DH 1 Test #2 seizures case study
a seizure is a result of what?
Results from a transient, uncontrolled alteration in brain function
preictal
Soon after the aura, the person will loss consciousness and may fall.
what symptoms can be mistaken for seizures?
Syncope Migraine headache Transient ischemic attack CVA Narcolepsy Movement disorders (cerebral palsy) Over dose of local anesthetic Insulin shock Hyperventilation
seizures treatment: ketogenic diet
To reduce fat metabolism and maintain ketosis, patient first fasts which induces fat metabolism and slowly food is reintroduced Effective particularly in children
patient with traumatic brain injury: oral hygiene management
Utilization of a laminated chart, which should show pictures of brushing, flossing and use of the recommended oral rinse. The visual cue can aid the patient in remembering how to accomplish proper oral hygiene.
seizure
a paroxysmal event that results from abnormal brain activity Sudden electrical discharge of neurons in the brain
generalized seizures: Absence (petite mal): loss of consciousness beings & ends in how long?
abruptly in about 5-30 seconds
seizure patient: gingival hyperplasia: in severe situations, the _______ grow enough to wedge the teeth apart & interfere w/ chewing
lobules
an aura may be
-A special sensory stimulus -A sensation of numbness -Tingling or a twitching Stiffness of certain muscles
seizure patient: gingival hyperplasia: oral findings: location?
-Anterior gingiva are usually more affected than posterior -Maxillary more than mandibular -Facial and proximal areas more than lingual and palatal -Can occur around implants
generalized seizures: Tonic-Clonic (grandmal): 4 phases
-Aura or prodromal phase -Preictal - Soon after the aura, the person will loss consciousness and may fall. -Ictal - pertaining to or resulting from a seizure (ex: tonic-clonic phase) -Postictal - after movements have stopped, patient remains unconscious.
simple partial seizure
-Cessation of ongoing activity -Staring spell -Dizziness -Jerking of muscles around the mouth -No loss of consciousness - does not affect awareness or memory
secondary seizures
-Congenital conditions such as maternal infection (rubella), toxemia during pregnancy -Perinatal injuries -Brain tumor -Cerebrovascular disease (stroke) -Head trauma -Infections such as meningitis, encephalitis -Degenerative brain disease -Metabolic and toxic disorders such as alcoholism, drug abuse -Complication of cancer *Accounts for 35% of seizure disorders*
primary seizures
-Genetic predisposition to seizures or to other neurologic abnormalities for which seizures may be a symptom *Comprises about 65% of seizure disorders*
aura
-Occurs prior to a seizure -Patient has slight warning a seizure is about to occur and they can move to a safe place and/or warn others
seizure patient: gingival hyperplasia: tissue characteristics
-Painless enlargement of interdental papillae with signs of inflammation -Eventually becomes fibrotic -Pink and stippled with a mulberry or cauliflower like appearance
generalized seizures: absence (petite mal) symptoms to looks for
-Patient has blank stare or absence spells -Usually does not fall, stop walking and start again after a few seconds, may drop whatever is being held -May become pale -May have rhythmic twitching of eyelids, eyebrows, head, or chewing movements -Patient quickly returns to activity unaware of what has occurred, wide awake and clearly thinking
seizures treatment: drug therapy: herbal supplements
-Patients need to inform their doctor if they are taking herbal supplements in addition to their prescribed drugs -It can interfere with prescribe medication and cause complications -Dental concerns: herbal supplements (ex: ginkgo biloba, St. John's wart, some essential oils) can increase in bleeding
seizure patient: gingival hyperplasia: effects
-Poses dental biofilm control problem -May affect mastication -Tooth eruption -Interfere with speech -Cause esthetic concerns
precipitating factors of seizures
-Psychological stress -Apprehension -Sensory stimuli such as flashing lights -Noises -Peculiar odors -Alcohol or other substance use or withdrawal
seizures treatment: surgery
-Resection of the epileptogenic area in the brain. -Gamma-knife radiosurgery- radiation to the epileptogenic area in the brain -Vagus nerve stimulation- utilizes a pacemaker-like device to deliver signals to the Vagus nerve.
