REFLEX EPILEPSY TRIGGERED BY DENTAL TREATMENT: A CASE REPORT

Öz

Loss of consciousness is one of the most common medical emergencies during dental interventions. Syncope, transient ischemic attacks, epileptic seizures and nonepileptic psychogenic events can induce loss of consciousness. Reflex epilepsy is characterized by seizures accompanied by loss of consciousness that are triggered in response to a specific external or internal stimulus. Our aim was to report of a reflex epilepsy case triggered by dental treatment. In this paper, a 22-year-old ASA I male patient developing loss of consciousness with generalised tonic-clonic seizures, severe bradycardia and asystole during dental treatment is presented. He was diagnosed with reflex epilepsy. The reflex epilepsy was thought to have been triggered by hyperventilation resulting from dental anxiety and fear. Special consideration must be given to the differential diagnosis for conditions leading to loss of consciousness. Reflex epilepsy should be considered in cases during which loss of consciousness accompanied by/followed by convulsive seizures has occurred while the patient was exposed to specific external and internal stimulus

Anahtar Kelimeler

• reflex,emergency treatment,epilepsy,reflex

DENTAL TEDAVİ İLE TETİKLENEN REFLEKS EPİLEPSİ: BİR OLGU BİLDİRİMİ

Öz

ABSTRACT                                                             

 

Loss of consciousness is one of the most common medical emergencies during dental interventions. Syncope, transient ischemic attacks, epileptic seizures and nonepileptic psychogenic events can induce loss of consciousness. Reflex epilepsy is characterized by seizures accompanied by loss of consciousness that are triggered in response to a specific external or internal stimulus. Our aim was to report of a reflex epilepsy case triggered by dental treatment.

In this paper, a 22-year-old ASA I male patient developing loss of consciousness with generalised tonic-clonic seizures, severe bradycardia and asystole during dental treatment is presented. He was diagnosed with reflex epilepsy. The reflex epilepsy was thought to have been triggered by hyperventilation resulting from dental anxiety and fear.

Special consideration must be given to the differential diagnosis for conditions leading to loss of consciousness. Reflex epilepsy should be considered in cases during which loss of consciousness accompanied by/followed by convulsive seizures has occurred while the patient was exposed to specific external and internal stimulus.

Key words: Dentistry; emergency treatment; epilepsy, reflex

DENTAL TEDAVİ İLE TETİKLENEN REFLEKS EPİLEPSİ: BİR OLGU BİLDİRİMİ

ÖZET

 

Bilinç kaybı diş hekimliği işlemleri esnasında sıklıkla oluşabilen acil tıbbi durumlardan biridir. Senkop, geçici iskemik ataklar, epileptik nöbetler ve epileptik olmayan psikojenik olaylar nedeniyle bilinç kaybı oluşabilmek- tedir. Refleks epilepsi belirli eksternal veya internal uyarılara bağlı olarak oluşan bilinç kaybının eşlik ettiği nöbetlerle karakterizedir.  Amacımız dental tedavi ile tetiklenen refleks epilepsi vakasını bildirmektir.

Bu makalede 22 yaşında ASA I erkek hastada diş tedavisi esnasında tonik-klonik jeneralize nöbet, ciddi bradikardi ve asistol oluşumu ile birlikte gelişen bilinç kaybı olgusu sunulmaktadır. Hasta refleks epilepsi olarak teşhis edilmiştir. Refleks epilepsinin dental kaygı ve korkudan kaynaklanan hiperventilasyon nedeniyle tetiklendiği düşünülmektedir.

Bilinç kaybına yol açan durumların ayırıcı tanılarına özel dikkat gösterilmelidir. Hastaların belirli eksternal ve internal uyarılara maruz kaldığı durumlarda bilinç kaybı eşliğinde/takibinde oluşan konvülsif nöbet olgularında refleks epilepsi göz önünde bulundurulmalıdır.

Anahtar kelimeler: Acil tedavi; diş hekimliği; epilepsi, refleks

Anahtar Kelimeler

• refleks,Acil tedavi,diş hekimliği,epilepsi

Kaynakça

1. Diagnosis and management of epilepsy in adults. http://www.sign.ac.uk/pdf/sign70.pdf
2. Benbadis SR, Tatum WO. Advances in the treatment of epilepsy. Am Fam Physician 2001;64:91-8.
3. Özkara C, Metin B, Küçükoğlu S. Convulsive syncope: A condition to be differentiated from epilepsy. Epileptic Disord 2009;11:315-9.
4. Salas-Puig J, Mateos V, Amorín M, Calleja S, Jiménez L. Reflex epilepsies.Rev Neurol. 2000; 30:85-9.
5. Haytac MC, Aslan K, Ozcelik O, Bozdemir H. Epileptic seizures triggered by the use of a powered toothbrush. Seizure 2008;17:288-91.
6. Eltas A, Uslu MÖ, Kamışlı Ö. Epilepsi tedavisinde uzun dönem fenitoin kullanımının alveolar kemik kaybı üzerine etkisi. Atatürk Üniv. Diş Hek. Fak. Derg. 2012;22:235-41.
7. Yeni SN. Epilepsi epidemiyolojisi. Turkiye Klinikleri J Neurol-Special Topics 2008;1:9-16.
8. Orebaugh SL, Bradford SM. Intravenous versus ıntramuscular midazolam in treatment of chemically ınduced generalized seizures in swine. Am J Emerg Med 1994;12:284-7.

9. Gherpelli JLD, Luccas FJC, Roitman I, Troster EJ. Midazolam for treatment of refractory neonatal seizures. Arq Neuropsiquiatr 1994;52:260-2.
10. Holmes GL, Riviello JJ Jr. Midazolam and pentobarbital for refractory status epilepticus. Pediatr Neurol 1999; 20:259-64.
11. Lahat E, Goldman M, Barr J, Eshel G. Berkovitch M. Intranasal midazolam for childhood seizures. Lancet 1998;352:620.
12. Jeannet PY, Roulet E, Maeder-Ingvar M, Gehri M, Jutzi A, Deonna T. Home and hospital treatment of acute seizures in children with nasal midazolam. Eur J Pediatr Neurol 1999;3:73-7.
13. Scheepers M, Comish S, Cordes L, Clough P, Scheepers B. Buccal midazolam and rectal diazepam for epilepsy. Lancet 1999;353:1797-8.