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Authors: John Morgan, Bonnie F. Zimble

Epilepsy/Seizure Disorders:

Etiology; Epidemiology and Statistics;
 
Diagnosis and Treatment:

 Dental Considerations

Special Care in Dentistry
John Morgan, DDS
Tufts University School of Dental Medicine, 2008


Study Questions:
   

  1. What is known about the cause of epilepsy?
  2. Summarize the epidemiological statistics for epilepsy.
  3. What methods are used in diagnosis?
  4. Summarize treatment options for young and adult patients with seizures.
  5. Describe two dental considerations associated with:
    1. Dilantin hyperplasia
    2. Facial trauma

Etiology 

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 have idiopathic 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 develop seizures. 

Click here to access the NINDS web site and find an article entitled: Seizures and Epilepsy: Hope through Research. 

Epidemiology and Statistics 

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 

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.

Treatment 

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 patient 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 (Depakene).
     
  • 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.

Dental Considerations  

  • Dilantin 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. 
  • Facial 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 are contraindicated.