EPILEPSY

ASSOC PROFESSOR DR. VINOTHINI

Learning objectives

Define epilepsy

Describe the classification of epilepsy

List the common causes of epilepsy

Describe the clinical features and management

of epilepsy
Epilepsy

Definition

- any disorder characterized by recurrent

seizures due to chronic underlying process

A single seizure is not an epilepsy

Epilepsy

Seizure a transient clinical event due to

abnormal paroxysmal excessive discharges from
a group of central nervous system neurones.

Convulsion the motor form of seizure

Classification
2 major types of seizures :

Partial seizure activity is restricted to localized

part of one cerebral hemisphere

Generalized involves both cerebral hemispheres

diffusely and simultaneously
 C-Slide 6

Partial Seizures

Simple
- Consciousness is preserved.
- May spread diffusely throughout the cortex
and result in secondary generalized seizures

Complex
- impaired consciousness
 C-Slide 7

Simple Partial Seizures

Various presentations are :

Focal motor : jerky movements of limbs or other

parts
Somatosensory :localised paraesthesias
Autonomic : flushing, sweating and piloerection
Psychic symptoms : illusions, hallucinations,
affective disturbances and deja vu
 C-Slide 8

Complex Partial Seizures

Impaired consciousness
Clinical manifestations vary with site of origin and degree of
spread
Presence and nature of aura
Stares blankly (blackouts)
Automatisms involuntary automatic behavioural movements
eg. chewing, lip smacking
Other motor activity
Duration (typically 1 minute)
Do not respond to visual or verbal commands
Drowsy following seizures
Amnesia
Primary generalized seizures
Tonic clonic seizures
Grand mal
Occur abruptly without warning/ some
premonitory symptoms
Sudden LOC
Fall to the ground
Sustain injuries
Primary generalized seizures
Tonic phase
Initial phase is characterized by increased
muscle tone
Cyanosis, impaired respiration, pooling of
secretions in oral cavity
Tongue bite due to contraction of jaw muscles
Increased sympathetic manifestations -
tachycardia
Primary generalized seizures
Clonic phase

Jerky movements for few minutes

Then muscular flaccidity and unresponsiveness
Bladder and bowel incontinence
Regains consciousness over minutes to hours
Postictal headache, confusion, muscle ache,
fatigue
Absence seizures
Petit mal
Occurs in childhood
Brief lapses of sensorium
Loss of postural control
Too subtle to be noticed
No postictal confusion
Mild motor movements eg. blinking of eyes,
chewing, and hand clonus
Etiology of Seizures
C-Slide 13

The aetiology depends on the age of the patient :

Infancy and childhood

- febrile seizures
Prenatal or birth injury (hypoxia)
Metabolic derangements
Congenital malformation

Childhood and adolescence

Idiopathic/genetic syndrome
CNS infection
Trauma
Etiology of Seizures
C-Slide 14

The aetiology depends on the age of the patient :

Adolescence and young adult

Head trauma
Drug intoxication and withdrawal*

Older adult
Stroke
Brain tumor
Acute metabolic disturbances*
Neurodegenerative
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Evaluation of a Seizure
History, physical

Blood tests:
- Full blood count, ESR(erythrocyte
sedimentation rate)
- Electrolytes
- Glucose
- calcium, magnesium, phosphate,
- hepatic and renal function
Evaluation of a Seizure
Electroencephalogram
- Helps in diagnosis and classifications of seizure
disorders
- Characteristic changes in different epilepsies

CT or MR brain scan
- Indicated in focal seizures, focal neurological
signs, age of onset > 20 years
Evaluation of a Seizure

Lumbar puncture
- only if meningitis or encephalitis suspected

Blood or urine screen for drugs

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Management
General precautions
Refrain from working with dangerous equipments
and avoid swimming, fishing or cycling.
Avoid activity eg. driving where LOC is dangerous,
fire or heights
Adequate sleep
Avoidance of alcohol, stimulants, etc.
Avoidance of known precipitants
Stress reduction specific techniques
Management

Immediate care of seizures

Patient is shifted to a safer place, away from

danger.
Patient turned to semi prone position to prevent
aspiration
Patient should not be left alone until full
recovery
Nil by mouth until full recovery
Hospitalization for prolonged duration of
seizures (> 5 mins)
Management
Treatment of underlying condition

Correct abnormalities immediately eg.

hypoglycaemia.

Withdraw offending drug.

Brain tumours to be managed surgically

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Management

Avoidance of precipitating factors

Avoidance of alcohol, stimulants, etc.

Avoidance of known precipitants eg. flickering

lights on TV, loud music,

Stress reduction specific techniques

Management
Antiepileptic drug therapy

Indicated in patients with recurrent seizures of

unknown aetiology.

Choice of medicine depends on type of seizures :

Initiated with single drug
Drug gradually increased until seizures are
controlled/side effects appear
Some patients may require 2 -3 drugs

Treatment should be continued until no seizures for 2

-3 years
Implications on dental practice

Fixed prosthesis is placed rather than removable

appliances because latter may dislodge during
seizure

Gingival hyperplasia occurs in patients taking

phenytoin.
Implications on dental practice

No need to increase dose of drugs in well

controlled epilepsy prior to procedures.

Routine use of sedation is not necessary

Drugs may precipitate seizures or interfere with

anticonvulsant drugs