Classic Seizures: Assessment, Analysis, and Associated Dental Management Guidelines
SEIZURE CLASSIFICATION, OVERVIEW, AND TREATMENT OPTIONS
Conditions associated with seizures are:
The first four causes have been discussed in Chapter 9. Causes 5 and 6 are major seizure disorders and are discussed in this chapter.
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.
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 is established as follows:
Management of seizures consists of the following:
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:
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)
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/>