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Questions and Answers
Which imaging technique is NOT typically used to rule out other causes of seizures?
Which imaging technique is NOT typically used to rule out other causes of seizures?
What is the primary mechanism by which phenytoin and carbamazepine reduce seizure frequency?
What is the primary mechanism by which phenytoin and carbamazepine reduce seizure frequency?
Which adverse effect is NOT associated with phenytoin?
Which adverse effect is NOT associated with phenytoin?
Which drug is contraindicated for patients taking carbamazepine due to potential drug interaction?
Which drug is contraindicated for patients taking carbamazepine due to potential drug interaction?
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Which is NOT a first-line treatment for epilepsy?
Which is NOT a first-line treatment for epilepsy?
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What is a potential consequence of using valproic acid?
What is a potential consequence of using valproic acid?
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Which information is NOT typically required when identifying a patient with seizures?
Which information is NOT typically required when identifying a patient with seizures?
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Which adverse effect is common to both phenytoin and carbamazepine?
Which adverse effect is common to both phenytoin and carbamazepine?
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What characterizes a stroke-in-evolution?
What characterizes a stroke-in-evolution?
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Which of the following is NOT typically included in the laboratory tests for stroke evaluation?
Which of the following is NOT typically included in the laboratory tests for stroke evaluation?
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What is the primary objective of medical management in stroke prevention?
What is the primary objective of medical management in stroke prevention?
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Which treatment method is used for acute strokes to attempt clot lysis?
Which treatment method is used for acute strokes to attempt clot lysis?
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What are common neurologic alterations that laboratory tests aim to rule out when evaluating for stroke?
What are common neurologic alterations that laboratory tests aim to rule out when evaluating for stroke?
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Which medication is administered intravenously during acute episodes of thrombosis or embolism?
Which medication is administered intravenously during acute episodes of thrombosis or embolism?
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After the initial treatment phase, which medication is often used to reduce the risk of thrombus formation?
After the initial treatment phase, which medication is often used to reduce the risk of thrombus formation?
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Which of the following is a risk factor for stroke?
Which of the following is a risk factor for stroke?
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What kind of appointments are recommended for patients with a history of stroke?
What kind of appointments are recommended for patients with a history of stroke?
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Which anesthetic agent is advised to be used in judicious amounts for patients with a previous stroke?
Which anesthetic agent is advised to be used in judicious amounts for patients with a previous stroke?
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What is a common oral manifestation of a complete stroke?
What is a common oral manifestation of a complete stroke?
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What should be avoided in gingival retraction cord for stroke patients?
What should be avoided in gingival retraction cord for stroke patients?
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Which of the following is NOT a sign of a stroke-in-evolution?
Which of the following is NOT a sign of a stroke-in-evolution?
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What measures are recommended to minimize hemorrhage during surgery?
What measures are recommended to minimize hemorrhage during surgery?
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What may occur in patients with right-sided brain damage regarding their perception?
What may occur in patients with right-sided brain damage regarding their perception?
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Which device is recommended to have available for hemostatic purposes during surgical procedures?
Which device is recommended to have available for hemostatic purposes during surgical procedures?
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What should be the first step in managing a patient who has a seizure during dental treatment?
What should be the first step in managing a patient who has a seizure during dental treatment?
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Which medication requires monitoring for bleeding tendencies due to its effect on platelet function?
Which medication requires monitoring for bleeding tendencies due to its effect on platelet function?
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When should dental treatment be scheduled for a patient taking anticonvulsants?
When should dental treatment be scheduled for a patient taking anticonvulsants?
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What is one of the adverse effects of anticonvulsants that should be monitored?
What is one of the adverse effects of anticonvulsants that should be monitored?
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What should dental professionals avoid doing when a patient is having a seizure?
What should dental professionals avoid doing when a patient is having a seizure?
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After a seizure has occurred, what is an important step to take?
After a seizure has occurred, what is an important step to take?
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What role does the PFA-100 play in managing patients with well-controlled seizures before dental treatment?
What role does the PFA-100 play in managing patients with well-controlled seizures before dental treatment?
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Which of the following is a preventive measure to take for dental patients with seizure disorders?
Which of the following is a preventive measure to take for dental patients with seizure disorders?
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What defines partial seizures in terms of consciousness?
What defines partial seizures in terms of consciousness?
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Which of the following is classified as a generalized seizure type?
Which of the following is classified as a generalized seizure type?
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Which of the following is an idiopathic epileptic syndrome?
Which of the following is an idiopathic epileptic syndrome?
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Which type of seizures begin diffusely and involve both cerebral hemispheres?
Which type of seizures begin diffusely and involve both cerebral hemispheres?
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Which of the following is NOT a characteristic of focal seizures?
Which of the following is NOT a characteristic of focal seizures?
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Which of the following conditions is classified under secondary or symptomatic epilepsies?
Which of the following conditions is classified under secondary or symptomatic epilepsies?
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Which seizure type is characterized as 'grand mal'?
