dh201 clinical sciences iii lisa mayo rdh, bsdh “what lies behind us and what lies before us are...

DH201 CLINICAL SCIENCES III Lisa Mayo RDH, BSDH What lies behind us and what lies before us are tiny matters compared to what lies within us Ralph Waldo Emerson CNS Disorders CH 58

CNS Disorders 1. Spinal Cord Injury 2. Stroke 3. Bells Palsy 4. Multiple Sclerosis 5. ALS 6. Parkinsons 7. Myasthenia Gravis 8. Cerebral Palsy 9. Spina Bifida 10. Seizure

1. Spinal Cord Injury

Spinal Cord Injury Spinal cord caries both motor and sensory nerves that branch to send messages between the brain and specific areas of the body Injury to the spinal cord which causes paralysis and loss of sensation in nerve cells 450,000 people in USA spinal cord injury (SCI) 100,000 new cases each year 16-30yrs of age most common

Spinal Cord Injuries Etiology 50% motorcycle/automobile accidents 25% occupational accidents 20% sports related 5% falls or violence

Spinal Cord Injury Spine anatomy 7 Cervical 12 Thoracic 5 Lumbar 5 Sacral Coccyx

Vertebrae Anatomy for Review

Spinal Cord Injury Sensor motor effects 1. Complete lesion: no sensation or motor function below the level of the lesion 2. Incomplete lesion: Partial injury to the spinal cord. Leaves some evidence of sensation or motor function below the level of the lesion Some function may return within a few hours after injury Max return = 6-18 months Most severe = lesion levels above C6

Spinal Cord Injuries Characteristics Paraplegia: damage to thoracic, lumbar or sacral vertebrae Quadriplegia: cervical vertebrae involved Oral Considerations Loss of function will affect daily oral hygiene Paralysis of face will affect mastication Wheelchair transfers will be necessary in dental office Shunt = premed Muscle spasms Meds w/ oral side effects Short morning appts recommended Home Fl, antimicrobial mouthwash

Spinal Cord Injuries Secondary Complications (Wilkins p.889) Tendency for pressure sores (decubitus ulcer) Muscle-reflex spasticity Vulnerability to infection Cardiovascular instability Bladder and bowel complications

3. Spinal Cord Injuries InjuryFunctional Level C-1,2,3None need ventilator. Loss of diaphragm function C-4,5,6,7Partial shoulders, arms, hands ALL CERVICAL INJURIES Quadriplegia All need personal care, Wheelchair transfers Unable to regulate body temp at times Unable to elicit a function cough respiratory issues Horners syndrome: drooping eyelids, constrict pupils, sweating 1 side of face

3. Spinal Cord Injuries InjuryEffects T1-T4Paralysis of legs, trunk. Loss sensation below nipples Normal movement of shoulders/elbows T5-T11Paraplegic L1-S2Various patterns of leg weakness and numbness Depending on level of injury, no feeling to sexual organs S3-S5Numbness in the pelvis & legs Some cases sexual organs are not harmed but many times are affected Any level spinal cord injury can cause loss of bladder & bowel control!!

Spinal Cord Injuries Special Patient Dental Tx Considerations Thorough med hx Restraints as needed for involuntary muscle control Short morning appts Diet counseling OHI: pt and caregiver Wheelchair adaptations Pt positioning for stabilization and easy access (mouth props) Consider special aids for daily care and for dental tx Caring, sincere attitude by clinician showing concern for pt

Question Which of the following patients is most likely to require a 2- man transfer technique from wheelchair to dental chair? A. 10-yr old with cerebral palsy B. 25-yr old man with spinal cord injury at C6 C. 30-yr old man with mild multiple sclerosis D. 65-yr old man with arthritis in his hands

Answer B. 25-yr old man with spinal cord injury at C6

Definition: life-threatening emergency condition in which the blood pressure increases sharply (Ex: 300/160mmHg) Reflex action: pulse rate will drop Symptoms: pounding headache, flushing, chills, perspiration, stuffy nose Prevention Avoid abrupt changes in body position Semi-supine Emergency care: position chair upright gradually, do NOT recline the chair, Monitor BP & call EMS if BP does not drop within 2-3min Spinal Cord Injury Autonomic Dysreflexia

