What is one of the most common neurologic disorders? It is synonymous with seizure disorder?
epilepsy
What is the goal of medications with seizure disorders?
to prevent recurrent seizures: question pt regarding daily compliance with anticonvulsant meds
What age groups does epilepsy most often effect?
children younger than 1
individuals older than 75
What condition is a symptom rather than a disease and is characterized by recurrent seizures or convulsions?
epilepsy
What is theorized to result from excessive nerve cell discharges within the brain; sudden disturbances in sensory or motor functions? Normal brain tissue has a balance between process of neuronal excitation and inhibition, and in this condition, balance is lost in favor of excitation?
seizure disorder: epilepsy
Are the following preventable/treatable or unpreventable causes of epilepsy?
trauma and sphyxia
infectious disease, fever
complications of pregnancy
toxicity, alcohol, drugs
metabolic, endocrine, and nutritional disorders
preventable/treatable
Are the following preventable/treatable or unpreventable causes of epilepsy?
genetic factors
postvaccination effects
tumors
degenerative disorders
circulatory disturbances
unpreventable
What are the 2 different classifications of seizures?
focal or partial
general seizures
The following seizures are partial or general?
motor sensory: somatic, visual, auditory, olfactory
psychomotor: automatism, psychical
focal or partial seizures
The following seizures are partial or general?
Tonic-clonic convulsion (grand mal)
Absence (petit mal): simple with minor motor accompaniment, with automatism, continuing or status
Myoclonic: jerks, atonic
general seizures
Focal or partial siezures are classified into what 3 different types?
simple
complex
partial
How are the different types of focal or partial seizures distinguished? And how might the practitioner be able to predict treatment modifications for seizures?
by effects of the seizures that develop
based on the sings and symptoms that pt describes about their seizures
Which type of partial seizure is a local discrete spread of excitation that does not become generalized? And what is a specific name for one of these types of seizures?
simple partial
Jacksonian motor seizure
What type of seizure is limited to a specific area of the brain effecting certain limbs or certain muscle group, or localized to specific sensory disturbances?
Jacksonian motor epilepsy
Jacksonian sensory epilepsy
Which type of focal or partial seizure causes an altered state of consciousness; simiple seizure may evolve to affect a greater area of the brain, a sensory aura is often followed by impaired consciousness and it is treated by meds or surgical procedures?
complex partial seizures
true or false. surgical procedures often cure complex partial seizures.
true
Which type of focal or partial seizures produce asymmetric tonic-clonic movments? The person may remain conscious but have twitching?
partial seizure and secondary generalized seizure
true or false. the most common populations affected by seizures are children younger than 1. Vascular diseases increase the prevalence of epilepsy in the aging population.
both are true
Which type of seizures involve both hemispheres of the brain?
generalized seizures
What are the 3 different categories of generalized seizures?
tonic-clonic
myoclonic
absence
What is the difference in drug tx between generalized and focal or partial seizures?
generalized seizures are treate with a drug specific for the seizure type; focal seizures can all be treated with similar drugs
which type of generalized seizure presents the most difficult seizure management in the dental office?
tonic-clonic form
Which type of generalized seizure is characterized by unconsciousness and rhythmic jerking; nystagmus, and can involve the entire body? An aura may alert the client of impending attack before loss of consciousness; spasms in the diaphragma muscle forces air out of the lungs resulting in an epileptic "cry"?
tonic-clonic seizure (grand mal)
Which phase of the tonic clonic (grand mal) seizure is when the body stiffens for 10-20 seconds resulting in an arched position?
tonic phase
Which phase of the tonic clonic (grand mal) seizure is when alternating contraction and relaxation of all muscles occur?
clonic phase
How long do tonic clonic (grand mal) seizures usually last?
