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Group 4: Epilepsy

Group 4: Epilepsy. Nurin Syahidah Syafiqah Nadhirah Nor Anis Zullyana Nik Mohd Haziq Asyraf Hamzi Muhamad Mohd Hanif Ahmad Fais Aimi Amalina. Definition.

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Group 4: Epilepsy

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  1. Group 4:Epilepsy NurinSyahidah SyafiqahNadhirah Nor AnisZullyana NikMohdHaziqAsyraf HamziMuhamad MohdHanif Ahmad Fais AimiAmalina

  2. Definition • Epilepsy is a chronic disorder of the brain that affects people in every country of the world. It is characterized by recurrent / two or more unprovoked seizures. • Seizures are brief episodes of involuntary shaking which may involve a part of the body (partial) or the entire body (generalized) and sometimes accompanied by LOC and loss control of bowel or bladder function. • Pathophysio > • Result of excessive electrical discharges in a group of brain cells. • Different parts of the brain can be the site of such discharges. • Seizures can vary from the briefest lapses of attention or muscle jerks, to severe and prolonged convulsions. • Seizures can also vary in frequency, from less than one per year to several per day.

  3. Epidemology (by WHO) • Epilepsy is a chronic noncommunicable disorder of the brain that affects people of all ages. • Around 50 million people worldwide have epilepsy. • ~ 80% of the people with epilepsy are found in developing regions. • Currently 70% - responds to treatment, • yet about 3/4 fourths of affected people in developing countries do not get the treatment they need. • Patient is associated with stigma and discrimination in many parts of the world

  4. By NICE • Incidence is estimated to be 50 per 100,000 per year • the prevalence of active epilepsy in the UK is estimated to be 5–10 cases per 1000. • Two-thirds of people with active epilepsy have their epilepsy controlled satisfactorily with anti-epileptic drugs (AEDs). • Other approaches may include surgery

  5. Causes (WHO) • The MC type – for 6/10 people with the disorder – is called idiopathic epilepsy and has no identifiable cause. In many cases > underlying genetic basis. • Secondary epilepsy/ symptomatic epilepsy > epilepsy with a known cause could be: • brain damage from prenatal or perinatal injuries • a loss of oxygen or trauma during birth, low birth weight • congenital abnormalities or genetic conditions with associated brain malformations; • a severe blow to the head; • a stroke that starves the brain of oxygen; • an infection of the brain such as meningitis, encephalitis, neurocysticercosis; • certain genetic syndromes; • a brain tumor

  6. Causes

  7. Classification of Epilepsy

  8. Grand mal (Tonic-clonic) Epilepsy • Begins in the pre-school child/occasionally at puberty • Warning/aura → LOC → tonic & clonic convulsions → recovery • Aura: • Mood change • Irritability • Brief hallucination • Headache • Sensation of strong smell (e.g burning rubber) • Initially: • Face become pale • Pupils dilate • Opisthotonous & glottic • Respiratory muscle spasm → cry & cyanosis

  9. Grand mal (Tonic-clonic) Epilepsy • Clonic phase: • Repetitive jerking movements of trunks, limbs, tongue & lips • Profuse salivation + bruxism + tongue biting + vomiting • Urinary/faecal incontinence • Tachycardia/hypertension/flushing • Flaccid semi-coma (10 – 15 min) → recovery

  10. Status Epilepticus • Definition • A seizure lasting for more than 30 min or repeated seizures over the same period without intervening periods of consciousness • dangerous: • Inhalation of vomit & saliva • Brain damage d/t cerebral hypoxia • Death

  11. Petit mal seizures • MC occur during childhood • Characterized by: • Minimal/no movements : may appear like a blank stare • Brief sudden loss of awareness/consciousness (few seconds) • Recur many times • Decreased learning (often thought to be daydreaming)

  12. Simple partial (focal) seizures • Can be motor/sensory/behavioral • Confined to one area • Present as: • Muscle contractions of a specific body part • Jacksonian epilepsy : spread to adjacent muscles on the same side of the body • Abnormal sensation • Nausea, sweating, skin flushing, dilated pupils

  13. Complex partial seizures • Aka temporal lobe epilepsy/psychomotor epilepsy • Characterized by: • Lip smacking, chewing movements, facial grimacing • Abnormal sensation • Nausea, sweating, skin flushing, dilated pupils • Recalled/inappropriate emotions • May/may not be disorientation, confusion & amnesia/LOC • Olfactory/gustatory hallucinations/impairment

  14. Management

  15. Epilepsy : Management • Call for help • Stop treatment • Lay the patient flat on the chair, do not try to move the patient while they are actively fitting • Protect the patient from injury; • Do not attempt to put spoon or tongue depressor on between the teeth or any other hard objects • Clear the working area • Do not attempt to restrain or holding down the patient during seizure

  16. If patient is having difficulty to breathe or becoming cyanosed, gently extending the neck to maintain the airway • CPR or mouth-to-mouth breathing cannot be performed during seizure and rarely needed after seizure. • Uncomplicated seizure: no other treatment is necessary • If attack continues longer than normal or > 10 minutes, give Midazolam 10mg IM • If attack does not resolve within the next 5 minutes, call ambulance (status epilepticus) • While waiting, protect the airway with suction (remove saliva) and administer high flow oxygen 10-15 L/min

  17. NICE

  18. MANAGEMENT • The AED (anti-epileptic drug) treatment strategy should be individualised according to the seizure type, epilepsy syndrome, co-medication and co-morbidity, the child, young person or adult's lifestyle, and the preferences of the person, their family and/or carers as appropriate. [NICE 2004]

  19. EMERGENCY • STOP treatment! • Medication: • Administer buccalmidazolam as first-line treatment in children, young people and adults with prolonged or repeated seizures in the community. • Administer rectal diazepam if preferred or if buccalmidazolam is not available. • If intravenous access is already established and resuscitation facilities are available, administer intravenous lorazepam. [NICE 2012]

  20. AAPD

  21. Reference • WHO; http://www.who.int/mediacentre/factsheets/fs999/en/ • NICE ; guidance.nice.org.uk/cg137 • Special Care in Dentistry. Churchill Livingstone. • ILAE ; Ihttp://www.ilae.org/Visitors/Centre/Definition.cfm

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