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seizure disorder chpt. 8

Terms in this set (33)

seizures
can be caused abnormal electrical discharges in the brain.

usually accompanied by convulsions or spasms

possible causes: damage to brain

half of seizures are idiopathic

can be result of another medical problem
- head injury/trauma
- hypoglycemia/ electrolyte imbalance
- infection
-drug overdose
-poisoning
seizures are not a disease
they are a disorder
two major categories:
generalized seizures

partial/focal seizure

some seizures begin as focal and then spread to other parts of the brain
partial/focal seizures
these seizures occur in a specific area of one cerebral hemisphere

of people who have epilepsy, about 60% have focal seizures, and although they are divided into two subcategories simple and complex, more specific ones are usually named, or described, based on the area of the brain they in which they begin.
partial/focal seizures
simple focal seizures

-duration- lasts 90 seconds

symptoms:
-no loss of consciousness
-sudden jerking
-may experience unexplainable feelings of joy, anger, sadness or nausea
-also may hear, smell, taste, see or feel things which are not real
-possible weakness or loss of sensation
partial/ focal seizures
complex focal seizures
-duration- lasts 1-2 mins
-symptoms:
-loss of consciousness
-may have aura
-unaware of environment
-amnesia during seizure events
-mild to moderate confusion
-sleepy
seizure medication
complex focal seizure

when a person has multiple recurring seizures they may be diagnosed with epilepsy.

there are many types of epilepsy, but usually medication can control the seizures in 70% of patients.

most common medications are:
-carbamazepine
-ethosuximide
-depakote
-valium
-phenytoin
-keppra
-lyrica
-topamax
generalized seizures
are characterized by the fact that both cerebral hemispheres are affected by the seizure at the same time

the symptoms include:
-loss of consciousness
-falls and/or major muscle spams
- & are categorized into 5 major subcategories
5 subcategories of generalized seizures
grand mal/generalized tonic-clonic/generalized convulsion


-may be distressing to watch
-loss of bladder/bowel contents can occur
-tonic phase- the contraction of muscles
-clonic phase- begins the muscle spams and violent jerking
-may go unresponsive after convulsion
-patients usually have an aura prior to the seizure
-will usually have a headache and be very tired afterwards
5 subcategories of generalized seizures

grand mal/generalized tonic-clonic/generalized convulsion
tonic phase (rigidity)
clonic phase (spasms)
post-seizure phase (exhaustion)
5 subcategories of generalized seizures

grand mal/ generalized tonic-clonic/ generalized convulsion
-most common type of seizure

-duration- usually last shorter than 1 min

-symptoms include:
sudden fall with dramatic, violent, involuntary shaking

muscular spams of limbs and body

moaning or cry from "forced exhalation" due to respiratory muscle spasms

eyes rolling upward

dilated pupils

possible cyanosis

slow deep breathing

unresponsiveness with a slowly returning consciousness

headache and muscle soreness

possibly a vertebral compression fracture of the back
petit mal/ absence seizure
conscious is lost and regained in a sudden off and on pattern

often confused with daydreaming except in daydreaming conscious is intact

a good way to differentiate is to ask questions to the person having the seizures to determine whether or not their conscious state was altered

they usually continue with their activity as if nothing happened
petit mal (absence) seizure
most common in children

duration- less than 30 seconds, most usually less than five

can occur dozens of times through the course of the day

symptoms include:
-staring

-eyelids twitching or fluttering

-automannerisms (lip smacking, picking at clothes fumbling)