NB Question A client with a spinal cord injury at the level of C- 6 would be a quadriplegic. Power scaling devices are CONTRAINDICATED for clients with paralysis. a. The first statement is TRUE; the second is FALSE b. The first statement is FALSE; the second is TRUE c. Both statements are TRUE d. Both statements are FALSE

NB Answer A client with a spinal cord injury at the level of C- 6 would be a quadriplegic. Power scaling devices are CONTRAINDICATED for clients with paralysis. a. The first statement is TRUE; the second is FALSE b. The first statement is FALSE; the second is TRUE c. Both statements are TRUE d. Both statements are FALSE

2. CVA (Stroke)

Cerebrovascular Accident (CVA)/Stroke Sudden loss of brain function Clinical manifestation of cerebrovascular disease Patient has changes in motor function, communication, perception Hemiplegia or hemiparesis common Death can occur within minutes

Etiologic Factors for Stroke 1. Thrombosis Clot within a blood vessel of the brain or neck Clot closes the vessel and shuts off the oxygen supply Results in cerebral infarction Cerebral thrombosis is the most common cause of stroke (NBQ) 2. Intracerebral embolism Blood vessel is blocked by a clot Atherosclerotic plaque buildup can become an embolism and risk of stroke Dental panoramic film Calcifications in the carotid artery may be observable Indicate an risk of stroke Contd next slide

Etiologic Factors for Stroke 3. Ischemia Blood flow to an area of the brain 4. Cerebral hemorrhage May rupture and bleed into brain 5. Predisposing factors Atherosclerosis & Hypertension: greatest risk factor that leads to stroke Hypercholesterolemia, hypertriglyceridemia Tobacco, drug abuse Cardiovascular disease Diabetes mellitus Use of oral contraceptives (enhanced by hypertension, tobacco use, age over 35, and high estrogen levels) Contd next slide

Transient ischemic attack (TIA) Mini-stroke or Little stroke Last few min to an hour May leave no permanent damage Risk factor for a full stroke CVA S&S

Lungs Breathing labored, deep, slow Vertigo, chills Paralysis 1 side body Speech defects Loss of consciousnessWilkins p.1077

CVA S&S Effects depend on the location of the damage to the brain Side of body affected is opposite that of the brain injury Ex: Left CVA = RT hemiplegia and vice versa RT hemiplegia: difficult verbal communication and are more apt to be cautious, anxious, and disorganized LF hemiplegia: difficulty with action requiring physical coordination and may respond impulsively with overconfidence 2/3 who survive= some degree of permanent disability

CVA Assessment Considerations Unilateral/bilateral loss of function HBP, diabetes, coronary disease increase risk Difficulty in communication Wilkins p.892, box 58-3 for common meds Poor oral hygiene & challenged with home care Increased caries, perio Do NOT tx for 6mo following stroke

NB Question Elective dental treatment should be postponed until ___ months after a stroke. a. 1 b. 2 c. 4 d. 6

NB Answer Elective dental treatment should be postponed until ___ months after a stroke. a. 1 b. 2 c. 4 d. 6

NB Question A sudden loss of brain functioning resulting from an interference of blood supply to the brain best describes: a. Alzheimers disease b. Stroke c. Myocardial infarction d. Ventricular septal defect

NB Answer A sudden loss of brain functioning resulting from an interference of blood supply to the brain best describes: a. Alzheimers disease b. Stroke c. Myocardial infarction d. Ventricular septal defect

NB Question A client presents with the following characteristics: paralysis on the left side of the body, personality change to a more abrupt manner, vocabulary problems, and a decrease in auditory memory. What is the most likely cause of these symptoms? a. Myasthenia gravis b. Multiple sclerosis c. Right cerebrovascular accident d. Parkinsons disease

NB Answer A client presents with the following characteristics: paralysis on the left side of the body, personality change to a more abrupt manner, vocabulary problems, and a decrease in auditory memory. What is the most likely cause of these symptoms? a. Myasthenia gravis b. Multiple sclerosis c. Right cerebrovascular accident d. Parkinsons disease

