Seizures

Seizures are a group of neurological disorders caused by excessive discharge of cerebral neurons. They may lead to focal (motor, sensory (somatic, visual, auditory, olfactory); psychomotor (automatisms, psychical); or generalized (myoclonic, absence, and tonic-clonic or grand mal (Table 12) seizures. The cause may be genetic; or head trauma, hypoxia, infection (fever) pregnancy, drug or alcohol overdose or withdrawal, sensory input (e.g., sound, light, touch, and smell), hypoglycemia, circulatory disturbances, degenerative disorders, and tumors.

Table 12. Tonic-clinic (grand mal) Seizure.

Prevention:

Identify at-risk patient
- Eliminate known causative or precipitating factors (if possible)
- Confirm compliance with anticonvulsant chemotherapy
- Reduce anxiety
- Ensure profound local anesthesia
  - Use local anesthetic agents containing a vasoconstrictor congruent with the patient’s functional capacity

Signs and symptoms:

Aura phase
- Visual and auditory disturbances
- Dizziness
Sudden loss of consciousness
- Initial convulsions explosively force air out of the lungs, resulting in the epileptic “cry”
- Generalized motor tonic-clonic seizures follow this eerie, birdlike scream
  - The tonic component is characterized by opisthotonos, the person is forced into an arched position when the violent spasm of all body musculature pulls his back muscles
    - Arching of the back creates a convexity in the ventral body region
  - The clonic component is characterized by alternating contraction and relaxation of all muscles
- Tongue-biting
- Increased salivation
- Incontinence
- Hyperventilation
Postictal depression of motor and sensory function
- Fatigue, mental confusion, and respiratory depression

Emergency response:

Place patient in a supine position
- Protect patient from injury
  - Guide the extremities during seizure, but do not restrain
- After the seizure is complete
  - Suction oral cavity if needed
  - Position patient on his/her side (recovery position)
  - Administer oxygen
    - 4 to 6 L/minute by nasal cannula
  - Monitor vital signs
    - If at any time the patient becomes unresponsive, no normal breathing, and no palpable pulse consider the diagnosis of cardiac arrest
      - Notify EMS
        
        Immediate CPR and defibrillation congruent with current recommendations

Nota bene:

Signs of recovery: patient regains consciousness, respiration returns to normal
Signs of deterioration: unconsciousness persists, respiratory depression progressing to respiratory arrest

Managing Adult Medical Emergencies in the Dental Office Seizures

Seizures

Managing Adult Medical Emergencies in the Dental Office
Seizures