A Practical Approach to Special Care in Dentistry. Группа авторов

Adapted from Scheffer, I.E., Berkovic, S., Capovilla, G. et al. (2017). ILAE classification of the epilepsies: Position paper of the ILAE Commission for Classification and Terminology. Epilepsia 58: 512–521.Type of seizureCharacteristicsSigns/symptomsFocal onset (may affect one lobe or a large part of one hemisphere)Focal aware or focal impaired awarenessMotor onset or non‐motor onsetCan be followed by a bilateral tonic–clonic seizureMotor symptomsAutomatisms (lip‐smacking, chewing movements, running, cycling, kicking, repeatedly picking up objects or pulling at clothes)Loud cry or screamTwitching, jerking or stiffening movements of a body partSudden loss of muscle tone or limbs suddenly becoming stiffNon‐motor symptomsChanges in sensation, emotions, experiencesFeeling of déjà vu (feeling like you have been here before)Unusual smell or tasteSudden intense feeling of fear or joyNumbness or tinglingVisual disturbances (coloured/flashing lights or hallucinations)Generalised onsetMotor (tonic–clonic/other) or non‐motor (absence)Tonic–clonicTypically last 1–3 minAt the start of the seizure:The person becomes unconsciousBody goes stiff and they may fallMay cry outMay bite their tongue or cheekDuring the seizure:Jerk and shake as their muscles relax and tighten rhythmicallyBreathing might be affected and become difficult or sound noisySkin may change colour and become very pale or bluishIncontinence may occurAfter the seizure:Often feel tired, confused, have a headache or want to sleepAbsenceMore common in childrenCan be frequentLast a few secondsTypical absences: ‘daydreaming’, blank, unresponsive, may be missedAtypical: start and end more slowly, can last longer, may also include reduced muscle toneUnknown onsetMotor (tonic/clonic/epileptic spasms) or non‐motorVariable symptoms as described aboveUnclassifiedDue to inadequate information/inability to place in the above categoriesFigure 1.2.6 Electroencephalogram (EEG) showing epileptiform activity.

       High‐resolution structural images (high‐field magnetic resonance) and functional radionuclide imaging (positron emission tomography/single‐photon emission computed tomography) can be useful (Figure 1.2.7)

       Genetic testing has gained importance in diagnosing some forms of epilepsy

      Management

       Drug treatment with glutamate inhibitors (e.g. carbamazepine, lamotrigine, phenytoin and topiramate)

       Gamma‐aminobutyric acid enhancers (e.g. barbiturates, benzodiazepines, gabapentin, primidone, tiagabine, valproate and vigabatrin)Figure 1.2.7 Magnetic resonance imaging (MRI) can identify structural changes in the brain that may cause seizures.

       Surgery for drug‐resistant focal epilepsy (resection or disconnection of a circumscribed cerebral area, or vagal nerve stimulation)

      Prognosis

       The prognosis is determined by the underlying disease, the extent of the brain damage and the severity and frequency of the seizures

       The estimated mortality of status epilepticus (generalised tonic–clonic seizures that last more than 5 minutes) is approximately 20%

       The risk of premature death in people with epilepsy is up to 3 times higher than for the general population

      A World/Transcultural View

       Approximately 80% of people with epilepsy live in low‐ and middle‐income countries

       Unfortunately, 75% of people with epilepsy living in low‐income countries do not receive the treatment they need

       In many parts of the world, people with epilepsy and their families suffer from stigma and discrimination

       The religious beliefs prevalent in some countries have resulted in a portion of the population still believing that epilepsy is caused by supernatural possession, resorting to religious healing for its treatment

       In Africa, Asia and Latin America, alternative therapies such as medicinal herbs are often used to treat epilepsy (e.g. rhizomes of Acorus calamus and leaves from the Bacopa monnieri plant), most of which have not been pharmacologically evaluated

       The socio‐economic and cultural environment significantly affects accessibility to drug treatment, which can jeopardise access for 75–90% of individuals with potentially treatable epilepsy in low‐income countries

Recommended Reading

      1 Aragon, C.E. and Burneo, J.G. (2007). Understanding the patient with epilepsy and seizures in the dental practice. J. Can. Dent. Assoc. 73: 71–76.

      2 Cornacchio, A.L., Burneo, J.G., and Aragon, C.E. (2011). The effects of antiepileptic drugs on oral health. J. Can. Dent. Assoc. 77: b140.

      3 Davidson, G.T., Eaton, M., and Paul, S.P. (2016). Childhood epilepsy: a clinical update. Community Pract. 89: 25–29.

      4 Fiske, J. and Boyle, C. (2002). Epilepsy and oral care. Dent. Update 29: 180–187.

      5 Morgan, H.I., Abou, E.F.R.K., Kabil, N.S., and Elagouza, I. (2019). Assessment of oral health status of children with epilepsy: a retrospective cohort study. Int. J. Paediatr. Dent. 29: 79–85.

      6 Robbins, M.R. (2009). Dental management of special needs patients who have epilepsy. Dent. Clin. North Am. 53: 295–309.

      7 Schöpper, M., Ludolph, A.C., and Fauser, S. (2016). Dental care in patients with epilepsy: a survey of 82 patients and their attending dentists and neurologists in southern Germany. Int. Dent. J. 66: 366–374.

      8 Thijs, R.D., Surges, R., O'Brien, T.J., and Sander, J.W. (2019). Epilepsy in adults. Lancet 393: 689–701.

1.3 Muscular Dystrophy

      Section I: Clinical Scenario and Dental Considerations

      Clinical Scenario

A 15‐year‐old patient is referred by the Ear, Nose and Throat (ENT) specialist for an orthodontic assessment. There is concern that the patient's palatal morphology may be responsible for his chronic nasal respiratory distress (Figure 1.3.1).

      Medical History

       Child of a primiparous mother who had Steinert myotonic myopathy (also known as myotonic dystrophy type 1)

       Patient diagnosed with myotonic muscular dystrophy, confirmed during the first days of life

       Hypertrophic cardiomyopathy

       Recurrent respiratory infections

       Obstructive sleep apnea

       Kyphoscoliosis

       Hypermetropia (long‐sightedness)

      Medications

       Atenolol

       Prednisone

      Dental History

       Good level of co‐operation

       Regular dental attender (yearly)

       No previous dental treatment received

       Patient brushes his teeth on a regular basis without supervision

      Social History

       Mother