Which seizure type is characterized as 'grand mal'?
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Which of the following is a recognized cause of secondary epileptic syndromes?
Which of the following is a recognized cause of secondary epileptic syndromes?
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Study Notes
Epileptic Syndromes
- Epilepsy classification - two main types:
- Primary (idiopathic) - seizures without a known underlying cause
- Localization-related - seizures originate in a specific brain region
- Benign epilepsy with centrotemporal spikes - seizures typically occur during sleep
- Autosomal dominant nocturnal frontal lobe epilepsy - seizures occur during sleep
- Generalized - seizures involve both hemispheres of the brain
- Juvenile myoclonic epilepsy - characterized by brief, involuntary muscle jerks often triggered by stress
- Juvenile absence epilepsy - involves brief lapses in consciousness
- Severe myoclonic epilepsy of infancy - seizures begin early in life and are often difficult to treat
- Progressive myoclonic epilepsies - characterized by progressive deterioration of neurological function
- Generalized epilepsy with febrile seizures - seizures occur with fever, common in childhood, usually benign
- Localization-related - seizures originate in a specific brain region
- Secondary (Symptomatic) - seizures are caused by an underlying medical condition
- Localization-related - seizures originate in a specific brain region
- Mesial temporal lobe epilepsy - often caused by hippocampal sclerosis
- Neoplasm (primary, metastatic) - seizures caused by brain tumors
- Infection - seizures caused by infections like encephalitis, meningitis, or Lyme disease
- Vascular (stroke, transient ischemic attack, migraine, hemorrhage) - seizures caused by vascular problems
- Developmental (migrational) - seizures related to abnormal brain development
- Perinatal - seizures related to complications during birth or neonatal period
- Traumatic - seizures caused by brain injury
- Degenerative (e.g., Alzheimer disease) - seizures caused by neurodegenerative diseases
- Immunologic (e.g., multiple sclerosis) - seizures caused by autoimmune disorders
- Generalized - seizures broadly involve both hemispheres of the brain
- West's syndrome - a severe form of epilepsy in infants, characterized by rapid spasms
- Lennox-Gastaut syndrome - a type of epilepsy that often begins in childhood, seizures can be difficult to control
- Tuberous sclerosis - a genetic disorder that can cause seizures and other developmental issues
- Sturge-Weber syndrome - a rare disorder that causes seizures, port-wine stain birthmarks, and other issues
- Localization-related - seizures originate in a specific brain region
- Primary (idiopathic) - seizures without a known underlying cause
Seizure Types
- Seizure classification - three main types:
- Partial seizures - limited to specific parts of the brain
- Simple partial seizures - consciousness remains intact, localized symptoms may include sensory, motor or autonomic changes
- Complex partial seizures - consciousness is impaired, may involve automatisms (repetitive unconscious movements)
- Partial seizures evolving to secondarily generalized seizures - begin as partial seizures then spread to involve the whole brain
- Generalized seizures - affect both hemispheres of the brain
- Absence seizures (petit mal) - brief periods of unresponsiveness, usually lasting only a few seconds, common in children
- Myoclonic seizures - sudden, brief muscle jerks, can occur in isolation or as part of other epilepsies
- Tonic-clonic seizures (grand mal) - characterized by loss of consciousness followed by stiffening of the body and rhythmic muscle jerking
- Tonic seizures - involve stiffening of the muscles
- Atonic seizures - involve sudden loss of muscle tone, resulting in a “drop attack”
- Unclassified epileptic seizures - seizures that do not fit neatly into the other categories
- Partial seizures - limited to specific parts of the brain
Medical Management
- Long-term drug therapy is the mainstay of treatment
- First-line treatments:
- Phenytoin (Dilantin)
- Carbamazepine (Tegretol)
- Valproic acid (Depakene)
- Mechanism of action:
- Elevate seizure threshold in motor cortex neurons
- Depress abnormal electrical discharge
- Limit spread of excitation from abnormal foci
- Potential adverse effects:
- Bone marrow suppression (leucopenia, thrombocytopenia)
- Gingival hyperplasia (phenytoin)
- Gingival bleeding (phenytoin, carbamazepine - due to leucopenia and thrombocytopenia)
- Osteoporosis (phenytoin, carbamazepine)
- Stevens-Johnson syndrome (phenytoin, carbamazepine)
- Xerostomia (carbamazepine)
- Decreased platelet aggregation (valproic acid) - risk of spontaneous hemorrhage
- First-line treatments:
Dental Management
- Patient history is paramount:
- Seizure type
- Age at onset of seizures
- Cause of seizures (if known)
- Medications
- Frequency of physician visits
- Degree of seizure control
- Frequency of seizures
- Date of last seizure
- Known precipitating factors
- History of seizure-related injuries
- Well-controlled seizures pose no significant management problems