generalized seizures: Tonic-Clonic (grandmal): symptoms
-Skin color is pale -Loss of bladder -Tongue may be bitten -Saliva may appears as foam because it mixed with air -Patient begins to recover, may be confused, complain of muscle soreness, sleepy
effects of accidents during seizures
-Tongue, lips or cheeks bitten -Scars may be observed -Fractured teeth - some may require endodontic treatment or removal, sharp edges can irritate soft tissues
complex partial seizure
-Trance like state with confusion -Involves impairment of consciousness -May manifest purposeless movements (lip smacking, grimacing, patting), followed by confusion, incoherent speech, ill humor, unpleasant temper
seizure patient: care plan: appt intervals
1-3 months depending on severity of the gingival overgrowth & the ability & motivation of the patient to maintain oral health
traumatic brain injury: incidence
2 million every year in the US
traumatic brain injury: ____% will require hospitalization
25%
how many people in the US have seizure disorder?
3.4 million
What % of seizures are secondary?
35%
traumatic brain injury: is the ____ leading cause of death in the US
3rd
traumatic brain injury: most common cause of brain damage in persons under ______
40
if seizure lasts for ____min, call 911
5
what % of seizures are primary?
65%
traumatic brain injury: ____-____% will experience a sigificant permanent disability & 2000 will remain in a vegetative state
70-90%
traumatic brain injury
A closed head injury or a penetration injury involving the skull and brain
generalized seizure
Affects the entire brain at the same time
seizure syndromes have been classified by:
Age-related onset Symptoms Anatomic localization in the brain
traumatic brain injury: victims with this may exhibit
Aggression Altered consciousness Memory loss Anxiety Apathy Attention deficits Mood disorders Depression Difficulty with routine activities Irritability Impulsiveness Psychotic disorders
seizure patient: gingival hyperplasia mechanism
Phenytoin causes fibroblasts and osteoblasts to deposit excessive extracellular matrix causing gingival overgrowth
seizures treatment: drug therapy side effects
Rash Fatigue Drowsiness Nausea Memory loss Damage to liver Gingival enlargement Increased risk of birth defects
seizure patient: what is given by emergency professionals?
Basic life support (CPR) and IV diazepam or lorazepam
possible causes of traumatic brain injury:
Bicycle accident Blunt trauma to the head Diving accident Injury due to excessive alcohol use Motor vehicle accident Physical abuse
traumatic brain injury: secondary injury
Can decrease blood flow to the brain and are the physiological and metabolic abnormalities that result from the injury
seizure patient: gingival hyperplasia: treatment
Change drug if possible Nonsurgical treatment Surgical removal removal of excess gingival tissue
diagnosis of seizures
Clinical signs and symptoms History EEG Functional neuroimaging
seizure patient: gingival hyperplasia: complicating factors
Dental biofilm and gingivitis Most important determinant of the severity of the enlargement is biofilm
seizure patient: postictal phase
Document emergency, allow patient to rest, talk in a low reassuring voice Remove on-lookers Check oral cavity for trauma to teeth or tissues Contact family or friend if requested
seizure patient: patient approach
Provide a calm reassuring atmosphere and treat with patience and empathy Be aware of possible side effects of meds
seizure patient: emergency care: prep for appt
Emergency materials should be in a specific place Have patient remove dentures for length of appointment Provide a calm, reassuring atmosphere Have other dental personnel available in case of an emergency - stamp medical alert
seizure patient: differential diagnosis of medicines causing overgrowth
Ethosuximide Valproic acid Primidone
traumatic brain injury: injury location
Frontal and temporal lobes are especially vulnerable to damage from a TBI
types of seizures
Generalized Focal Idiopathic
seizure patient: gingival hyperplasia: occurence
Greater in younger patients May start within a few weeks or few years of beginning drug Size and length of dose does NOT seem to have an affect
seizure patient: patient history
If seizure activity has increased or changed or patient is unable to provide adequate information then their doctor may need to be consulted
seizure prognosis
If seizure control is good- approximately 75% of the patients become seizure free
seizure patient: gingival hyperplasia: what makes it worse?
