Med Emergency, altered consciousness

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Seizure Disorders
Chapter 5

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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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Petit Mal Seizure (cont’d.)
• Seen mostly in children and often
misdiagnosed as a behavioral problem
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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
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Partial Seizure (cont’d.)
• Sometimes classified as a Jacksonian
seizure
• Can progress into a grand mal seizure
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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
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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
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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
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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
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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
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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
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Dental Implications of Seizure
Disorders (cont’d.)
Figure 5-2: Dilantin hyperplasia
Courtesy of Dr. Robert Tracy, DDS
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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
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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
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Summary
• Seizure disorders can be frightening
• Being aware of what takes place during a
seizure can help the dental team handle
the situation effectively
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