- Consultation with a physician is needed if the seizure history is unclear or poorly controlled - medications may need to be adjusted
- Anti-convulsant side effects are important to consider:
- Drowsiness
- Slow mentation
- Dizziness
- Ataxia (poor coordination and balance)
- Gastrointestinal upset
- Allergic signs (rash, erythema multiforme)
- Bleeding tendency can be a concern in patients on valproic acid or carbamazepine - consider pretreatment platelet function analysis:
- If results are abnormal, consult with the patient's physician
- Managing seizures:
- Preventive measures:
- Know the patient’s history
- Schedule appointments close to the time of medication intake
- Use a mouth prop
- Remove dentures
- Instruct the patient to mention the aura as soon as it is sensed
- If time permits (for generalized seizures) - give sublingual lorazepam (0.5 to 2 mg) or intravenous diazepam (2 to 10 mg)
- If a seizure occurs:
- Primary focus is patient safety - prevent injury
- Clear the treatment area and position the patient in a supine position with support
- Maintain airway patency (turn the patient to the side to prevent aspiration)
- Limit physical restraint to prevent further injuries
- Post-seizure management:
- Provide 100% oxygen (if available)
- Maintain airway patency
- Suction the mouth (to minimize aspiration of secretions)
- Discontinue dental treatment
- Assess for injuries (lacerations, fractures)
- Locate any avulsed teeth or appliance fragments to rule out aspiration
- Preventive measures:
Stroke
- Types of strokes:
- Stroke-in-evolution - neurologic deficit gets worse over time
- Completed stroke - neurologic deficit is stabilized
- Common signs/symptoms:
- Hemiplegia (weakness or paralysis on one side of the body)
- Temporary loss of speech or difficulty understanding speech
- Temporary dimness of vision, particularly in one eye
- Unexplained dizziness
- Unsteadiness, sudden fall
- Laboratory findings:
- Tests ordered to rule out conditions mimicking stroke
- Urinalysis
- Blood sugar level
- Complete blood count
- Erythrocyte sedimentation rate
- Serologic tests for syphilis
- Blood cholesterol and lipid levels
- Chest radiograph
- Electrocardiogram
- Imaging tests:
- Doppler blood flow
- Electroencephalogram (EEG)
- Cerebral angiography
- Computed tomography (CT)
- Magnetic resonance imaging (MRI) - used to determine the extent and location of injury
- Tests ordered to rule out conditions mimicking stroke
- Medical management:
- Prevention is key:
- Identifying risk factors:
- Hypertension
- Diabetes
- Atherosclerosis
- Cigarette smoking
- Reducing or eliminating as many risk factors as possible - lifestyle modifications, medications
- Blood pressure lowering medications
- Antiplatelet therapy
- Statin therapy
- Identifying risk factors:
- Stroke treatment:
- Immediate care:
- Sustain life - life support, transport to hospital, monitoring
- Emergency measures:
- Prevent further thrombosis or hemorrhage
- Thrombolysis (using medications like rt-PA) to dissolve the clot in cases of thrombosis or embolism
- Long-term management:
- Anticoagulants - heparin (IV), coumarin, aspirin, dipyridamole combined with aspirin (Aggrenox), subcutaneous low molecular weight heparin, platelet receptor antagonists (ticlopidine)
- Immediate care:
- Prevention is key:
- Dental management of patients with stroke:
- Minimize risks of bleeding and hemorrhage:
- Atraumatic surgical techniques
- Gentle pressure
- Hemostatic agents (e.g., Gelfoam)
- Suturing
- Use caution with vasoconstrictors in local anesthetics:
- Limit the use of vasoconstrictors to less than 4 mL
- Avoid epinephrine in gingival retraction cord
- Schedule short, stress-free, midmorning appointments
- Provide nitrous oxide sedation for patients who need extra comfort
- Monitor blood pressure and oxygen saturation
- Recognize signs and symptoms of stroke:
- Be prepared to provide emergency care and activate an emergency medical system
- Be patient and supportive - prior strokes may require assistance with getting to the dental chair, oral hygiene, and effective oral evacuation
- Minimize risks of bleeding and hemorrhage:
- Oral manifestations and complications related to stroke:
- Stroke-in-evolution:
- Slurred speech
- Muscle weakness
- Difficulty swallowing
- Completed stroke:
- Loss of or difficulty with speech
- Unilateral paralysis of orofacial musculature (on one side of face)
- Loss of sensory stimuli in oral tissues
- Flaccid tongue with multiple folds, possible deviation on protrusion
- Dysphagia (difficulty swallowing)
- Difficulty managing liquids and solids
- Patients with right-sided brain damage might neglect the left side of their mouth, leading to food and debris accumulation
- Severe periodontal bone loss is associated with carotid artery plaques and increased risk of stroke
- Stroke-in-evolution:
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Description
This quiz explores the various classifications of epileptic syndromes, detailing both primary and generalized types. It covers specific conditions like juvenile myoclonic epilepsy and benign epilepsy with centrotemporal spikes. Test your understanding of the characteristics, triggers, and implications of these syndromes.
