1. The Patient with a Neurological or Seizure Disorder
Baylor College of Dentistry
Tammy Fisher RDH BS
March 22, 2016

2. Objectives
Upon completion of the classroom presentation and reading assignments, the student will be able to:
Explain the etiology of seizure disorder.
Describe factors that may precipitate a seizure.
Compare and contrast the characteristics of the three common types of seizures…Absence, Tonic-Clonic, Status Epilepticus
Recognize the generic and brand names of the drugs of choice used to control seizures and the possible side effects.
Etiology is very difficult to pinpoint. Birth trauma, genetic, head injury, metabolic disorders, alcohol, drugs, stroke, fever, infection, brain tumors and chemical imbalances may cause seizures.

3. Objectives
Explain the role of the dental hygienist in the treatment of a patient with seizure disorder.
Explain the emergency management of a seizure.
Discuss the clinical procedure at Baylor College of Dentistry for management of the patient with a seizure disorder. Medical clearance by the physician!!
Define all related terminology for the patient with a seizure disorder.

4. Definitions
Epilepsy-describes a group of functional disorders of the brain
Seizure-a paroxysmal event resulting from abnormal brain activity
Convulsion-a violent spasm
Prodrome-a symptom indicating the onset of a condition, may begin a few days or hours before the onset, headache, irritability, depression, insomnia, bad mood
Paroxysmal- a sudden violent attack

5. Definitions
Aura-vague feelings immediately preceding a seizure, there may be unpleasant smells, hallucinations, dream-like visions, feelings of fear
Absence-a generalized seizure of sudden onset characterized by a brief period of unconsciousness
Tonic-Clonic-(Grand Mal seizures)a sudden sharp tonic contraction of muscles followed by clonic convulsive movements
Status Epilepticus-rapid succession of epileptic spasms without intervals of consciousness; life threatening; emergency care urgent; may last from 5 to more than 30 minutes
42,000 deaths per year with Status Epilepticus. A common precipitating factor in adults is noncompliance with medication or withdrawals from medication.

6. Sudden Unexplained Death in Epilepsy (SUDEP)
living with epilepsy and seizures that may increase the risk of early death. 
not well understood,  suspected to be related to heart rhythm problems during a seizure.
more often among people with convulsive seizures, especially generalized Tonic-Clonic seizures that are not well controlled.
Person with seizures dies unexpectedly

7. Sudden Unexplained Death in Epilepsy (SUDEP)
Other risk factors include:
Poorly controlled seizures
Treatment with multiple anticonvulsant drugs
Chronic epilepsy
Epilepsy at a young age
Generalized Tonic – Clonic seizures
Discontinuing or irregular taking of medications

8. Seizures may be precipitated by:
STRESS
Fatigue
Sleep Deprivation
Apprehension and Anxiety
Sensory Stimuli
Every dental hygiene student!!

9. 4 Stages of a Seizure
Prodromal
Aura
Seizure (Ictus)
Post-Ictal Phase

10. Treatment No known cure
Medications first line of therapy for epilepsy – dozens of anti-epileptic medications
Drug of choice – should control seizures with no side effects. Most medications do not completely control the condition. Drugs work by making over-active brain cells less excitable. Others drugs work by decreasing the brain cells’ ability to transmit abnormal impulses. Do not stop meds abruptly – cause seizure
Other treatment include: Vagus Nerve Stimulation Therapy(only for uncontrolled cases over age 12), Medical Marijuana and the Ketogenic Diet
Ketogenic diet- high fat, moderate protein and low carb.
Vagus nerve stimulation reduces seizures by ½ for 1/3 of patients who receive the treatment, 1/3 see some reduction and 1/3 see no reduction.
Medical marijuana does relieve some seizure activity in the 1/3 that do not respond to other treatment, Tx passed a law in 2015 to allow a cannibis oil for intractable seizures but did not allow a broad use of medical marijuana.

11. Advanced Gingival Hyperplasia
Lobules
Cleft-like grooves
Increased size of marginal gingiva
Maxillary anterior – usually affected

12. Seizure Characteristics
Unprovoked
Unpredictable
Involuntary
Uncontrollable length
Sudden paroxysmal electrical discharge of neurons in the brain

13. What to do: #1 Do not panic! Call for help Terminate treatment
Position patient to supine position and monitor safety
Push away any movable equipment

14. What to do: Do not place ANYTHING in the mouth!
Place patient on their side
Stay with the patient
If seizure reoccurs or is still continuing in five minutes, call 911
Document!

16. Emergency procedures Stop all treatment
Try to keep patient calm. Do not restrict movement
If seizure continues for more than 5 minutes call 911
Turn patient on side
Prompt treatment is key to preventing death
Hospital treatment consists of IV drugs such as diazepam, lorazepam, phenytoin and phenobarbital.

17. Commonly Prescribed Medications
Keppra
Lyrica
Neurontin
Tegretol
Topamax
Clonazepam
Phenobarbital
Phenytoin
Gabapentin

18. Jigsaw Exercise
30 Students will number off from 1-6, and move into 6 groups. Then they will number off from 1-5 and pick up a numbered envelope according to their number. All the 1’s will gather with envelope #1, and so on. The students will have 10 minutes to research the questions with their group. Then they will return to their original group and teach those classmates the part they learned for 10 minutes.
Group 1- clinical manifestations
Group 2- treatment other than medications
Group 3- common medications
Group 4- oral findings
Group 5- dental hygiene care plan

19. Closing
Wrap up
Two minute free write

20. References
Darby, M Dental hygiene theory and practice (pp ). St. Louis, MO: Saunders/Elsevier Wilkins, E. M The patient with a seizure disorder. In Clinical practice of the dental hygienist (pp ). Philadelphia, PA: Lippincott, Williams & Wilkins.