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Chapter 5- Seizure Disorders
1.
©2013 Delmar, Cengage
Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Seizure Disorders Chapter 5
2.
©2013 Delmar, Cengage
Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Objectives • Upon completion of this chapter, you will be able to: – Define epilepsy – Explain some of the causes of epilepsy – Describe what takes place during a grand mal seizure – Define an absence seizure – Define a partial seizure 2
3.
©2013 Delmar, Cengage
Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Objectives (cont’d.) – Describe status epilepticus – Explain the treatment of an epileptic seizure – Describe some possible dental implications of epilepsy – Explain how some epileptic seizures may be prevented 3
4.
©2013 Delmar, Cengage
Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Causes • Seizure occurs as a result of a sudden discharge of electrical energy somewhere in the central nervous system caused by an imbalance among the neurons – Area in the brain that is affected determines what kind of seizure – Epilepsy: type of seizure disorder that affects people for a variety of reasons 4
5.
©2013 Delmar, Cengage
Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Causes (cont’d.) • Most causes of epilepsy are unknown • Known causes of epilepsy: – Accidents can result in brain injury and the development of a seizure disorder – Injury during birth – Severe infection – Fever high enough to injure the brain – Heredity 5
6.
©2013 Delmar, Cengage
Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Types of Seizures • Epileptic seizures are usually identified by the actions that occur while the seizure is in progress • Types of seizures: – Grand mal seizure – Petit mal seizure – Partial or Jacksonian seizure 6
7.
©2013 Delmar, Cengage
Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Grand Mal Seizure • Most common type of seizure • Named the tonic/clonic seizure from the body movements the patient makes during the seizure • Three phases: – Prodromal – Convulsive – Postictal 7
8.
©2013 Delmar, Cengage
Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Prodromal Phase • Period before the actual seizure • Patient may experience slight personality changes • Patients may experience an aura – May consist of a certain smell, a flash of light, or a certain noise – Unique to the individual and occur before the patient advances to the convulsive phase 8
9.
©2013 Delmar, Cengage
Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Convulsive Phase • Consists of the actual tonic and clonic movements • Patient loses consciousness, falls down, and might give out the epileptic cry – Epileptic cry results from air rushing out of the lungs 9
10.
©2013 Delmar, Cengage
Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Convulsive Phase (cont’d.) • Patient’s body stiffens and becomes rigid (tonic stage) • Patient’s body then begins to jerk violently (clonic phase) – Patient may foam at the mouth – Patient may lost control of bladder or sphincter muscles 10
11.
©2013 Delmar, Cengage
Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Postictal Phase • Final phase of the grand mal seizure • Actual seizure is over • Patient may begin to regain consciousness – May experience confusion – May need to sleep while recovering 11
12.
©2013 Delmar, Cengage
Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Petit Mal Seizure • Also known as an absence seizure • Patient loses awareness of the surroundings for a very short time – May have a blank stare, twitch, or blink rapidly • This type may come and go without anyone noticing 12
13.
©2013 Delmar, Cengage
Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Petit Mal Seizure (cont’d.) • Seen mostly in children and often misdiagnosed as a behavioral problem 13
14.
©2013 Delmar, Cengage
Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Partial Seizure • Involves only one hemisphere of the brain • Patient may have: – Jerking movements on one side of the body – May also appear to be in a trance-like state, fidget, pick at clothing, wander around, or engage in continuous lip smacking 14
15.
©2013 Delmar, Cengage
Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Partial Seizure (cont’d.) • Sometimes classified as a Jacksonian seizure • Can progress into a grand mal seizure 15
16.
©2013 Delmar, Cengage
Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Status Epilepticus • Most dangerous type of seizure – Causes death in ten percent of seizures • Patient experiences either one continuous seizure or one seizure after another 16
17.
©2013 Delmar, Cengage
Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Treatment • Witnessing a seizure can be traumatic – Remain calm – Remember that seizures are usually brief, usually not life threatening, and requires little care – Main method is to keep the patient from injuring themselves and provide supportive care after the seizure 17
18.
©2013 Delmar, Cengage
Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Treatment (cont’d.) • Remove all dental objects from the patient’s mouth • Remove all dental equipment on which the patient may hit and injure himself – If possible, do not move the patient • Remove glasses and loosen tight clothing • Call EMS 18
19.
©2013 Delmar, Cengage
Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Treatment (cont’d.) • Do not put anything into the patient’s mouth • Do not restrain the patient • After the seizure, turn the patient on one side so any secretions are not aspirated • Once patient regains consciousness, provide reassurance 19
20.
©2013 Delmar, Cengage
Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Treatment (cont’d.) • Do not give anything to eat or drink until patient is fully alert • Patient should be given plenty of time to rest and recover – Some patients go into a deep sleep – Place the patient in an appropriate area for recovery 20
21.
©2013 Delmar, Cengage
Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Dental Implications of Seizure Disorders • Dental office is a likely setting for the occurrence of seizures • Dilantin hyperplasia: – Dilantin is a drug given to treat seizures • May result in gingival tissue growing at a rapid rate • Gingival tissue might cover the teeth completely – Surgical removal is necessary 21
22.
©2013 Delmar, Cengage
Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Dental Implications of Seizure Disorders (cont’d.) Figure 5-2: Dilantin hyperplasia Courtesy of Dr. Robert Tracy, DDS 22
23.
©2013 Delmar, Cengage
Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Prevention • In cases where cause is unknown, prevention is impossible • In those who have identified seizure disorders, anticonvulsants can help control • When a seizure occurs, it is important to remember what happened prior to the seizure to help determine the trigger 23
24.
©2013 Delmar, Cengage
Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Prevention (cont’d.) • Some seizures can be triggered by extremely stressful situations • Important to reduce stress: – Demonstrate the use of equipment – Do not keep the patient waiting in the reception area – In some cases, premedicate the patient after consultation with patient’s physician 24
25.
©2013 Delmar, Cengage
Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Summary • Seizure disorders can be frightening • Being aware of what takes place during a seizure can help the dental team handle the situation effectively 25
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