q

What are the Medical Treatment when it comes to medications?

A
  • Medications- Antiepileptic
    Phenytoin
    Clonazepam
    Dilantin
    Depakote
    Klonopin
    Luminal
    Neurotin
    Lamictal
    Topamax
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15
Q

What are the side effects of the antiepileptic medications?

A
  • Allergic reaction
  • Liver damage
  • Delayed healing and infection
  • ↑ bleeding
  • Gingival hyperplasia → common with phenytoin
  • Drug interactions: Acetaminophen, NSAIDs, Erythromycins, Oral Contraceptives, Herbal supplements
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16
Q

What are the medical treatment?

A
  • 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
17
Q

What are the prognosis of seizures?

A

Good control
75% seizure-free
Stable, do not worsen

18
Q

What are the Implications?

A

Career
License
Independent Living

19
Q

What are the oral manifestations ?

A
  • Scars
    Oral tissues bitten
    Differentiate cause
  • Fractured Teeth
    Bruxism, clenching
    Sharp → lacerate tissue
    Extends into pulp → RCT or EXT
20
Q

What are the oral manifestations with hyperplasia within seizures?

A
  • Gingival Hyperplasia
    -25-50% using phenytoin
    -Dilantin hyperplasia, phenytoin-induced hyperplasia
21
Q

What are the mechanism of oral manifestions with a patient with seizures?

A

Fibroblasts and osteoblast deposit excessive extracellular matrix
▪ Normal color, texture; lobular shape
▪ Local irritants → more excessive
▪ OH reduce occurrence and severity

22
Q

When is the occurance of the oral manifestations w/ hyperplasia ?

A

Younger
▪ Few weeks to years
▪ Dose and length ≠ incidence
▪ Gingiva affected: Anterior, Maxillary, Facial, proximal

23
Q

What are the effects?

A

Biofilm control and removal
Mastication, tooth eruption, speech
Esthetic concerns

24
Q

What are the tissues characteristics?

A

▪ Early
-Fibrotic, pink, stippled, cauliflower-like
▪ Advanced- Size ↑, cleft-like grooves
▪ Severe
- Wedge teeth apart, interferes with mastication

25
Q

What does it look like microscopicly?

A

▪ Fibroblasts and collagen ↑ in CT
▪ Thick stratified squamous epithelium
▪ Inflammatory cells greatest at pocket base

26
Q

What are some complicating factors?

A

Dental Biofilm

27
Q

What are some contributing factors?

A

▪ Mouth breathing
▪ Overhangs, defective restorations
▪ Large carious lesions
▪ Calculus

28
Q

By removing what factors will help to treat hyperlasia?

A

Complicating and contributing factors

29
Q

What are the treatment for oral manifiestations of hyperplasia?

A

▪ Change in Drug Prescription → lower incidence
▪ Non-surgical
Scaling calculus & biofilm control
Strict OH program
Fibrotic ≠ shrinkage
Chlorhexidine gluconate rinses

Surgical
▪ Gingivectomy
▪ Periodontal flap

30
Q

What are the dental management?

A

Patient History
▪ Last physical exam, MD name & contact info
▪ Emergency contact name & number

Treatment
▪ Medications, surgery, diet?
▪ Interactions of dental treatment and side effects
▪ Level of control (meds)

31
Q

What are other differential diagnosis?

A
  • Syncope
    ▪ Migraine headache
    ▪ Transient ischemic attack
    ▪ CVA, stroke
    ▪ Narcolepsy
    ▪ Hypoglycemia or insulin overdose
    ▪ Hyperventilation
32
Q

What is the emergency procedure for a patient with seizure?

A
  • Do not stop convulsion or restrain patient
  • Stop procedure; call for assistance
  • Protect patient from injury
  • Lower chair, tilt to supine, raise feet
    Keep patient from falling out of chair
    Move equipment, sharp objects
    Loosen tight belt, collar, necktie
    Do not put anything between teeth
    Provide ABCs if necessary
    Monitor vitals
    Stay with patient
    Check level of consciousness
    5 MINUTES = call 911, EMS
33
Q

After the seizure occur what happens in the postictal phase?

A

Complete record of emergency
▪ Allow patient to rest
▪ Low, reassuring tone
▪ Check oral cavity for trauma
▪ Broken tooth: determine if aspirated
▪ Contact family / friend if requested

34
Q

What is status epilepticus?

A

One or more seizures lasting longer than 30 minutes

35
Q

Seizure > 5 minutes equals what?

A

→ status epilepticus unless emergency intervention taken
Call 911 if longer than 5 minutes
Brain injury; long-term morbidity or death
Hospital: BLS, IV lorazepam or diazepam

DH 2 (21 decks)

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