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GROUP 4: EPILEPSY Nurin Syahidah Syafiqah Nadhirah Nor Anis Zullyana Nik Mohd Haziq Asyraf Hamzi Muhamad Mohd Hanif Ahmad Fais Aimi Amalina

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DEFINITION Epilepsy is a chronic disorder of the brain that affects people in every country of the world. It is characterized by recurrent / two or more unprovoked seizures. Seizures are brief episodes of involuntary shaking which may involve a part of the body (partial) or the entire body (generalized) and sometimes accompanied by LOC and loss control of bowel or bladder function. Pathophysio > 1. Result of excessive electrical discharges in a group of brain cells. 2. Different parts of the brain can be the site of such discharges. 3. Seizures can vary from the briefest lapses of attention or muscle jerks, to severe and prolonged convulsions. 4. Seizures can also vary in frequency, from less than one per year to several per day.

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EPIDEMOLOGY (BY WHO) Epilepsy is a chronic noncommunicable disorder of the brain that affects people of all ages. Around 50 million people worldwide have epilepsy. ~ 80% of the people with epilepsy are found in developing regions. Currently 70% - responds to treatment, yet about 3/4 fourths of affected people in developing countries do not get the treatment they need. Patient is associated with stigma and discrimination in many parts of the world

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BY NICE Incidence is estimated to be 50 per 100,000 per year the prevalence of active epilepsy in the UK is estimated to be 510 cases per 1000. Two-thirds of people with active epilepsy have their epilepsy controlled satisfactorily with anti-epileptic drugs (AEDs). Other approaches may include surgery

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CAUSES (WHO) The MC type for 6/10 people with the disorder is called idiopathic epilepsy and has no identifiable cause. In many cases > underlying genetic basis. Secondary epilepsy/ symptomatic epilepsy > epilepsy with a known cause could be: 1. brain damage from prenatal or perinatal injuries a loss of oxygen or trauma during birth, low birth weight 2. congenital abnormalities or genetic conditions with associated brain malformations; 3. a severe blow to the head; 4. a stroke that starves the brain of oxygen; 5. an infection of the brain such as meningitis, encephalitis, neurocysticercosis; 6. certain genetic syndromes; 7. a brain tumor

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CAUSESCAUSES

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CLASSIFICATION OF EPILEPSY

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TypeSub-typeMain features Generalized seizuresTonic-clonic (Grand mal)Loss of consciousness Tonic phases Clonic phases Tongue biting Incontinence Seizure lasts < 5 minutes Absences (Petit mal)Brief period of unresponsiveness Episode lasts < 30 seconds Partial seizuresSimple (Jacksonian epilepsy)Motor, sensory, autonomic or psychic features Comples (Temporal lobe epilepsy) Impaired consciousness Automatic repetitive acts OthersMyoclonic Atonic

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GRAND MAL (TONIC-CLONIC) EPILEPSY Begins in the pre-school child/occasionally at puberty Warning/aura LOC tonic & clonic convulsions recovery Aura: Mood change Irritability Brief hallucination Headache Sensation of strong smell (e.g burning rubber) Initially: Face become pale Pupils dilate Opisthotonous & glottic Respiratory muscle spasm cry & cyanosis

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GRAND MAL (TONIC-CLONIC) EPILEPSY Clonic phase: Repetitive jerking movements of trunks, limbs, tongue & lips Profuse salivation + bruxism + tongue biting + vomiting Urinary/faecal incontinence Tachycardia/hypertension/flushing Flaccid semi-coma (10 15 min) recovery

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STATUS EPILEPTICUS Definition A seizure lasting for more than 30 min or repeated seizures over the same period without intervening periods of consciousness dangerous: Inhalation of vomit & saliva Brain damage d/t cerebral hypoxia Death

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PETIT MAL SEIZURES MC occur during childhood Characterized by: Minimal/no movements : may appear like a blank stare Brief sudden loss of awareness/consciousness (few seconds) Recur many times Decreased learning (often thought to be daydreaming)

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SIMPLE PARTIAL (FOCAL) SEIZURES Can be motor/sensory/behavioral Confined to one area Present as: Muscle contractions of a specific body part Jacksonian epilepsy : spread to adjacent muscles on the same side of the body Abnormal sensation Nausea, sweating, skin flushing, dilated pupils

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COMPLEX PARTIAL SEIZURES Aka temporal lobe epilepsy/psychomotor epilepsy Characterized by: Lip smacking, chewing movements, facial grimacing Abnormal sensation Nausea, sweating, skin flushing, dilated pupils Recalled/inappropriate emotions May/may not be disorientation, confusion & amnesia/LOC Olfactory/gustatory hallucinations/impairment

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MANAGEMENT

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EPILEPSY : MANAGEMENT Call for help Stop treatment Lay the patient flat on the chair, do not try to move the patient while they are actively fitting Protect the patient from injury; Do not attempt to put spoon or tongue depressor on between the teeth or any other hard objects Clear the working area Do not attempt to restrain or holding down the patient during seizure

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If patient is having difficulty to breathe or becoming cyanosed, gently extending the neck to maintain the airway CPR or mouth-to-mouth breathing cannot be performed during seizure and rarely needed after seizure. Uncomplicated seizure: no other treatment is necessary If attack continues longer than normal or > 10 minutes, give Midazolam 10mg IM If attack does not resolve within the next 5 minutes, call ambulance (status epilepticus) While waiting, protect the airway with suction (remove saliva) and administer high flow oxygen 10-15 L/min

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NICE

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MANAGEMENT The AED (anti-epileptic drug) treatment strategy should be individualised according to the seizure type, epilepsy syndrome, co- medication and co-morbidity, the child, young person or adult's lifestyle, and the preferences of the person, their family and/or carers as appropriate. [NICE 2004]epilepsy syndrome

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EMERGENCY STOP treatment! Medication: Administer buccal midazolam as first-line treatment in children, young people and adults with prolonged or repeated seizures in the community. Administer rectal diazepam if preferred or if buccal midazolam is not available. If intravenous access is already established and resuscitation facilities are available, administer intravenous lorazepam. [NICE 2012]

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AAPD

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REFERENCE 1. WHO; http://www.who.int/mediacentre/factsheets/fs999/en/ 2. NICE ; guidance.nice.org.uk/cg137 3. Special Care in Dentistry. Churchill Livingstone. 4. ILAE ; Ihttp://www.ilae.org/Visitors/Centre/Definition.cfm