43: Classic Seizures: Assessment, Analysis, and Associated Dental Management Guidelines

43

Classic Seizures: Assessment, Analysis, and Associated Dental Management Guidelines

SEIZURE CLASSIFICATION, OVERVIEW, AND TREATMENT OPTIONS

Seizure Classification

Conditions associated with seizures are:

1. Vasovagal syncopal reaction
2. Orthostatic hypotension
3. Hyperventilation syndrome
4. Hypoglycemic reaction
5. Grand mal epilepsy
6. Petit mal epilepsy

The first four causes have been discussed in Chapter 9. Causes 5 and 6 are major seizure disorders and are discussed in this chapter.

General Introduction

Seizures are caused because of abnormal electrical discharges in the brain and they can occur as grand mal seizures, petit mal seizures, or temporal lobe seizures. Occurrence of repeat seizures leads to a diagnosis of epilepsy.

A seizure is generalized if the abnormal electrical discharges cross over the midline in the brain. When the seizures involve only a few muscles in the face, arms, or legs, it is a focal seizure. A grand mal seizure or a tonic-clonic seizure is characterized by loss of consciousness with the patient falling down, loss of bowel or bladder control, and rhythmic-to-arrhythmic convulsions.

Seizure Etiology

The following are etiological factors associated with seizures:

  • Familial: Seizures can be familial affecting several members in the family.
  • Unknown etiology: Often the etiology is unknown and there is no associated family history.
  • Metabolic disturbances: Seizures can occur from chemical imbalance due to liver or kidney disease or very low levels of sodium, calcium, or magnesium.
  • Trauma: Head injuries can cause seizures.
  • Space-occupying lesions: Tumors or arterial-venous malformations in the brain can trigger seizures.
  • Cerebrovascular accidents (CVA) or strokes: CVAs can cause seizures in older patients.
  • Drug addiction: Withdrawal from recreational drugs can be associated with seizures.
  • Cerebral infection: Meningitis or encephalitis can trigger a seizure.
  • Other causes: Seizures can also be triggered by stress, lack of sleep, flickering lights, alcohol, or touch.

Seizure Diagnosis

Seizure diagnosis is established as follows:

1. History and physical (H&P) examination: A thorough H&P can reveal the etiology and presenting symptoms and signs of the seizure.
2. Electroencephalography (EEG): EEG measures the electrical activity in the brain and can show areas of increased activity.
3. Magnetic resonance imaging (MRI): MRI can detect brain pathology.

Seizure Treatment

Management of seizures consists of the following:

1. Treatment of the underlying cause, if known.
2. Surgery is an option when a tumor or vascular malformation is the cause of the seizure. Surgery is also an option when the patient does not respond to medications and has such frequent seizures that it significantly compromises the patient’s life style.
3. Antiseizure medications.

SEIZURE MEDICATIONS: OVERVIEW

Grand Mal Seizure Medications

The most common medications used for grand mal epilepsy are phenytoin sodium (Dilantin), carbamazepine (Tegretol), phenobarbital (Barbita/Luminal), primidone (Mysoline), gabapentin (Neurontin), clonazepam (Klonopin), oxcarbazepine (Trileptal), and the benzodiazepines lorazepam (Ativan) or diazepam (Valium).

Petit Mal Seizure Medications

The following are the petit mal medications:

1. Older medications: valproic acid (Depakene), divalproex (Depakote), and ethosuximide (Zarontin)
2. Newer medications: lamotrigine (Lamictal), topiramate (Topamax), and zonisamide (Zonegran).

SEIZURE MEDICATIONS: DETAILED DISCUSSION

To better manage a patient with a history of seizures, it is important to understand the medications used to treat the disorder. Significant facts relevant to dentistry have been highlighted with each drug.

Phenytoin Sodium (Dilantin)

Dilantin Facts

Phenytoin (Dilantin) is used in the management of grand mal epilepsy, and chronic use is associated with gingival hyperplasia. Dilantin inhibits the absorption of folic acid from the gut and predisposes the patient to develop folic acid deficiency/megaloblastic anemia. Evaluate the CBC and follow the suggested AAA guidelines for anemia if anemia is detected on the CBC. Chronic alcohol use or abuse decreases the serum levels of Dilantin and predisposes the pat/>

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Jan 4, 2015 | Posted by in General Dentistry | Comments Off on 43: Classic Seizures: Assessment, Analysis, and Associated Dental Management Guidelines
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