Epilepsy By Dr Haider Al Shamaa

1. Epilepsy By Dr Haider Al Shamaa

2. Epilepsy Syndrome due to excessive temporary neural discharging which results from intracranial or exracranial causes, epilepsy is characterized by discrete episodes, which tend to be recurrent in which there is disturbance of movement, sensation, behavior, perception, and or consciousness. The possible causes include trauma, intracranial neoplasm,hypoglycemia, drug withdrawal and febrile illness; however sometimes it is idiopathic.

3. Epilepsy is classified according to seizure type: generalized type, partial type, and status epilepticus. Generalized Type is classified into three groups: generalized tonic-clonic seizures (grand mal), atonic seizures, and absence seizures (petit mal) Partial Typeis classified into three groups: simple partial seizures, complex partial seizures and secondarily generalized seizures Status Epilepticus“Status epilepticus” is a term that used to describe any continuous seizure. It arises frequently after tonic-clonic seizure. It can be fatal if not treated

4. Factors Provoking Seizures: The following factors may all provoke seizures:  Incorrect use of medication;  Sleep deprivation;  Drug abuse;  Excessive use of alcohol;  Use of medication that reduces the effectiveness of antiepileptic medicines;  Excessive use of caffeine;  Hormonal changes;  Low blood sugar level (hypoglycemia);  Deficiency of vitamin B6;  Electrolyte imbalance in the blood;  Congenital diseases.

5. Idiopathic grandmal seizures: It is a sever generalized clinical manifestation of epilepsy. The patient loses consciousness and falls to the ground. Then generalized muscles rigidity occurs, followed by uncontrolled beating and movement of the limbs and head. All movements soon ceas and the person become comatose. Then generally within a few minutes, the person gradually regains consciousness with headache and confusion. Once the seizure has begun, the jaws and teeth are clamped tightly and cannot be separated apart. Relaxation occurs with termination of the seizure. These patients usually receive dilantin sodium (phenytoin), Phenobarbital mysoline or tegretol.But phenytoin causes gingival hyperplasia.

6. Dental management 1-Identification of epileptic patient by history: a) Type of seizure. b) Age at time of onset. c) Cause of seizure (if known). d) Medications. e) Frequency of physician visits. f) Degree of seizure control. g) Date of last scizure. h) Known precipitating factors. i) History of scizure related injuries. 2-Well controlled patients present no management problems, treat as a normal patient provided precaution is taken as use of mouth probe or pack during dental treatment and local anesthesia is normal.

7. 3-If questionable history or poorly controlled scizure consult with the physician. 4-be prepared to manage grand mal scizure on the dental chair by: a)No attempt should be made to move the patient to the floor, the chair is put in a supine position and the patient should if possible be turned to the side to control the airway and minimize aspiration of secretions. b) Fix the patient limbs to prevent him from nearby objects and causing injury. c) Once the teeth are clenched no attempt should be made to open the mouth and insert a towel because it may damage the oral structures. d)Scizure usually last for few minutes ,then the patient falls into a deep sleep and after a few minutes he will gradually regain consciousness but may be confused ,embarrassed ,and have a severe headache ,but sometimes patient may suffer from repeated scizure over a short period (status epilepticus) so we give him an injection of dilantin sodium.

8. 5-Treatment plan considerations: a) Because of gingival hyperplasia(side effect of dilantin sodium) , the oral hygiene of the patient must be improved, but if significant hyperplasia exists, surgical reduction will be necessary. b) Missing teeth should be replaced, preferably by a fixed prosthesis to prevent the tongue from being caught in the edentulous spaces during scizure. c) If acrylic removable appliances are constructed it should have metallic plates or base or reinforced with a wire mesh.To prevent the appliance from fracture and to localized it by x-ray if swallowed.