Local irritants such as biofilm or ill fitting appliances make response more excessive
recovery of traumatic brain injury:
Majority of recovery occurs in the first 6 months following injury After first 6 months, recovery progresses at a slower rate, may take up to several years Support from spouse or caregiver is crucial
patient with traumatic brain injury: diet counseling
Many medications have xerostomic side effects. Advise patient to drink water, utilize saliva substitutes, chew sugarless gum/mints, rinse daily with fluoride rinses, avoid beverages with high sugar content, discontinue use of mouthrinse containing alcohol
seizure begins with abrupt onset of symptoms that may be...
Motor Sensory Cognitive Emotional
seizure patient: gingival hyperplasia: contributing factors
Mouthbreathing Overhanging and defective restorations Large carious lesions Calculus Biofilm retentive factors
Is seizures or epilepsy considered a mental disorder?
No, A seizure is not a disease but a symptom of underlying central nervous system dysfunction.
seizure patient: status epilepticus
One or more seizures that lasts longer than 30 minutes Brain injury can occur and result in long term morbidity or death
seizure implications
People may choose to be restricted or legally be restricted from doing some things Ex: Operating machinery, driving, independent living
traumatic brain injury signs & symptoms
Personality changes Seizures Language deficiencies Insensitivity Post traumatic stress disorder Obsessive/compulsive disorder Pathological laughing/crying Slow selection response
seizure patient: objectives of emergency care
To prevent body injury and accidents related to oral structures such as tongue bite, broken or dislocated jaw, broken or dislocated teeth, broken appliances, ensure adequate ventilation
generalized seizures: Absence (petite mal): might lead to what?
learning difficulties if not identified
Bill, a 30 year-old patient, presents to the office for a routine dental hygiene therapy. Bill has always reported that he has had seizures. This visit he indicates that he has been having a seizure about once a week. Since his seizures have been happening more frequently, his doctor has put him on phenytoin. The dental hygienist asks Bill about his seizures and he states that he usually notice is very strong smells before his seizures. His seizures usually last about 10 seconds, he loses consciousness, and usually his eyelids twitch.he comes out of it quickly and usually does not remember what has happened. During the intro oral exam the dental hygienist notes that the gingiva and the upper anterior interdental area is enlarged and a somewhat fibrotic. Bill says he has noticed it but it is not painful. What type of seizures doe Bill describe?
absence
Bill, a 30 year-old patient, presents to the office for a routine dental hygiene therapy. Bill has always reported that he has had seizures. This visit he indicates that he has been having a seizure about once a week. Since his seizures have been happening more frequently, his doctor has put him on phenytoin. The dental hygienist asks Bill about his seizures and he states that he usually notice is very strong smells before his seizures. His seizures usually last about 10 seconds, he loses consciousness, and usually his eyelids twitch.he comes out of it quickly and usually does not remember what has happened. During the intro oral exam the dental hygienist notes that the gingiva and the upper anterior interdental area is enlarged and a somewhat fibrotic. Bill says he has noticed it but it is not painful. all of the following medications can cause gingival enlargement except: A. Valproic acid B. Calcium channel blockers C. Cyclosporin D. Acetaminophen
acetaminophen
Postictal
after movements have stopped, patient remains unconscious
Bill, a 30 year-old patient, presents to the office for a routine dental hygiene therapy. Bill has always reported that he has had seizures. This visit he indicates that he has been having a seizure about once a week. Since his seizures have been happening more frequently, his doctor has put him on phenytoin. The dental hygienist asks Bill about his seizures and he states that he usually notice is very strong smells before his seizures. His seizures usually last about 10 seconds, he loses consciousness, and usually his eyelids twitch.he comes out of it quickly and usually does not remember what has happened. During the intro oral exam the dental hygienist notes that the gingiva and the upper anterior interdental area is enlarged and a somewhat fibrotic. Bill says he has noticed it but it is not painful. What determines the severity of phenytoin-induced gingival enlargement?
