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  • The term "epilepsy" is not a specific diagnosis.  It is a term that refers to a group of disorders characterized by chronic and recurrent, paroxysmal changes in neurologic function (seizures), altered consciousness, or involuntary movements caused by abnormal and spontaneous electrical activity in the brain.

  •  Seizures may be convulsive or other changes in neurologic function.  

  • Although seizures are required for the diagnosis of epilepsy, not all seizures imply presence of epilepsy.  Epilepsy can be idiopathic/primary (50%) or secondary/symptomatic.

 

Secondary epilepsy can be related to:

  • Neoplasm

  • Infection

  • Vascular (stroke, migraine, hemorrhage)

  • Perinatal

  • Traumatic

  • Degenerative (Alzheimer's disease)

  • Immunologic (multiple sclerosis)

  • Developmental (cavernous malformation)

 

Causes of seizures NOT associated with epilepsy:

  • stress

  • sleep deprivation

  • fever

  • alcohol or drug withdrawal

  • syncope - diminished oxygen to the brain

 

Conditions known to evoke seizures

  • Flickering lights

  • Monotonous sounds

  • Music or other loud noise

 

Types of seizures

There are many types of seizures, with many different types of manifestations.  Be sure to ask the patient not only what type of seizure they have, but more importantly, how the seizures manifests.  

 

Seizure Disorder - Epilepsy

Introduction

Risks to the dental patient

Management During Treatment

  • Occurence of generalized tonic-clonic seizure in dental office which may cause injury to patient

  • Increased bleeding if patient is taking valproic acid or carbamazepine (interferes with platelets)

Questions to Ask 

  • The degree of control is determined by the patient and physician, depending on the type and degree of medication side effects.  The patient may be willing to have a seizure rather than have certain side effects.

  • Ideal control is for the patient to have few to no seizures, with medication side affects that are manageable for the patient

  • The patient is uncontrolled if the patient is not compliant with their medications or if he/she has more seizures than in the past

Controlled vs. Uncontrolled

  • The patient has an increase in seizures or their severity

  • The patient is having more than 1-2 seizures a year

  • Poorly controlled patients may need to have an increase in medication dosage in order to have dental treatment, or have sedation, as recommended by the physician.

Clinical Findings 

  • Drug-induced gingival overgrowth that affects periodontal health with dilantin

Prevention 

  • Maintain optimal oral hygeine

  • Surgical reduction of gingival overgrowth, if indicated

  • Replace missing teeth with fixed prosthesis as opposed to removable

  • Fixed partial dentures should be metal whenever possible

  • All-porcelain crowns or fixed partial dentures should be avoided, and metal should be placed in functional and parafunctional areas to minimize fracture.

  • If removable is necessary, metallic palates and bases should be used, or acrylic should be reinforced with wire mesh

  • No more than 2 cartridges local anesthesia with 1:100,000 epinephrine

  • Signs of impending seizure

    • An aura (a momentary sensory alteration leading to an unusual smell or visual disturbance) preceds the seizure in one third of patients.

    • Irritability

  • Use mouth prop whenever possible, with floss attached

  • Protect patient during seizure

    • Activate EMS

    • Clear the area

    • Roll patient on his/her side to prevent aspiration

    • Do not try to place tongue blade between patient' teeth unless patient is aware of oncoming seizure and can place him/herself

    • Passively restrain (keep patient from danger, but don't hold the patient down)

  • After the seizure

    • Manage airway if patient is unconscious

    • Examine for traumatic injuries

    • Discontinue treatment

References

Dental Management of the Medically Compromised Patient.  Little, Falace, Miller and Rhodus. 8th Edition

Medical Consultation Recommended 

  • Type of seizure - there are many types of seizures and characteristics are different for each patient

  • Age at onset

  • Cause of seizures

  • Medications 

  • Did the patient take their medications today?  Does the patient take the medications as directed?

  • Regularity of physician visits

  • Is the patient anxious or fearful of dental procedures?

  • Degree of control

  • Type of manifestations - ask the patient what happens during the seizure

  • Any signs of impending seizure (aura)

  • Frequency of seizures, last seizure

  • Precipitating factors

  • History of seizure-related injuries

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