Emergency: seizure

Aberrant cortical neural pathway activation

Motor activity

Sensory activity 

Mixed

Long lasting 

Life threatening

no

but have to notice the time length that could indicate status epilepticus

Focal source of excessive neuronal electrical discharge in the brain

Cause:  

Epilepsy

Head trauma

Fever (quick change in body temp --> feverile seizure)

ETOH withdrawal

Hypoxia (birth, syncope) 

Stroke

Brain tumor  Meningitis

Local anesthetic overdose  Hypoglycemia

Epilepsy

Head trauma

Fever (quick change in body temp --> feverile seizure)

ETOH withdrawal

Hypoxia (birth (inc chance of having epilepsy later on), syncope)

Stroke

Brain tumor

Meningitis

Local anesthetic overdose *** (for dentist)

Hypoglycemia

--Generalized seizures spread to entire brain

Absence (froze completely for a short time) or petit mal seizures

Tonic/ clonic or grand mal seizures

• --Partial seizures remain focal and
• localized

Medications


Vagal nerve stimulation


Ketogenic diet


Neurosurgery

Barbiturates

Benzodiazepines

Hydantoins

Succinimides

Others (carbamazepine, felbemate, gabapenin, lamotrigine. levetiracetam, oxcarbazepine, valproic acid, zonisamide)

Spontaneous discharge (periodically)

Patient-controlled discharge (aura prior to seizure) 

when med fails

Used mostly in children

• About one third who try it become
• completely or near-completely seizure free

• Another third still have seizures,
• but with many less and with less medical therapy

• The remainder do not respond, or
• find it too hard to continue the diet.

Patients with a history of seizures

Frequency (1x or 2x a week --> high chance of having seizure)

Last seizure?

Precipitating factors (stress?)

• Medications:
•          last time serum drug levels were checked (could varied) 
•          Changes in medications since last check (the more change, the high the chance of having seizure)

• 1x or 2x per week 
• no change in med 
• normal drug serum level

Failure to comply with medications (no stopping abruptly, waning. if not, result in status epilepticus) 

Stress

Other emergency conditions

Flashing lights

status epilepticus

Confirm that patient has taken anti-seizure medications on day of procedure


Limit stress: Sedation, Benzodiazepines, Barbiturates

Prodromal phase with personality changes

Aura, depends on the location of the initiating seizure focus (smell, visual) 

Loss of consciousness

Ictal phase (tonic-clonic phase)

Post-ictal phase

need to control airway

reassurance

Stop dental treatment

all objects out of mouth

• Remove dangerous items from around
• patient

Gently restrain and protect patient during ictal phase

• Nothing placed in the patient’s
• mouth

Let the seizure run its course

• ---Supportive therapy during post-ictal phase
• Maintain airway
• Oxygen
• Monitor vital signs

---Consider 911, especially if seizure continues or repeats

---Possible valium 5-10 mg IV or midazolam 2-4 mg IV / IM if seizure continues or repeats

false

true

-----No need for assistance:

If a known epileptic patient (medical I.D.)

If seizure ends in less than 5 minutes

If normal consciousness returns

If there is no physical injury

If not pregnant or diabetic

If the seizure happened in water

If it’s a first time seizure

• If the person is not known to have
• epilepsy

• vIf the person is pregnant, injured
• or diabetic

• vIf the seizure lasts more than 5
• minutes

• If a second seizure starts shortly
• after the first

• If consciousness does not start to
• return shortly after the ictal
• phase