3. Bells Palsy

Bells Palsy Idiopathic, unilateral facial muscle paralysis Etiology unknown May be assoc w/viral infections or damage to the nerve oHerpes simplex, herpes zoster, cytomegalovirus oDamage to nerve or parotid gland surgery Affects 7 th cranial nerve (Facial) Unilateral Eyelids will not close, pre-disoposes to eye infections Recovery: 3 weeks-6mo or not at all Tx: no cure Seen positive results with use corticosteroids + antivirals given w/in first 72 hours Surgery to repair damage

Bell s Palsy Characteristics Abrupt weakness or paralysis of facial muscles, usually w/out pain Mouth: corner droops = salivation, drooling is uncontrollable Eyelids may not close Speech and mastication may be impaired

Bells Palsy Tx plan modifications Lack of eye closure Need eye and airway protection Excessive salivation/drooling Emphasize personal home care on afflicted side

Review Bell s palsy is paralysis of which cranial nerve? A) Fourth B) Fifth C) Sixth D) Seventh E) Eighth

Answer D) Seventh is the correct answer. Bell s palsy is paralysis of the facial muscles innervated by the seventh, or facial, cranial nerve.

NB Question Each of the following conditions is associated with paralysis EXCEPT one. Which one is the EXCEPTION? a. Bells palsy b. Graves disease c. Stroke d. Spinal cord compression

NB Answer Each of the following conditions is associated with paralysis EXCEPT one. Which one is the EXCEPTION? a. Bells palsy b. Graves disease c. Stroke d. Spinal cord compression

Multiple Sclerosis (MS) Chronic degenerative disease of the myelin sheath within the white matter of the CNS and becomes sclerotic Myelin is the fatty tissue around the nerve fibers Results in interference with the transmission of nerve impulses and frequent involvement of the spinal cord and optic nerves Women more than men Caucasians more common Average onset is 30 Normal life span 80% have functional limitations after 15 years Periods of remission

Multiple Sclerosis Characteristics Unilateral facial numbness or pain Paralysis in 1+ extremities Balance abnormalities Disruptions in thinking/behavior & speech (dysarthria) Nystagmus: involuntary eye motions & diplopia Susceptibility to infections Oral Characteristics Swallowing problems (dysphagia) Facial muscle weakness Increased susceptibility to dental disease

MS Diagnosis/Treatment Early tx w/in 6mo of onset is crucial to deter neurologic damage TX Goal= prevent relapses & worsening symptoms Palliative tx to manage symptoms, improve function, and safety Psychological support Meds: Wilkins p.894, Box 58-4

MS Dental Treatment General hygiene care Adequate nutrition Avoidance of strain & stress Prevention of infections & injury Medication side effects Wheelchair & catheters common towards end of life

NBQ: Which of the following disorders is characterized by periods of active symptoms, then remission when toxins that damage nerve fibers and replace the myelin sheath with sclerotic tissues? a. Muscular dystrophy b. Multiple sclerosis c. Myasthenia gravis d. Parkinsons disease

Which of the following disorders is characterized by periods of active symptoms, then remission when toxins that damage nerve fibers and replace the myelin sheath with sclerotic tissues? a. Muscular dystrophy b. Multiple sclerosis c. Myasthenia gravis d. Parkinsons disease A: muscle disease B: when myelin sheath of nerves is destroyed and replaced by sclerotic tissue C: weakness of voluntary muscles such as facial expression, chewing, swallowing D: chronic neurological disorder that affects substania nigra neurons of the brain

NB Question MS patients have the following symptoms except: A. Vision problems B. Enamel hypoplasia c. Balance abnormalities D. Urinary tract problems

Answer B. Enamel hypoplasia

NB Question A genetically linked, chronic, demyelinating disease of the central nervous system best describes: a. Multiple sclerosis b. Cerebral palsy c. Graves disease d. Epilepsy

NB Answer A genetically linked, chronic, demyelinating disease of the central nervous system best describes: a. Multiple sclerosis b. Cerebral palsy c. Graves disease d. Epilepsy