amount of biofilm
CASE STUDY: Bill, a 30 year-old patient, presents to the office for a routine dental hygiene therapy. Bill has always reported that he has had seizures. This visit he indicates that he has been having a seizure about once a week. Since his seizures have been happening more frequently, his doctor has put him on phenytoin. The dental hygienist asks Bill about his seizures and he states that he usually notice is very strong smells before his seizures. His seizures usually last about 10 seconds, he loses consciousness, and usually his eyelids twitch.he comes out of it quickly and usually does not remember what has happened. During the intro oral exam the dental hygienist notes that the gingiva and the upper anterior interdental area is enlarged and a somewhat fibrotic. Bill says he has noticed it but it is not painful. The strange smells Bill notices before his seizures are called:
aura
generalized seizures: Absence (petite mal): most common in who?
children
seizures can be a symptom of many different ________
conditions
generalized seizures: Tonic-Clonic (grandmal): tonic phase
continuous tense rigidity
other names for seizure
convulsions, fit, spell or ictus
seizure patient: care plan: prevention
daily biofilm removal, fluoride therapy, pit and fissure sealants and dietary control can play a vital role in the prevention or control of oral disease
unknown seizure
don't know cause don't know if generalized or local
seizures treatment
drug therapy surgery ketogenic diet
Bill, a 30 year-old patient, presents to the office for a routine dental hygiene therapy. Bill has always reported that he has had seizures. This visit he indicates that he has been having a seizure about once a week. Since his seizures have been happening more frequently, his doctor has put him on phenytoin. The dental hygienist asks Bill about his seizures and he states that he usually notice is very strong smells before his seizures. His seizures usually last about 10 seconds, he loses consciousness, and usually his eyelids twitch.he comes out of it quickly and usually does not remember what has happened. During the intro oral exam the dental hygienist notes that the gingiva and the upper anterior interdental area is enlarged and a somewhat fibrotic. Bill says he has noticed it but it is not painful. gingival hyperplasia is caused by:
fibroblasts & osteoblasts depositing excessive extracellular matrix
seizure patient: what to use to remove vomit?
high speed suction
traumatic brain injury: primary injury
injuries sustained upon impact
seizure patient: care plan: instrumentation
instruct and motivate to adhere to biofilm control procedures
generalized seizures: Tonic-Clonic (grandmal): clonic phase
intermittent contraction & relaxation
a seizure is usually unprovoked, unpredictable and __________
involuntary
focal seizure
involves only a part of the brain (more common in adults)
generalized seizures: absence (petite mal): often mistaken for what?
lack of attention or other misbehavior
seizure patient: gingival overgrowth/gingival hyperplasia
occurs in 25-50% of those using phenytoin for treatment AKA: dilantin hyperplasia
focal seizure is AKA?
partial seizure
generalized seizures: Tonic-Clonic (grandmal): how long loss of consciousness?
patient stiffens & falls out of dental chair lasts 1-3 min
seizure patient: care plan: before phenytoin therapy
perform deposit removal and biofilm removal education
Ictal
pertaining to or resulting from a seizure (ex: tonic-clonic phase)
seizures are divided into _________ & __________ causes
primary ; secondary
Gamma-knife radiosurgery
radiation to the epileptogenic area in the brain
epilepsy is characterized by
recurrent seizures
seizure patient: emergency care: if pt warns you or seizure begins, then what?
stop procedure and call for assistance Do not attempt to stop convulsion or restrain patient Protect patient from injury, lower chair, tilt to supine to keep patient from falling out of chair Move objects out of the way- ADEC cart, cabinet stools, etc. Do not force anything between their teeth Establish airway - check for breathing Place on side when seizure is over
seizure patient: emergency care: emergency procedure
the dental team should be assigned responsibilities prior to an emergency.
generalized seizures: Absence (petite mal): may progress to what?
tonic-clonic seizure
the length of a seizure is ___________
uncontrollable
generalized seizures: Absence (petite mal) recurrence?
up to 100 times a day
Vagus nerve stimulation
utilizes a pacemaker-like device to deliver signals to the Vagus nerve.
