Classification of Epilepsy

Group 4:EpilepsyNurin SyahidahSyafiqah NadhirahNor Anis ZullyanaNik Mohd Haziq AsyrafHamzi MuhamadMohd HanifAhmad FaisAimi AmalinaDefinitionEpilepsy 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 > Result of excessive electrical discharges in a group of brain cells.Different parts of the brain can be the site of such discharges.Seizures can vary from the briefest lapses of attention or muscle jerks, to severe and prolonged convulsions. Seizures can also vary in frequency, from less than one per year to several per day.

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

By NICEIncidence 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

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:brain damage from prenatal or perinatal injuriesa loss of oxygen or trauma during birth, low birth weightcongenital abnormalities or genetic conditions with associated brain malformations;a severe blow to the head;a stroke that starves the brain of oxygen;an infection of the brain such as meningitis, encephalitis, neurocysticercosis;certain genetic syndromes;a brain tumor

Causes

Classification of EpilepsyTypeSub-typeMain featuresGeneralized seizuresTonic-clonic (Grand mal)Loss of consciousnessTonic phasesClonic phasesTongue bitingIncontinenceSeizure lasts < 5 minutesAbsences (Petit mal)Brief period of unresponsivenessEpisode lasts < 30 secondsPartial seizuresSimple (Jacksonian epilepsy)Motor, sensory, autonomic or psychic featuresComples (Temporal lobe epilepsy)Impaired consciousnessAutomatic repetitive actsOthersMyoclonicAtonicGrand mal (Tonic-clonic) EpilepsyBegins in the pre-school child/occasionally at pubertyWarning/aura LOC tonic & clonic convulsions recoveryAura:Mood changeIrritabilityBrief hallucinationHeadacheSensation of strong smell (e.g burning rubber)Initially:Face become palePupils dilateOpisthotonous & glotticRespiratory muscle spasm cry & cyanosisGrand mal (Tonic-clonic) EpilepsyClonic phase:Repetitive jerking movements of trunks, limbs, tongue & lipsProfuse salivation + bruxism + tongue biting + vomitingUrinary/faecal incontinenceTachycardia/hypertension/flushingFlaccid semi-coma (10 15 min) recovery

Status EpilepticusDefinitionA seizure lasting for more than 30 min or repeated seizures over the same period without intervening periods of consciousnessdangerous:Inhalation of vomit & salivaBrain damage d/t cerebral hypoxiaDeath

Petit mal seizuresMC occur during childhoodCharacterized by:Minimal/no movements : may appear like a blank stareBrief sudden loss of awareness/consciousness (few seconds)Recur many timesDecreased learning (often thought to be daydreaming)Simple partial (focal) seizuresCan be motor/sensory/behavioralConfined to one areaPresent as:Muscle contractions of a specific body partJacksonian epilepsy : spread to adjacent muscles on the same side of the bodyAbnormal sensationNausea, sweating, skin flushing, dilated pupilsComplex partial seizuresAka temporal lobe epilepsy/psychomotor epilepsyCharacterized by:Lip smacking, chewing movements, facial grimacingAbnormal sensationNausea, sweating, skin flushing, dilated pupilsRecalled/inappropriate emotionsMay/may not be disorientation, confusion & amnesia/LOCOlfactory/gustatory hallucinations/impairmentManagementEpilepsy : ManagementCall for helpStop treatmentLay the patient flat on the chair, do not try to move the patient while they are actively fittingProtect the patient from injury; Do not attempt to put spoon or tongue depressor on between the teeth or any other hard objectsClear the working areaDo not attempt to restrain or holding down the patient during seizure

If patient is having difficulty to breathe or becoming cyanosed, gently extending the neck to maintain the airwayCPR or mouth-to-mouth breathing cannot be performed during seizure and rarely needed after seizure.Uncomplicated seizure: no other treatment is necessaryIf attack continues longer than normal or > 10 minutes, give Midazolam 10mg IMIf 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/minNICEMANAGEMENTThe 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]

EMERGENCYSTOP 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 diazepamif preferred or if buccal midazolam is not available.If intravenous access is already established and resuscitation facilities are available, administer intravenous lorazepam.[NICE2012]

AAPD

ReferenceWHO; http://www.who.int/mediacentre/factsheets/fs999/en/NICE ; guidance.nice.org.uk/cg137Special Care in Dentistry. Churchill Livingstone.ILAE ; Ihttp://www.ilae.org/Visitors/Centre/Definition.cfm