We make a living by what we get; we make a life by what we give. Sir Winston Churchill

5. ALS (Amyotrophic Lateral Sclerosis)

Stephen Hawking http://www.youtube.com/watch?v=pjYrkI_mL4E http://www.youtube.com/watch?v=7mc5z4LIsqE http://www.youtube.com/watch?v=pjYrkI_mL4E

Amyotrophic Lateral Sclerosis Also called Lou Gehrigs Disease Progressive neurodegenerative disorder characterized by loss of motor neurons Men more than women Caucasians more common Onset: middle age or later 5% of cases prior to age 30 Average life expectancy is 35 years, but range is broad and some live much longer Respiratory failure most common cause of death

Amyotrophic Lateral Sclerosis Diagnosis No diagnostic tests for ALS Diagnosis is usually made after ruling out other disorders with similar symptoms Clinically diagnosed with both upper and lower neuron dysfunction w/no periods of remission Etiology unknown 5-10% genetic (autosomal dominant)

ALS Symptoms Cramps and spasticity Weakness in extremities Muscle wasting Increasing respiratory difficulty Difficulty swallowing (dysphagia) and chewing Facial weakness Spasticity/wasting of tongue Sialorrhea (excessive saliva)

ALS Treatment Only FDA-approved treatment: Rilusole Only extends life by 2mo Palliative tx Sialorrhea managed with medications (Atropine) Later stages Radiation Botox injections every 3mo

6. Parkinsons Disease http://www.youtube.com/watch?v=EC kPVTZlfP8

Parkinsons Slow progressive degeneration of certain neurons in the substantia nigra of the basal ganglion - leads to lack of dopamine (hormone that helps control nerve transmissions) Results in loss of control of voluntary muscles, loss of postural stability, slowness of spontaneous movement, resting tremor, and muscular rigidity After age 50, more men then women (2:1) Etiology: not known

Parkinsons Characteristics Muscle rigidity, stiffness Akinesia: impairment of motor function Slow involuntary tremors Festinating gait: bradykinesia Slurred speech Stooped posture & postural instability Fingers may be involved in a pill-rolling motion Systemic: variations in blood pressure, cardiac dysrhythmias, excessive sweating, bowl and bladder dysfunction, and sleep disorder Intellect is seldom affected except in the advanced stages = dementia Oral Characteristics Excessive salivation, drooling w/difficulty swallowing Face blank, staring, expressionless & unblinking eyes Tremors of facials muscles

Parkinsons Dental Tx Modifications Modified home care instructions and aids Directly face the patient when communicating Appt 2-3 hours after taking meds Antimicrobial mouth rinse & home fluoride

Parkinson s Treatment Diet Physical therapy Drugs to replenish dopamine shortage (Levodopa) Surgery: brain

NB Question Which of the clients conditions is a degenerative disorder of the central nervous system that often impairs motor skills, speech, and postural stability? a. Gastroesophageal reflux disease (GERD) b. Hyperlipidemia c. Parkinsons disease d. Hypertension

NB Answer Which of the clients conditions is a degenerative disorder of the central nervous system that often impairs motor skills, speech, and postural stability? a. Gastroesophageal reflux disease (GERD) b. Hyperlipidemia c. Parkinsons disease d. Hypertension

7. Myasthenia Gravis

Myasthenia Gravis Autoimmune neuromuscular disease Weakness, fatigability of symmetric voluntary muscles Causes defect in nerve transmission at neuromuscular junctions # ACH (acetylcholine) receptors in each junction is reduced Women more than men

Myasthenia Gravis Characteristics Lack of facial expression (distress difficult to see) Eyes Diplopia: double vision Ptosis: drooping eyelids Eye muscle weakness Dysphagia Weakened voice Patient may support the chin with one hand to help during talking Muscles of respiration involved = breathing crisis

Myasthenia Gravis & Types of Crisis 1. Myasthenic Crisis 2. Cholinergic Crisis

Myasthenia Gravis & Types of Crisis Myasthenic crisis Results from under medication or increased severity of the disease Deficiency of ACH leads to the crisis symptoms & can be alleviated by anticholinesterase med Inability to maintain an airway Emergency care 1. Suction 2. Provide a patent airway 3. Transport to ER

