DH Seizure Disorders CH.62

Generalized seizures

1. Nonconvulsive - spasms involving some muscle group 2. Convulsive - generalized convulsions

DH treatment/education that can prevent or inhibit growth of gingival tissue taking medications that cause overgrowth.

1. OHI; through biofilm control (particularly prior to taking administration of phenytoin 2. Scaling and root planing 4. Identifying & recommending treatment of overhangs & defective restorations

Although most seizure disorders tend to be stable, some individuals experience a random pattern of seizure that disrupt their lives. List some activities that may be compromised for an individual who experienced recurrent seizures.

1. Occupational choices 2. Licensure (especially driving licenses) 3. Independent living status

What medications, in addition to phenyoin, are associated with gingival overgrowth?

1. Other anti-convulsants 2. Calcium channel blockers 3. Immunosuppressant Cyclosporine

Surgical interventions that are used to medically treat patients with seizure disorders

1. Resection 2. Multiple subpial transections 3. Gamma-knife radiosurgery 4. Vagus nerve stimulator implantation

A partial seizure involves only part of the brain. Clinical manifestations of a partial seizure.

1. Simple - involves no loss of consciousness 2. Complex - involves loss of consciousness Both involve a transient spell of cessation of activity with a possible manifestation of some movement of muscle groups

Partial seizure categories

1. Simple - no loss of consciousness 2. Complex - involves loss of consciousness 3. Secondarily generalized - evolving to loss of consciousness

Identify factors that can trigger a seizure in susceptible patient during dental hygiene treatment

1. Stress and apprehension 2. Fatigue 3. Sensory stimuli such as light & sound 4. Substance withdrawal

List of other medical conditions to consider if your patient is manifesting some clinical signs of a seizure (seizure disorder not indicated on history)

1. Syncope 2. Migraine headache 3. Transient ischemic attack 4. Stroke 5. Sleep disorder 6. Movement disorder with CP or MS 7. Local anesthetic overdose 8. Hypoglycemia or insulin overdose 9. Hyperventilation

What oral injuries are associated with generalized seizures?

1. Tongue and soft tissues injures 2. fractured teeth from chewing motions 3. possibility of trauma injuries to teeth, dentures or soft tissues from falling

In what three ways are epileptic syndromes classified?

1. Age of onset 2. Symptoms 3. Anatomic location in brain

What surgical options are available for treating phenytion-induced gingival hyperplasia?

1. Gingivectomy 2. Perio flap

If your patient has a history of seizures activity, when should you contact/consult with your patient's physicians?

1. If the patient is unable or unwilling to supply needed information 2. If seizure activity has changed or increased 3. If treatment has oral implicatios

If your patient does have a seizure during dental hygiene treatment, what emergency measures will you take to protect your patient from injury?

1. Lower dental chair; place in supine position 2. Move all movable objects 3. Loosen tight clothing 4. Stay by patient's side to maintain airway 5. monitor vitals 6. reassure the patient 7. do NOT place anything between teeth

A general seizure affects both sides of the brain at the same time. Clinical manifestation of an absence seizure.

A complete loss of consciousness that begins and ends abruptly in 5-30 seconds with a full return of consciousness & no awareness of the lapse; a blank stare, fixed posture, dropping of held objects & some rhythmic facial movements are characteristic features.

What is the etiology of a seizure?

Abnormal alteration of brain activity; sudden electrical discharge of neurons in the brain

Status epilepticus

One or more seizures continue, last more than 30 minutes; brain injury, long term disability or death result

Tonic-clonic seizure

This is the CLASSIC grand mal seizure with sudden, complete loss of consciousness, uncontrolled muscular contractions & other autonomic manifestations. The seizure can continue & progress to status epilepticus

What action should you take in the event

This patient is at risk for status epilepticus. 1. Call of help 2. activate the emergency medical system 3. be prepared to deliver basic life support

Which treatment for seizure disorders will require you to modify the use of some dental devices?

Vagus nerve stimulator implantation will require careful use of dental devices such as ultra-sonic, scalers, pulp testers, etc.