-amnesia during seizure events

-no confusion
atonic/ akinetic seizures
conscious and posture is lost suddenly without warning

will usually cause injury to head and face

when this occurs in children they normally wear protective headwear
atonic (akinetic) seizure
duration- varies

occurs suddenly without warning

symptoms:
-abrupt loss in muscle tone

-head drops

-loss of posture

-sudden collapse

-possible loss of consciousness, though brief
myoclonic seizures
produce sudden and brief involuntary actions

a myoclonic jerk is much like the jerking of a foot when one is sleeping

can be general or limited to a single part of muscle in the body

occurs most often in children under 5
myoclonic seizures
duration- varies, ranges from a single jerk to multiples

occurs suddenly without warning

symptoms include:
-rapid brief contractions of bodily muscles
-sudden jerks of clumsiness
febrile seizures
associated with high fever 100 deg. f/38 deg. Cel in infants and children

usually harmless unless and injury occurs during the seizure

the child should be checked or meningitis after having this type of seizure

family history increases the risk

the risk is small to develop epilepsy after having these seizure
in the dental clinic, protect the patient!
several potential etiologies

-hypoglycemia

-hypoxia- secondary to syncope

-local anesthetic toxicity

- epilepsy
in the dental clinic, protect the patient!
cease all dental treatment

remove all instruments from the patient

move all equipment out of the way

place the head, chest, and knees at the same level
-supine

loosen tight clothing

activate EMS

administer O2 4-6 L/M
in the dental clinic, protect the patient!
monitory vital signs

maintain an open airway

use gentle restraints to prevent injury

when the seizure is over:
reassurance is helpful

keep an open airway

patient may have a headache, muscle soreness, be very tired

they should not drive themselves home
essenital info about seizures
length of time since last seizure

types of seizures, severity, duration

presence of aura

alteration or loss of consciousness

history of injuries

postictal symptoms

medications
in the dental clinic, protect the patient!
if not well-controlled or factors exist which would predispose the patient to seizure that day, treatment should be postponed until more stable

early morning appointments after a meal and within a few hours of taking medication is the optimal time for treatment

remove dentures, use a mouth prop

tell the patient to advise you if they feel an onset
All of the following are associated with increased seizure activity except one. Which one is the exception?
a. hypoglycemia
B.hyperglycemia
C.hypoxia
D.pyrexia
B.hyperglycemia
Which of the following are responsibilities of the clinician in treating a patient with seizure disorder?

A. thoroughly reviewing the medical history and discussing it with the patient
B. monitoring the patient for signs and symptoms of impending seizures
C. protecting the patient from harm during the seizure
D.monitoring the patient's vital signs during recovery and arranging a ride home.
E. All of the above
E. All of the above
Generalized tonic-clonic seizures are often preceded by an aura. Patients are always aware that they have had an aura.
A. Both statements are true.
B. Both statements are false.
C. The first statement is true, and the second state-
ment is false.
D. The first statement is false, and the second state-
ment is true.
C. The first statement is true, and the second statement is false.
All of the following are factors used to classify sei- zure types except one. Which one is the exception?
A. signs and symptoms
B. duration of seizure
C. age of patient
D. type of aura
E. precipitating factors
C. age of patient
Your patient stiffens and starts to experience a seizure in the middle of periodontal debridement. What is the first thing you should do?

A.Activate the EMS system.
B. Stop treatment and remove everything from the
patient's mouth.
C. Administer CPR.
D. Administer antiepileptic medications.
B. Stop treatment and remove everything from the
patient's mouth.
The following oral signs and symptoms are often present in a patient with a history of seizure disor- ders. Which of the following is an exception?
A. advanced periodontitis
B. gingival overgrowth
C. fractured teeth
D. tongue lacerations and scarring
A. advanced periodontitis
Antiepileptic drugs fall into which of the following pharmaceutical classifications?
A. muscle relaxants
B. opioids
C. central nervous system stimulants
D. anticonvulsants
D. anticonvulsants
The most common type of seizure disorder is
A. absence or petit mal seizures
B. tonic-clonic or grand mal seizures
B. tonic-clonic or grand mal seizures
The injectable drug of choice in the emergency treat- ment of GTCS or status epilepticus is
A. phenytoin
B. carbamazepine
C. diazepam
D. codeine
C. diazepam
Respiratory arrest is most likely to occur during which phase of a generalized tonic-clonic seizure?
A. aura
B. preictal
C. ictal
D. postictal
D. postictal
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