-
a sudden paroxysmal electrical
discharge of neurons in the brain
Seizure definition
-
Classification of seizures
- Age of onset
- Symptoms
- Anatomic location in brain
-
Types of seizures
- Generalized – affects entire brain at the
- same time
- Partial – involves only a part of the brain
-
Etiology of Seizures
- Primary: (idiopathic) Genetic predisposition
- Secondary: (symptomatic) Congenital conditions
-
genetic predisposition to seizures or to other neurologic abnormalieties for which seizure may be a symptom
Primary (Idiopathic)
-
sezures can arise during many neurologic and nonneurologic medical condition
secondary (symptomatic)
-
Congenital conditions such as maternal infection (rubella); toxemia of pregnancy
perinatal injuries
brain tumor
cerbrovascular disease (stroke)
trauma (head injury)
infection (meningitis, encephalitis, opportunistic infection of AIDS
degenerative brain disease
metabolic and toxic disorders (alcohol/drugs)
complication of cancer
secondary (symptomatic)
-
other names for a seizure
-
Prognosis for seizure control
good 75% become seizure free
-
do seizures worsen over time?
no
-
Seizure patients avoid three activities
- Certain vocations
- Licenses
- Independent living
-
Factors that precipitate a seizure
- Psychological stress: apprehension
- Fatigue: sleep deprivation
- Sensory stimuli (flashing lights, noises, peculiar odors)
- Use of withdrawal of alcohol or other addictive drugs
-
Special sensory stimulus, a sensation of numbness, tingling, or twitching or stiffness of certain muscles (warning sign)
Aura
-
International classification of seizures
- Partial seizures (beginning locally): simple and complex
- Partial seizures evolving to generalized tonic-clonic convulsions
- generalized seizures: nonconvulsive and convulsive
-
without loss of consciousness
simple partial seizures
-
4 indications of simple partial seizures
- motor signs
- autonomic symptoms
- psychic problems
- somatosensory or special sensory symptoms
-
same as simple partial seizures, but with loss of consciousnes
complex partial seizures
-
which are more common: generalized or partial
generalized
-
-
types of nonconvulsive seizures
- absence seizures
- atypical absence sweizures
- myoclonic seizures
- atonic seizures
-
grand mal seizures
convulsive seizures
-
types of convulsive seizures
-
length of nonconvulsive (petite mal)
5-30 sec
-
length of convulsive seizures
1-30 min
-
Partial Simple (5)
- Cessation of ongoing activity,
- staring spell,
- dizziness,
- jerking of muscles around the mouth,
- no loss of consciousness
-
Partial Complex (7)
- Trance-like state,
- consciousness impaired,
- purposeless movements with confusion, incoherent speech,
- ill humor,
- temper,
- doesn’t remember what happened during attack
-
Absence (petite mal) seizure
- Begins and Ends abruptly 5-30secs.
- Most common in children
- Patient returns to full awareness
- Unaware of what occured
-
Tonic-clonic (grand mal) seizure
- “Epileptic cry”
- Sudden & complete loss of consciousness Musculature contraction
- Skin color pale
- Breathing shallow
- Possible loss of bladder control
- Lasts 1-3 minutes
- Saliva mixed with air (foam) flows
- Deep sleep
-
side effect of phenytoin
gingival enlargement
-
side effects of meds
- allergic reaction, rash
- fatigue, weakness, ataxia, headache, slurred speech
- nausea vomiting
- memory loss
- damage to liver
- leukopenia: delayed healing and infection
- thrombocytopenia: decreased platelet aggregation
- osteoporosis
- increased risk of birth defects
- gingival enlargement
- reduce efficancy of oral contraceptives
-
who forgets to take meds
elderly
-
more sensitive to side effects of weakness, unsteadiness, and cognative alterations
elderly and children
-
Problems with herbal supplements
- may interfere with perscription drugs
- may incease bleeding
-
Surgery and other options
- Resection
- Gamma-knife radiosurgery
- Vagus nerve stimulation
- Ketogenic diet
-
Certian dental instruments, such as the diathermy devices for electrosugery and electric pulp testing may interfere with implaintable devices and must not be used.
