MANAGEMENT OF EPILEPTIC PATIENT, PREVENTION AND MANAGEMENT OF EPILEPTIC ATTACK

EPILEPSY: is defined as chronic brain disorder of various etiologies characterized by recurrent seizures due to excessive discharge of cerebral neurons. ( WHO) SEIZURES: is defined as a symptom .. an occasional, an excessive and a disorderly discharge of nerve tissue.( 1870 by Hughling Jackson) MANAGEMENT OF EPILEPTIC PATIENT:  Discontinue surgery until seizures are well controlled  Consider having serum levels of antiseizures medications measured if patient compliance is questionable  Use anxiety reduction protocol  Avoid hypoglycemia and fatigue MANAGEMENT OF EPILEPTIC ATTACK:

Prodromal stage
Recognize aura

[Before a tonic-clonic seizure occurs,the epileptic patient exhibits subtle to obvious changes in emotional reactivity,including increase in anxiety or depression

Discontinue dental treatment

Ictal stage
[A series of sustained generalized skeletal muscle contractions occur first in flexion,which then progress to a tonic extensor rigidity of extremities and trunk]

Activate office emergency team

P - Position patient in supine position with legs elevated

Consider activation of emergency medical services

Assess and perform basic life support as needed A B C (Airway,Breathing,Circulation)

D-Defintive care Protect patient from injury

IF SEIZURE PERSISTS FOR MORE THAN 5MIN STATUS EPILEPTICUS

A B C Assess and perform basic life support as needed Perform venipuncture and administer Anticonvulsant(Diazepam 5mg/min IV mg)

Administer 50%IV dextrose solution

PREVENTION

NON EPILEPTIC CAUSES History and Physical evaluation before treatment

EPILEPTIC CAUSES goal of doctor is to determine the probability of acute seizure developing

Care of selection of LA and technique.

during treatment and take necessary steps to minimize that possibility. minimize clinical complications associated with seizure.

REFERENCES: -MEDICAL EMERGENCIES IN DENTAL OFFICE-MALAMED ( 6 Edition) -CONTEMPORARY ORAL AND MAXILLOFACIAL SURGERY-PETERSON ( 2 Edition)
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