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Syncope and Epilepsy |
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Syncope
Syncope may be vaso-vagal in origin (the simple faint) or may occur in response to certain situations such as coughing. A vaso-vagal attack may be precipitated by the fear of dental treatment, heat or a lack of food. It occurs due to a reflex bradycardia and peripheral vasodilatation. Onset is not instantaneous and the patient will look pale, often feel sick and notice a 'closing in' of visual fields. It cannot occur when a patient is lying down and placing the patient flat with legs raised is the treatment. Jerking of limbs may occur. In carotid sinus syncope, hypersensitivity of the carotid sinus may cause syncope to occur on turning the head. Unlike vaso-vagal syncope this may happen in the supine position.
Epilepsy
Precipitating factors should be asked about, and enquiry made about altered breathing, cyanosis or tongue biting during a fit. Medication taken and its efficacy should be assessed in terms of the degree of control achieved. Tonic-clonic or Grand Mal epilepsy is classically preceded by a warning or aura which may comprise an auditory, olfactory or a visual hallucination. A loss of consciousness follows leading to convulsions and subsequent recovery. The patient may be incontinent during a fit. The 'tonic phase' gives way to a 'clonic phase' in which there is repetitive jerky movements, increased salivation and marked bruxism. After a fit of this type, a patient may sleep for up to 12 hours. If the fit continues for more than 5 minutes or continues without a proper end point, 'status epilepticus' is said to be present. This is an emergency situation, which requires urgent intervention with a benzodiazepine e.g. intravenous diazepam.
Absence seizures or 'Petit Mal' tend to occur in children who may suddenly arrest speech, attention and movement. So-called 'partial' seizures may be simple or complex. Simple seizures consist of clonic movements of a group of muscles or a limb. Complex seizures may involve hallucinations of hearing, sight or taste.
REF: British Dental Journal 12 July 2003; Volume 195, No. 1
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