Which tx option is this?
vagus nerve stimulation
-
goal of the ketogenic diet
induce fat metabolism and maintain ketosis
-
Does epilepsy produce oral changes
no
-
Effects of accidents during seizures
- scars of lips and tongue
- fx teeth
-
effects of antiantileptic meds
- gingival overgrowth/hyperplasia
- occurs in 25-50% of patients using phenytoin
-
Mechanism of Phenytoin
- may cause fibroblasts and osteoblasts to
- deposit excessive extracellular matrix, causing gingival overgrowth
-
Occurance of gingival overgrowth/hyperplasia
incidence is greater in younger patients than in older patients just beginning therapy
-
Effects of gingival overgrowth/hyperplasia
(5)
- Biofilm control issues,
- mastication,
- alter tooth eruption,
- speech interference,
- esthetics
-
Tissue characteristics of gingival overgrowth/hyperplasia
- Early clinical features
- Advanced Lesion
- severe Lesion
- Microscopic Appearance
-
Painless, enlargement of papillae,fibrotic, pink , stippled, and cauliflower-like appearance
Early clinical features
-
Increase in size, extends to marginal gingiva, cover most of anatomic crown, clefts between loblules
Advanced lesion
-
Large bulbous, covers enamel, wedges teeth apart, interferes with mastication
Severe lesion
-
Phenytoin present , fibroblasts and collagen increase, stratified squamous epithelium thick, long rete ridges,
inflammatory cells greatest at base of pockets
Microscopic appearance
-
Complicating factors
- Dental biofilm and gingivitis: Most important determinant of the severity of the gingival enlargement
- Contributing factors:
- Mouth breathing
- Defective restorations
- Large carious lesions
- Calculus
-
Treatment of gingival overgrowth/hyperplasia
- Change in drug prescription
- Nonsurgical treatment (scaling and chlorhexidine gluconate rinses)
- Surgical removal
-
Sugery for gingival enlargement are that is small less than 6 teeth with no atttachment or horizontal bone loss
adequate keratinized tissue
gingivectomy
-
gingival enlargement area is lareg greater than 6 teeth
osseous defects present
limited keratinized tissue
periodontal flap
-
other meds besides phenytoin that cause gingival enlargement
- ethosuximide
- valproic acid
- primidone
-
DH care plan
- Patient history
- Information to obtain
- Patient approach
-
Patient hx
physician is contacted if patient is unable to provide needed info, is noncompliant, if seizure activity has increased or changed, or if treatment fo repilepsy is impacting dental tx
-
Information to obtain
- basic: medical hx review, physician,, emergency contact
- additional factors: recent illness, stress, alcohol use, mestrual cycle, fatigue, or pain, general well-being
- tx: medications, surger, diet, effectiveness of seizure control tx, adherence to perscribed tx
- about the seizures: type, severity , duration, age at onset, precipitating factors or cause, frequency, description of prodrome, loss of consciousness, charcteristic motor movements, urinary/fecal incontinence, hx of injuries, confusion after
-
Patient Approach
calm reassuring atmosphere
-
Prior to/at start of phenytoin therapy
- a rigorous biofilm control program and
- complete scaling are introduced in
- preparation for phenytoin therapy
-
Initial appointment series for patient treated with phenytoin
- Slight/mild gingival overgrewth: nonsurgical tx, scaling, frequent maintenance appts
- Moderate gingival overgrowth: scaling, decide if further indication needed
- Severe fibrotic overgrowth: scaling and prepare for surgical pocket removal, plan for change drug or altering dose with physician
-
Maintenance appointment intervals
1-2-or 3 months
-
Care plan: prevention
- Daily biofilm removal
- Fluoride therapy
- Sealants
- Dietary counseling
-
Emergancy care Objectives
- Prevent body injury and accidents to
- the oral cavity
- Ensure adequate ventilation
-
differential diagnosis of seizure
- syncope
- migraine
- TIA
- CVA
- sleep disorder (narcolepsy)
- movement disorders such as dyskinesia
- overdose of local anesthetic
- hypoglycemia or insulin od
- hyperentilation
-
Preparation for appointment
- Have emergency materials easily
- accessible
- Remove dentures/partials
- Provide clam atmosphere
- Make other dental personal aware and
- available in case of emergency
-
Emergency care steps
- Terminate procedure – call for help
- Protect patient from injury
- Lower chair, raise feet
- Push aside sharp objects
- Loosen tight belt, collar, necktie
- Do NOT place anything between teeth
- Establish airway – place on side recovery postion
- Monitor vitals
- Stay with patient
- Check consciousness level
- Seizures occuring/reoccuring within 5 mins. Call EMS
-
Postictal phase
Complete record of emergency, allow to rest, patient privacy, check oral cavity for trauma, palliative care, contact someone to accompany patient
-
seizure lasting longer than 30 minutes
Must be transported to Emergency department
BLS and intravenous lorazepam or diazepam are given
Status epilepticus
|
|
