Seizure in the dental clinic

# Which of the following is true concerning a young epileptic who has a grand mal seizure in the dental office?
A. It is generally fatal
B. It is best treated by injecting insulin
C. They generally recover if restrained from self-injury and oxygen is maintained
D. It can be prevented with antibiotics

 The correct answer is C. They generally recover if restrained from self-injury and oxygen is maintained

Of the multiple types of seizures, the tonic-clonic (grand mal) type is the most frightening and the one that most often requires treatment. Grand mal seizures are manifested in four phases: the prodromal phase, the aura, the convulsive (ictal) phase, and the postictal phase.

The prodromal phase consists of subtle changes that may occur over minutes to hours. It is usually not clinically evident to the clinician or the patient. The aura is a neurologic experience that the patient goes through immediately prior to the seizure. It is specifically related to trigger areas of the brain in which seizure activity begins. It may consist of a taste, a smell, a hallucination, motor activity, or other symptoms. As the CNS discharge becomes generalized, the ictal phase begins. The patient loses consciousness, falls to the floor, and tonic, rigid skeletal muscle contraction ensues. This usually lasts 1 to 3 minutes.

As this phase ends, the muscles relax and movement stops. A significant degree of CNS depression is usually present during this postictal phase, and it may result in respiratory depression. Management of the seizure consists of gentle restraint and positioning of the patient in order to prevent self-injury, ensuring adequate ventilation, and supportive care, as indicated, in the postictal phase, especially airway management. Single seizures do not require drug therapy because they are self-limiting.

Important: Should the ictal phase last longer than 5 minutes or if seizures continue to develop with little time between them, a condition called status epilepticus has developed. This may be a life-threatening medical emergency. This condition is best treated with intravenous diazepam, and transport should be arranged to take the patient to the hospital.

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