Myasthenia Gravis & Crisis Cholinergic crisis Caused by overmedication with ACH Muscle weakness w/in 30-60min after meds taken Tx 1. Stop meds 2. EMS immediately 3. Respiratory symptoms develop = ventilation urgent

Myasthenia Gravis: Tx 2 purposes 1. Influence the course of the disease 2. Induce remission Meds Anticholinesterase agents Corticosteroids Azathioprine (immunosuppressive) Cyclosporine (immunosuppressive)

8. Cerebral Palsy

Cerebral Palsy (CP) Disorder of movement and posture resulting from a non- progressive defect of the immature brain Not contagious 4 types Etiology: injury to the brain NBQ Prenatal: anoxia, uterine bleeding, infections (rubella), blood type incompatibility, lack nutrition, gestational diabetes Postnatal: carbon monoxide poisoning, lead poisoning, trauma from accidents or battering, cerebral hemorrhages, infections (encephalitis, meningitis)

Cerebral Palsy Classifications 1. Spastic palsy 2. Dyskinetic or athetoid palsy 3. Ataxic palsy 4. Combined palsy: combo of the 3 SEE WILKINS P.898 KNOW DIFFERENCES BETWEEN THE TYPES

Cerebral Palsy Characteristics Motor disability Exaggerated contractions, inability to use arms/leg (Oral hygiene an issue) Deafness common Intellect affects in 50% of patients Seizures common Oral Characteristics Impaired speech (dysarthria), chewing, swallowing Muscles of mastication abnormal functioning Mouth breathing, tongue thrust = Open bite, protruded ant teeth Bruxism = attrition GERD = erosion Caries, perio Poor head control

Which of the following infectious diseases is a common postnatal cause of cerebral palsy? a. Rubella b. Mumps c. Encephalitis d. Herpes zoster NB Question

Which of the following infectious diseases is a common postnatal cause of cerebral palsy? a. Rubella b. Mumps c. Encephalitis d. Herpes zoster NB Answer

Cerebral Palsy Treatment Surgical, orthopedic, speech, physical therapy Bracing to support the lower limbs and the use of cane, crutches, walker, or wheelchair Meds: seizure control meds can cause gingival hyperplasia NO CURE

NB Question Which of the following is a common oral finding in persons with cerebral palsy? a. High incidence of bruxism b. Class 1 occlusion c. Decreased gag reflex d. Low incidence of periodontitis

NB Question Which disease is a non-progressive disorder of posture and movement resulting from a lesion on the brain? A. Multiple Sclerosis B. Downs Syndrome C. Cerebral Palsy D. Myasthenia Gravis

NB Answer Which disease is a non-progressive disorder of posture and movement resulting from a lesion on the brain? A. Multiple Sclerosis B. Downs Syndrome C. Cerebral Palsy D. Myasthenia Gravis

NB Question All of the following oral conditions are common in clients with cerebral palsy EXCEPT one. Which one is this EXCEPTION? a. Open bite b. Facial asymmetry c. Nerve paralysis d. Swallowing problems

NB Answer All of the following oral conditions are common in clients with cerebral palsy EXCEPT one. Which one is this EXCEPTION? a. Open bite b. Facial asymmetry c. Nerve paralysis d. Swallowing problems

9. Spina Bifida

Spina Bifida (Myelomeningocele) Congenital defect or opening in the spinal column When spinal cord protrudes through spina bifida = myelomeningocele Folic acid prior to pregnancy can help prevent Patients risk for latex allergy

Spina Bifida Embryo Neural tube forms during 1 st mo of pregnancy Neural tube = brain, brainstem, spinal cord arise When a place in the spinal column fails to close, the result is an open defect in the spinal canal (spina bifida)

Spina Bifida Types 1. Myelomeningocele Protrusion or outpouching of the spinal cord and its covering (meninges) through an opening in the bony spinal column Paralysis of legs, trunk 2. Meningocele Protrusion of the meninges through a defect in the skull or spinal column Paralysis is uncommon 3. Spina bifida Occulta Congenital cleft in the bony encasement of the spinal cord when no out-pouching of the meninges or spinal cord exists Asymptomatic