2-5 minutes
What are 2 characteristics of postseizure depression of motor and sensory function that occurs after a person has experienced a tonic clonic (grand mal) seizure?
pt may sleep for hours
the decision needs to be made whether to take pt home or to call EMS
What are 2 oral signs of tonic clonic (grand mal) seizures?
scars invloving lips and tongue
broken or fractured teeth
true or false. The clinician must have a certificate in basic life support to help manage seizures in the dental office
true
In the management of seizure disorders in the dental office, what is a protocol for responsibilities of dental team members to manage the situation referring to?
someone to call EMS, someone to get BSL equipment, someone to stay w/pt etc
The procedure for management of seizure events in the dental office includes what 8 steps?
instruments and devices removed from oral cavity
place pt in supine position
move bracket tray and equipment out of the way
if time allows move pt to clear area of the floor
pt should have seizure without intervention: place nothing in mouth
BLS adequate for most seizures
if seizure lasts longer than 5 minutes: call EMS and provide oxygen
EMS provides IV for benzodizepine
Which type of generalized seizure is characterized by rhythmic body jerks without loss of consciousness, and sudden involuntary, excessive movements that last a few seconds; the pt is often aware of the seizure and it is commonly inherited?
myoclonic seizure
do myoclonic seizures involve management of the situation during DH appointment?
no
Which type of generalized seizure is characterized by brief periods of impaired consciousness and cessation of activity, but no loss of consciousness? They often present with motor manifestations (twitching eye), pt loses mental awareness of immediate surroundings and stares into space?
absence seizure (petit mal)
When is it most common for absence (petit mal) seizures to occur?
common in prepubertal years and may resolve as the child reaches adulthood
Which type of seizure can result from any type of seizure that does not resolve and continues into multiple seizures? It is an emergency situation and requires immediate intervention and is defined as a seizure lasting longer than 30 minutes?
status epilepticus
What form of status epilepticus is the most dangerous form? for what reason? And how is it treated?
tonic clonic
inhibits respiration causing hypoxia - permanent effects or death
treated with benzodiazepines
What is the major cause of status epilepticus in children?
infection resulting in high fever
What are 3 acute causes of status epilepticus in adults?
stroke
hypoxia
alcohol intoxication and withdrawal
If a pt is taking many numerous different anticonvulsant drugs, what does it indicate?
the epilepsy is poorly controlled and they are at a higher risk for status epilepticus
Successful treatment of epilepsy is to determine and resolve what?
the underlying cause of the attack
often surgical therapy is effective
What is the goal of treatment for pts with recurrent seizure disorders?
control or prevent seizures with: anticonvulsant meds
they come in elixir, tablets, and capsules
What is a major reason for recurrence of seizures in pts taking medication for seizures?
noncompliance in taking the medication
What drug is the prototype for the anticonvulsant drug class? And it is approved for tonic-clonic and partial seizures
phenytoin (Dilantin)
What drug may increase effects and toxicity of phenytoin (Dilantin)?
aspirin
Which type of anticonvulsant drug is also effective in the treatment of myotonia and cardiac arrhythmias?
phenytoin (dilantin)
The following are ADE's for which anticonvulsant agent?
gingivival hyperplasia: in 50% of those taking it
coarsening of the facial features and hirsutism
serum folic acid and vitamin K concentration is depressed
hypersensitivity reactions
long-term therapy: may result in loss of bone mineral density
may interfere with cognitive function
phenytoin (dilantin)
What aer 3 dental hygiene management considerations for the pt taking the anticonvulsant phenytoin (dilantin)?
chronic xerostomia: use of home fl2
poor plaque control may increase hyperplasia: give pt effective plaque removal instructions which may help reduce time for them to enlarge
3-month maintenance interval is recommended
which type of anticonvulsant drug is structurally related to pheytoin (dilantin) and has a similar mechanism of action? And what is it recommended for tx for?
carbamazepine: tegretol
treatment for: tonic-clonic and partial seizures
Which type of anticonvulsant agent is used for treatment of trigeminal neuralgia?
carbamazepine (tegretol)
What are 8 adverse reactions with the use of the anticonvulsant agent carbamazepine (tegretol)?
drowsiness
diplopia
ataxia
thrombocytopenia
blood dyscrasia
cardiac toxicity
hepatitis
stevens-johnson syndrome
List 2 dental hygiene management considerations for the pt taking carbamazepine (tegretol).
