contemp II epilepsy an seizures

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contemp II epilepsy an seizures
2011-03-04 17:09:19
contemp II

contemp II
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  1. a sudden paroxysmal electrical
    discharge of neurons in the brain
    Seizure definition
  2. Classification of seizures
    • Age of onset
    • Symptoms
    • Anatomic location in brain
  3. Types of seizures
    • Generalized – affects entire brain at the
    • same time
    • Partial – involves only a part of the brain
  4. Etiology of Seizures
    • Primary: (idiopathic) Genetic predisposition
    • Secondary: (symptomatic) Congenital conditions
  5. genetic predisposition to seizures or to other neurologic abnormalieties for which seizure may be a symptom
    Primary (Idiopathic)
  6. sezures can arise during many neurologic and nonneurologic medical condition
    secondary (symptomatic)
  7. 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)
  8. other names for a seizure
    • clonvulsion
    • fit
    • spell
    • ictus
  9. Prognosis for seizure control
    good 75% become seizure free
  10. do seizures worsen over time?
  11. Seizure patients avoid three activities
    • Certain vocations
    • Licenses
    • Independent living
  12. 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
  13. Special sensory stimulus, a sensation of numbness, tingling, or twitching or stiffness of certain muscles (warning sign)
  14. International classification of seizures
    • Partial seizures (beginning locally): simple and complex
    • Partial seizures evolving to generalized tonic-clonic convulsions
    • generalized seizures: nonconvulsive and convulsive
  15. without loss of consciousness
    simple partial seizures
  16. 4 indications of simple partial seizures
    • motor signs
    • autonomic symptoms
    • psychic problems
    • somatosensory or special sensory symptoms
  17. same as simple partial seizures, but with loss of consciousnes
    complex partial seizures
  18. which are more common: generalized or partial
  19. petite mal
  20. types of nonconvulsive seizures
    • absence seizures
    • atypical absence sweizures
    • myoclonic seizures
    • atonic seizures
  21. grand mal seizures
    convulsive seizures
  22. types of convulsive seizures
    • tonic-clonic
    • tonic
    • clonic
  23. length of nonconvulsive (petite mal)
    5-30 sec
  24. length of convulsive seizures
    1-30 min
  25. Partial Simple (5)
    • Cessation of ongoing activity,
    • staring spell,
    • dizziness,
    • jerking of muscles around the mouth,
    • no loss of consciousness 
  26. Partial Complex (7)
    • Trance-like state,
    • consciousness impaired,
    • purposeless movements with confusion, incoherent speech,
    • ill humor,
    • temper,
    • doesn’t remember what happened during attack
  27. Absence (petite mal) seizure
    • Begins and Ends abruptly 5-30secs.
    • Most common in children
    • Patient returns to full awareness
    • Unaware of what occured
  28. 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
  29. side effect of phenytoin
    gingival enlargement
  30. 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
  31. who forgets to take meds
  32. more sensitive to side effects of weakness, unsteadiness, and cognative alterations
    elderly and children
  33. Problems with herbal supplements
    • may interfere with perscription drugs
    • may incease bleeding
  34. Surgery and other options
    • Resection
    • Gamma-knife radiosurgery
    • Vagus nerve stimulation
    • Ketogenic diet
  35. 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
  36. goal of the ketogenic diet
    induce fat metabolism and maintain ketosis
  37. Does epilepsy produce oral changes
  38. Effects of accidents during seizures
    • scars of lips and tongue
    • fx teeth
  39. effects of antiantileptic meds
    • gingival overgrowth/hyperplasia
    • occurs in 25-50% of patients using phenytoin
  40. Mechanism of Phenytoin
    • may cause fibroblasts and osteoblasts to
    • deposit excessive extracellular matrix, causing gingival overgrowth
  41. Occurance of gingival overgrowth/hyperplasia
    incidence is greater in younger patients than in older patients just beginning therapy
  42. Effects of gingival overgrowth/hyperplasia
    • Biofilm control issues,
    • mastication,
    • alter tooth eruption,
    • speech interference,
    • esthetics
  43. Tissue characteristics of gingival overgrowth/hyperplasia
    • Early clinical features
    • Advanced Lesion
    • severe Lesion
    • Microscopic Appearance
  44. Painless, enlargement of papillae,fibrotic, pink , stippled, and cauliflower-like appearance
    Early clinical features
  45. Increase in size, extends to marginal gingiva, cover most of anatomic crown, clefts between loblules
    Advanced lesion
  46. Large bulbous, covers enamel, wedges teeth apart, interferes with mastication
    Severe lesion
  47. Phenytoin present , fibroblasts and collagen increase, stratified squamous epithelium thick, long rete ridges,
    inflammatory cells greatest at base of pockets
    Microscopic appearance
  48. 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
  49. Treatment of gingival overgrowth/hyperplasia
    • Change in drug prescription
    • Nonsurgical treatment (scaling and chlorhexidine gluconate rinses)
    • Surgical removal
  50. Sugery for gingival enlargement are that is small less than 6 teeth with no atttachment or horizontal bone loss
    adequate keratinized tissue
  51. gingival enlargement area is lareg greater than 6 teeth
    osseous defects present
    limited keratinized tissue
    periodontal flap
  52. other meds besides phenytoin that cause gingival enlargement
    • ethosuximide
    • valproic acid
    • primidone
  53. DH care plan
    • Patient history
    • Information to obtain
    • Patient approach
  54. 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
  55. 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
  56. Patient Approach
    calm reassuring atmosphere
  57. Prior to/at start of phenytoin therapy
    • a rigorous biofilm control program and
    • complete scaling are introduced in
    • preparation for phenytoin therapy
  58. 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
  59. Maintenance appointment intervals
    1-2-or 3 months
  60. Care plan: prevention
    • Daily biofilm removal
    • Fluoride therapy
    • Sealants
    • Dietary counseling
  61. Emergancy care Objectives
    • Prevent body injury and accidents to
    • the oral cavity
    • Ensure adequate ventilation
  62. 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
  63. 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
  64. 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
  65. Postictal phase
    Complete record of emergency, allow to rest, patient privacy, check oral cavity for trauma, palliative care, contact someone to accompany patient
  66. seizure lasting longer than 30 minutes
    Must be transported to Emergency department
    BLS and intravenous lorazepam or diazepam are given
    Status epilepticus