Review A protrusion of the meninges through a defect in the skull or spinal column is called: A) meningocele B) spina bifida C) myelomeningocele D) occulta

Spina Bifida Characteristics Bony deformities Club foot Spinal curvatures: humpback (kyphosis), curvature (scoliosis), or swayback (lordosis) Loss of sensation to pain, temp Bladder, bowel paralysis Hydrocephalus: excessive accumulation of fluid in the brain which dilates ventricles & compresses brain tissues Seizures common

Spina Bifida Tx Surgical, orthopedic, medical, urologic, physical therapy Wheelchair, walkers, crutches, cane Neurosurgery (closure, hydrocephalus) Orthopedic surgery

Spina Bifida & Dental Care Impaired motor ability Need for body stabilization and support May need premed Increased risk for latex allergy

10. Seizure Wilkins CH62

Seizures Sudden paroxysmal electrical discharge of neurons in the brain Results from a transient, uncontrolled alteration in brain function Unprovoked, unpredictable, involuntary Abrupt onset May or may not cause loss of consciousness Also called convulsion fit spell ictus Seizure

Seizures Epileptic syndromes are complex Diagnosis based on: Clinical S&S, Hx, EEG, Functional neuroimaging Classification 1. Age-related onset 2. Symptoms 3. Anatomic localization in the brain (temporal, frontal, parietal, occipital lobes) Epileptic Syndrome

Seizure Types 1. Generalized: affects the entire brain at the same time 1) Absence (petite mal) seizure 2) Tonic-clonic (grand mal) seizure 2. Partial: A seizure of focal origin that involves only a part of the brain is called a partial seizure 1) Simple 2) Complex

The Seizure 1. Generalized 1) Absence (petite mal) seizure Loss of consciousness Lasts 5-30 seconds Most common in children Patient has blank stare, usually does not fall, posture becomes fixed, may drop whatever is being held Patient quickly returns to full awareness, resumes activities, unaware of what occurred 2) Tonic-clonic (grand mal) seizure (next slide) Seizure Types

The Seizure 1. Generalized 2) Tonic-clonic (grand mal) seizure Muscles of the chest and pharynx contract at the same time, forcing air out and a sound known as the epileptic cry Loss of consciousness is sudden and complete Patient becomes stiff and falls or may slide out of the dental chair Musculature contraction oTonic phase: tension with rigidity oClonic phase: movements follow w/intermittent muscular contraction & relaxation Tongue may be bitten Lasts 1-3 minutes then respiration returns Saliva: may become mixed w/ air & appear as foam Patient begins to recover, may be confused, tired, complain of muscle soreness or injury; falls into a deep sleep Phases of seizure may be called preictal, ictal, and postictal Seizure Types

Seizure

The Seizure 2. Partial: (more common in adults) 1) Simple Staring spell Dizziness Jerking of muscles around the mouth No loss of consciousness 2) Complex Trance-like state with confusion Lasts few min to hours Does not remember the attack Seizure Types (contd)

You Tube Seizure http://www.youtube.com/watch?v=Nds2U4CzvC4

Seizure Types Status epilepticus (SE) One or more seizures lasting longer than 30min Brain injury may occur Life-threatening MEDICAL EMERGENCY Seizure lasting more than 5min = seizure unlikely to self- terminate & considered to progress to SE

Etiology Etiology: divided into primary & secondary 1. Primary (idiopathic): genetics, neurologic abnormalities 2. Secondary (symptomatic) oMaternal infection (rubella) oPerinatal injuries oBrain tumor, stroke, head injury oInfections: meningitis, encephalitis, opportunistic infections of AIDS oMetabolic & toxic disorders (alcohol, drugs) Seizure

NB Question The type of seizure where consciousness begins and ends abruptly in 5 to 30 seconds followed by a quick resuming of activities describes: a. Simple seizure b. Tonic clonic (grand mal) seizure c. Absence (petite mal) seizure d. Complex-focal seizure

