- What is known about the cause of epilepsy?
- Summarize the epidemiological
statistics for epilepsy.
methods are used in diagnosis?
- Summarize treatment options for young and adult
patients with seizures.
two dental considerations associated with:
- Dilantin hyperplasia
- Facial trauma
Seizures can result from either primary central nervous
system dysfunction or an underlying metabolic derangement, or systemic
disease. The 50 to75 percent of patients with epilepsy with
no known cause for the disorder are said to
seizures. Seizures that
initially occur after age 25 are often associated with brain tumors or
head trauma. Approximately 15% of people with Alzheimer’s disease
Click here to access the
web site and find an article entitled:
Epilepsy: Hope through
According to NINDS…
“More than 2 million people in the
United States -- about 1 in 100 -- have experienced an unprovoked
seizure or been diagnosed with epilepsy. For about 80 percent of those
diagnosed with epilepsy, seizures can be controlled with modern
medicines and surgical techniques. However, about 20 percent of people
with epilepsy will continue to experience seizures even with the best
available treatment. Doctors call this situation intractable epilepsy.
Having a seizure does not necessarily mean that a person has epilepsy.
Only when a person has had two or more seizures is he or she considered
to have epilepsy.”
Diagnosis begins with an evaluation to determine causative
factors. The physician takes a complete history, gives a physical and
neurological exam, and orders appropriate laboratory tests, which can
include blood chemistries, cerebrospinal fluid analysis, and
electroencephalography (EEG). EEG patterns can aid in the
classification of a seizure disorder because typical patterns are
associated with various types of seizures.
Characteristics of treatment include
- Treatment depends on diagnosis. If a cause
can be found, treatment is aimed at eliminating the cause. If no cause
can be found, treatment is aimed at reducing the number of seizures to
promote integration of the patient in the community, and to help
maximize the individual’s potential.
- Reduction of seizures is
achieved through the use of anticonvulsant drugs, which must be
monitored closely to minimize adverse reactions, such as blood
dyscrasias, and to correlate blood levels with seizure activity.
Sometimes, when the patient has more than one type of seizure, control
can be very difficult to maintain.
- Phenobarbitol is the first drug
of choice for the
young patient, for all types of seizures except
petit mal. Phenytoin (Dilantin) or carbamazapine (Tegretol) is usually
selected first for the adult
for focal or generalized seizures, with the exception of
petit mal. Phenytoin is the drug of choice for adults because, if used
correctly, it will provide complete control for most patients.
Antiepileptic drugs prescribed for petit mal seizures include
ethosuximide (Zarontin), trimethadione(Tridone), and valproic acid
- Status Epilepticus.
Repeated or prolonged seizures, in which the patient is unable to
regain consciousness, is a true medical emergency. Activation
of EMS at once for patient transport to the nearest hospital
emergency room is crucial. Treatment consists of prompt administration
of IV diazepam or IM phenobarbitol.
Hyperplasia. An overgrowth of attached
gingiva occurs as a side effect of Dilantin therapy in 20-30% of
patients treated for epilepsy.
- Risk of Increased
Bleeding. Tegretol and Depakene therapy may cause
increased bleeding during surgical procedures.
Trauma. If a patient presents with a history
of repeated facial trauma due to seizures and falling, it is advisable
to modify the treatment plan. Avoid removable appliances that could
fracture and be aspirated during a seizure. Fixed bridgework is
preferable for replacement of missing teeth; however, if a removable
partial must be used, it should be well-reinforced with metal. Flippers