question pt regarding bleeding tendency and recent infection: examine oral cavity for effects
chewable tablets of the drug contain sugar: increase risk for caries; recommend home fl2 and sealants
What are 3 dental drug interactions with the use of the anticonvulsant agent carbamazepine (tegretol)
decrease effect of doxycycline
effects may be increased by erythromycin and propoxyphene
dentist warnings should be included in pt info
Which type of anticonvulsant drug is used to treat tonic-clonic and partial seizures; it is the prototype in this group of drugs used for anticonvulsant effects; and is often used in combination with phenytoin?
phenobarbital (Luminal)
What are 3 ADEs with the use of the anticonvulsant agent phenobarbital (Luminal)?
relatively safe
some pts may experience pronounced sedation reduced activity, and cognitive impairment
skin reactions: are rare but cases of stevens-johnson have been noted
What type of anticonvulsant agent is a nonbarbiturate compound that is structurally and functionally related to phenobarbital and is effective for the same types of seizures?
primidone (mysoline)
What are 6 ADEs with the use of the anticonvulsant primidone (mysoline)?
sedation
vertigo
nausea
ataxia
disturbances in behavior
difficulty in concentration
What is an anticonvulsant agent that is not structurally related to other anticonvulsants? It is used in the treatment of absence seizures; but has also proven to prevent tonic clonic and myoclonic seizures?
valproate (valproic acid)
valproic acid, valprate sodium, and divalproex sodium are all examples of what type of anticonvulsant drug?
valproate
What are 5 ADEs with the use of the anticonvulsant drug valproate?
nausea
vomiting
sedation
inhibits platelet aggregation
can prolong bleeding: determine bleeding time, and use other drugs that influence bleeding with caution
What type of anticonvulsant agent is in the benzodiazepine class; used for myclonic and absence seizures that are resistant to other treatment; and adverse effects include drowsiness, ataxia, and behavioral disorders?
clonazepam
Which type of anticonvulsant agent is used in the treatment of uncomplicated absence seizures? And adverse reactions include nausea, vomiting, headaches, drowsiness, eosinophilia, and leukoplenia?
ethosuximide (Zarontin)
The drug of choice in the treatment of absence (petit mal) seizures is what?
Ethosuximide
What is an alternative anticonvulsant drug for tonic-clonic seizures?
phenobarbital
What are the 3 drugs of choice for focal and tonic-clonic seizures?
phenytoin
carbamazepine
What is an alternative drug for the treatment of absence and myclonic seizures?
clonazepam
Which anticonvulsant agent is used as adjunctive therapy in partial and generalized seizures; also used in postherpetic neuralgia? common side effects include stevens-johnson syndrome, and there are no documented drug-drug interactions?
Gabapentin
What is an anticonvulsant agent that is used in the treatment for refractory partial and tonic-clonic seizures? common side effects include: photosensitivity, dizziness, abnormal gait, and GI irritation; and severe ADEs include: aplastic anemia, hepatic failure, and stevens johnson syndrome?
felbamate
Which anticonvulsant agent is used in the treatment of refractory complex partial seizures and is also approved for treatment of bipolar disorder? common ADEs include dizziness, ataxia, comnolence, headache, diplopia, nausea and vomiting, and there are no drug-drug interactions?
lamotrigine
true or false. Pts with chronic pain do not respond to conventional analgesic therapy.
true
List 7 agents that have been used to relieve neuropathic pain associated with diabetic neuropathy and trigeminal glossopharyngeal, and postherpetic neralgia.
carbanazepine
clonazepam
valproic acid
gabapentin
lamotrigine
topiramate
phenytoin
What type of drug may be prescribed for pts taking anticonvulsants for seizures to combat risk for osteopeorosis?
bisphosphonates
If the pt has been free of seizures for ______- the physician may reduce or withdraw therapy.
2 years
true or false. Most elderly pts will take anticonvulsant meds for the rest of their life.
true
What question might be asked to determine the risk for status epilepticus?
