WK4 - Lecture 17 - Seizure PDF

DH 410 EMERGENCIES IN DENTAL PRACTICE LECTURE: SEIZURE DISORDERS Objectives  Understand and discuss pathophysiology of seizures  Understand and discuss seizure etiology  Recognize signs and symptoms associated with seizures  Explain needed steps to be taken for a patien...

DH 410 EMERGENCIES IN DENTAL PRACTICE LECTURE: SEIZURE DISORDERS Objectives  Understand and discuss pathophysiology of seizures  Understand and discuss seizure etiology  Recognize signs and symptoms associated with seizures  Explain needed steps to be taken for a patient experiencing a seizure Seizure  Temporary episode of behavior alteration due to massive abnormal electrical discharges in the brain  Alterations in state of consciousness, motor activity, or sensory phenomena  Sudden onset and brief activity  Maybe accompanied by convulsions or other sensory or emotional changes Seizure  Anyone may experience a seizure under extreme circumstances (isolated non-recurrent attacks)  Caused by systemic distress Hypoxia Hypoglycemia (rapid drop in blood glucose) Children – rapid rise in body temperature (fever)  Caused by brain damage Tumor Trauma Seizure  Genetic tendency  50% all seizures are idiopathic (unknown cause)  Most seizures are not life-threatening Epilepsy (Epileptic)  A group of seizures that involve chronic recurrent attacks 2 or more unprovoked seizures more than 24 hrs apart  Most common neurological disorder among children 2nd most common in adults  Highest incidence rate < 2 years and > 65 years Etiology of Seizures  Imbalances in neurotransmitters  Excess of excitatory neurotransmitter acetylcholine  Deficiency of inhibitory neurotransmitter gamma-aminobutyric acid (GABA) Seizures – Dental Setting Risk factors in a dental setting:  Hypoglycemia  Syncope  Hypoxia (need for oxygen)  after administering nitrous oxide  Local anesthetic toxicity  Epilepsy Preventive Strategies in Dental Office  Preparing for management if a seizure should occur  Medical History  Information about seizures essential  Types of seizures?  How often? When was your last seizure?  Triggers?  How long do they last?  Aura (warning sensation)  History of injuries  Medications Preventive Strategies in Dental Office  If not well controlled or factors exist which would predispose the patient to a seizure that day – treatment should be postponed until more stable BEST SEEN:  Early morning appointments after a meal and within a few hours of taking medication optimal time for treatment Types of Seizures  Determined by EEG pattern  Some patients may suffer more than one type of seizure  Focal / Partial Simple Complex  Generalized Generalized tonic-clonic (GTCS) “grand mal” Absence “petit mal” Types of Seizures  Focal / Partial seizures  Simple Partial seizures  No loss of consciousness  One hemisphere  Complex Partial seizures  Impaired awareness  Travels to the opposite hemisphere  Simple Partial Seizures  Symptoms:  Illusions  Déjà vu  Flashing lights  Hallucinations  Tingling or creeping sensations  Vertigo  Sounds  Foul smells  Aura  Aura Auras now considered to be a simple partial seizure Warning signs of impending complex or generalized seizure Symptoms reflect area of brain affected Visual – occipital lobe Auditory – temporal lobe Olfactory Amnesia often follows – patient unaware of Aura Examples of Partial Seizures  Stiffening  Jerking  Tingling of extremity  No loss of consciousness  May progress to generalized tonic-clonic seizure  Complex Partial Seizures  Impairment of consciousness  Often begin in temporal lobe  33% of people with temporal lobe seizures have psychiatric disorder – 10% schizophrenia or depressive psychoses  Complex Partial Seizures  Signs and symptoms  Losingcontact with surroundings – a few seconds to 20 minutes  Automatisms – repetitive, non-purposeful activity (lip smacking, grimacing (sharp contortion of the face expressive of pain, contempt, or disgust), patting, wandering in circles, unintelligible speech)  At the end of motor activity – mental confusion or fear Generalized Seizures  Abnormal electrical activity of both sides of brain at the same time  Loss of consciousness Types of Generalized Seizures  Tonic-clonic  “grand mal”  Absence  “petit mal” Generalized Tonic-Clonic Seizures (GTCS) “grand mal”  MOST COMMON type of seizure disorder  90% of epileptics have GTCS  Occurs equally in both sexes  Any age – although 60% by puberty  Generalized Seizures Precipitating factors:  Anxiety  Fear  Fatigue  Flickering of lights or sounds  Phases of GTCS  Generalized Tonic-Clonic Seizures (GTCS)  Specific sequence Aura Pre-Ictal Ictal Post-Ictal Not all people experience all symptoms  Aura  Warning sign  Can be prelude (introduction) to GTCS (Grand Mal)  Considered a simple partial seizure  Usually same aura  Patient recognizes and prepares for seizure  Lasts only a few seconds  Not all seizures preceded by auras  May not remember aura due to amnesia from seizure  Pre-Ictal Phase  Soon after aura  Patient loses consciousness  May fall if standing  oftencauses injuries  Most common cause of seizure related injury  Ictal Phase  Tonic phase  Muscles have sustained contraction (rigid body)  Epileptic cry – lung or vocal cord contraction  Dyspnea - contraction of respiratory muscles  10-20 seconds  Ictal Phase  Clonic phase  Convulsions (rhythmic muscular contractions and relaxation)  Heavy, labored breathing  Clenched jaw  Saliva + air = froth at mouth  Biting tongue or soft tissues  2-5 minutes – gradually slow with final flexor jerk  Post-Ictal Phase  Movement stopped – total relaxation of muscles  Unconscious  CNS, CVS, and respiratory system depression  time when death is most likely May awake with:  Confusion  Fatigue  Amnesia  Emergency Management: GTCS Seizures  Primary task is to protect patient and try to prevent injury before, during, and after  Cease dental treatment  Remove instruments from mouth  Move equipment out of the way  Position: supine  Contact EMS  C-A-B, as needed  Monitor vitals  Gently restrain (protect injury)  Oxygen 4-6 L/min if necessary  Reassure patient  Dismiss patient with responsible adult Generalized Absence Seizures “petit mal”  Generalized electrical abnormality throughout the brain WITHOUT loss of consciousness  May progress to GTCS  Amnesia of episode  Rare after age 20 Generalized Absence Seizures Symptoms  Brief change in level of consciousness  Eye rolling  Blinking  Blank stare  Lasts 5-30 seconds Emergency Management: Generalized Absence Seizures  Stop dental treatment for duration of episode  Remove instruments from mouth  Position: supine, feet elevated  Reassure patient  Allow recovery before dismissal to a responsible adult  References Malamed, S. F. (2022). Medical emergencies in the dental office. Elsevier. Little, J. W., Miller, C., & Rhodus, N. L. (2017). Little and Falace’s dental management of the medically compromised patient. Mosby. Grimes, E. B. (2014). Medical emergencies: Essentials for the Dental Professional. Prentice Hall  https://www.epilepsy.com/learn/about-epilepsy-basics/what-epilepsy  https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact- Sheets/Febrile-Seizures-Fact-Sheet  https://www.epilepsy.com/learn/about-epilepsy-basics/what-epilepsy  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3931180/  https://www.colgatedentaleducatorsnetwork.com/webinar/medical- emergencies-for-the-dental-professional-part-3-medical-emergency- scenarios/