epilepsy in children

epilepsy in children






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  German | IMC Wiki | Epileptical attack Epileptical attack << back Table of Contents:     introduction
   causes 
  Seizure risk during dental treatment 
  Symptoms of a tonic-clonic seizure (Grand mal)
    emergency measures 
  Status epilepticus
    emergency measures 
  Left 
  sources introduction Epilepsies are seizure disorders with seizure-like spontaneous discharges of central neurons. Epilepsy is a symptom and not a diagnosis. The symptoms vary from brief extinction (attention) to prolonged unconsciousness with abnormal motor activity (tonic-clonic seizures). In practice, it must be distinguished whether it is the first epileptic seizure at all or another single epileptic seizure in known epilepsy. The first epileptic seizure must always be regarded as an emergency, as it is often an expression of an acute brain disease or affection and the risk of further epileptic seizures or the transition to a status epilepticus is great. Notify ambulance and ambulance immediately! causes
    early childhood brain damage
   intracranial masses
   genetic disposition  
 brain trauma 
  cerebrovascular disease 
  Metabolic disorders (eg hyperglycemia, hypoglycaemia) 
  drugs
   Discontinuation of antiepileptic drugs

     Discontinuation of centrally attenuating drugs Seizure risk during dental treatment An epileptic seizure is the second most common (Chapman 1997) and third most common (Girdler et Smith 1999) incident during dental treatment. Statistically, every dentist experiences 1.5 generalized tonic-clonic seizures during his working life (Chapman 1997). Symptoms of a tonic-clonic seizure (Grand mal) I. Preconvulsive Phase ( This phase does not precede every attack.

    sweating  
 Pale or blushing   
Fear, restlessness 
  visual and auditory hallucinations II. Convulsive phase   
tonic seizure stage (10 sec)
   The most severe seizure symptom is the generalized tonic seizure (Greek tonos = tension) with a "tonic" (stiff, rigid) spasm of the skeletal muscle, which usually covers the whole body or large parts with emphasis on the trunk for a few seconds to minutes Unconsciousness and respiratory arrest. This can lead to violent, dangerous falls.
        initial scream    
   Loss of consciousness  
     abrupt fall  
     Stretching cramps of the extremities       
Opisthotonus (backward tilt of the head and overstretching of the trunk and extremities)


Twisted Bulbi with wide pupils
        Apnea with cyanosis
        hypersalivation
    clonic seizure stage (about 10-90 sec)
    In the case of clonic seizure, longer-lasting rhythmic twitchings of the flexor muscles ("kloni", from Greek klonos = violent movement) of all limbs occur. The succession (frequency) of the clones is usually rapid at first (about 3 / sec) and slows down at the end of the seizure.
        forced, deep breathing movement
        rhythmic flexion and extension cramps of the trunk and extremities
        possibly bite injury of the tongue
        possibly wetting

III. Postconvulsive stage
Coma (5-15 min)

    general muscle relaxation
    quiet sleep

Twilight (hours to days)

    slow awakening
    Dazed and confused
    retrograde amnesia

emergency measures
During the seizure:

    Interrupt any activity on the patient!
    Protect the patient from injury.
    Put away any objects that might hurt the person. Put something soft under your head. Tight clothes on the neck!
    Do not hold on !! (can lead to dislocation of the joints)
    Do not try to push anything between your teeth! (can lead to dental and temporomandibular joint injuries, no good)
    Staying with the patient, watching the seizure closely and, if possible, stopping the time (seizure duration).
    If the treating physician provides information about an emergency medication after a certain period of time (eg diazepam), this emergency order is given and the doctor informed.

Postkonvulsiv:

    Stable lateral storage, so that the saliva and any vomit can drain away and it can not come to an aspiration.
    Removal of the oral cavity from mucus, blood or vomit
    Protecting the patient from self-injury during twilight

After a single attack does not necessarily have to be treated with medication. 95% of all epileptic seizures stop spontaneously within 3 minutes (Motzek-Noé 2005).
However, if a second seizure occurs in rapid succession (if the duration of a tonic-clonic seizure exceeds 5 minutes), a benzodiazepine should be administered i.v. directly, buccally or rectally. If an indication of the treating physician about an emergency medication is available, then the procedure is appropriate.
Do not perform these actions:

    Inserting a rubber wedge between the jaws (can lead to dental and temporomandibular joint injuries, does not help)
    Ventilation of the patient in a single attack, as a temporary cyanosis belongs to the attack
    Limb fixation (can lead to dislocation of the joints)

Status epilepticus
In principle, status epilepticus can occur in every epileptic disorder and in every type of seizure.

Status epilepticus (SE) is defined either as an epileptic seizure that persists for a sufficiently long time or as repetitive seizures without regaining consciousness in between (Lowenstein et alldredge 1998). From an epidemiological point of view, the duration is defined as 30 min. However, in clinical practice epileptic seizures lasting more than 5 minutes have to be treated as status epilepticus (SE). Every SE is an urgent medical emergency requiring immediate on-the-spot therapy, such as hospitalization (Werhahn 2005).
emergency measures

    See above!
    Lorazepam (eg, initial 2.5 mg sublingual) is a benzodiazepine and the first choice drug (Werhahn 2005).
        It has a higher binding affinity to the benzodiazepine receptor and thus a significantly longer effect than diazepam.
        In addition, it can be given preclinically orally in a rapidly absorbable form and is there with easier to use than z. B. diazepam rectosols.
    alternatively: Diazepam 10-20 mg rectal rectal
    (German Society of Neurology)
    Call paramedic and ambulance in parallel.


    
sources   
Chapman PJ (1997) Medical emergencies in dental practice and choice of emergency drugs and equipment: a survey of Australian dentists Aust Dent J 42: 103-8
    Girdler NM, Smith DG (1999) Prevalence of emergency events in British dental practice and emergency management skills of British dentists Resuscitation 41: 159-67 
  Kennedy BT, Haller JS (1998) Treatment of the Epileptic Patient in the Dental Office N Y State Dent J 64: 26-31 
  Lowenstein DH, Alldredge BK (1998) Status epilepticus N Engl J Med 338: 970-976     Motzek-Noé (2005) The Conscious Patient - Behavior in an Emergency Bayerisches Ärzteblatt 2, page 92 
  Pick L, Farmer J (2001) Dentistry and Epilepsy Neurologist. 2001 72: 946-9 
  Werhahn KJ (2005) Status epilepticus Emergency & Rescue Medicine 8: 261-264