NB Answer The type of seizure where consciousness begins and ends abruptly in 5 to 30 seconds followed by a quick resuming of activities describes: a. Simple seizure b. Tonic clonic (grand mal) seizure c. Absence (petite mal) seizure d. Complex-focal seizure

Clinical Manifestations Can be induced by flashing lights (dental light), odors (dentistry) Aura (warning) May be a sensation of numbness, tingling, twitching or stiffness of certain muscles Some do NOT have Ask patient about Seizure

Treatment Medications (Antiepileptic drugs) Table 62-1, p.944 (meds to know are on next slide) Many side effects: gingival enlargement Phenytoin (Dilantin) most common Causes fibroblasts and osteoblasts to deposit excessive extracellular matrix Ant gingiva & maxillary teeth most affected More facial & interprox than lingual Effects: biofilm control problem, affect mastication, alter tooth eruption, interfere with speech, esthetic concerns Advanced lesion: tissue covers a large portion of the anatomic crown Tx 1. Nonsurgical tx with 1-3mo RC 2. Cessation of drug 3. Surgery Seizure

Wilkins p.944, Table 62-1 Drugs most commonly used for both Gen & Partial Seizures 1) phenytoin (Dilantin) 2) carbamazepine (Tegretol, Carbatrol) 3) valproic acid (Depakene) 4) levetiracetam (Keppra) 5) topiramate (Topomax) Drugs most commonly use for Partial Seizures 1) gabapentin (Neurontin) 2) lamotrigine (Lamictal) Drugs most commonly use for Status Epilepticus 1) lorazepam(Ativan) 2) phenytoin (Dilantin) First name = Generic name (official name of the drug) Second name = Trade name (mult companies may manufacturer the drug and will call it different names)

(Source: Reprinted with permission from Langlais RP, Miller CS. Color atlas of common oral diseases. 3 rd ed. Philadelphia: Lippincott Williams & Wilkins; 2003. Section 5, Intraoral findings by color changes; 81 p.)

Surgical Tx of the brain Vagus nerve stimulation: pacemaker-like device is implanted in the upper left chest and delivers an intermittent signal to the vagus nerve (dental considerations) Ketogenic diet: to induce fat metabolism and maintain ketosis, used primarily in kids Seizure TX

Review What type of diet may be recommended for patients with epilepsy? A) Ketogenic B) Low calorie C) Vegetarian D) Macrobiotic

Seizure Dental Considerations Effects of accidents during seizures: Scars of lips, tongue, oral cavity may note in EIOE exam, Fractured teeth Patient positioning: supine in chair Do not place tongue blade between teeth Watch for warning signs of AURA BLS Postictal phase Document incident Reassure patient Check oral cavity Contact family emergency contact

Seizure Dental Considerations MD Consult Questions Has seizure activity increased or changed Does dental treatment impact epilepsy condition A well-controlled patient with epilepsy may still have a seizure When seizure-prone, a person is advised to wear the Medical Alert jewelry Information to obtain from patients MD name, #, emergency contact person Age of onset of seizures Precipitating factors Frequency of seizures Date of last seizure & type Date of last medical examination Recent illness, stress, alcohol, menstrual cycle, fatigue, pain Tx: meds, surgery, diet, herbs

Review The emergency medical system should be activated if the seizure is still occurring or has reoccurred within: a. 5 minutes b. 30 minutes c. 1 hour d. Emergency medical systems should be activated immediately for all seizures

Board Question When taking a medical history about a seizure disorder, all the following are critical questions EXCEPT one. Which is the exception? a. What medications are you taking and did you take them today? b. Did you bring your medications to this appointment? c. What behaviors do you exhibit during a seizure? d. How long do the seizures last? e. Do you know when youre going to have a seizure, ie: aura or sensations?

Board Answer When taking a medical history about a seizure disorder, all the following are critical questions EXCEPT one. Which is the exception? a. What medications are you taking and did you take them today? b. Did you bring your medications to this appointment? c. What behaviors do you exhibit during a seizure? d. How long do the seizures last? e. Do you know when youre going to have a seizure, ie: aura or sensations?

dh201 clinical sciences iii lisa mayo rdh, bsdh “what lies behind us and what lies before us are...

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