Information Sourced May 2020
Patients with epilepsy must continue with their normal dosage of anticonvulsant drugs when attending for dental treatment. It is not uncommon for epileptic patients not to volunteer the information that they are epileptic but there should be little difficulty in recognising a tonic-clonic (grand mal) seizure.
Symptoms and signs
- There may be a brief warning (but variable)
- Sudden loss of consciousness, the patient becomes rigid, falls, may give a cry, and becomes cyanotic (tonic phase)
- After 30 seconds, there are jerking movements of the limbs; the tongue may be bitten (clonic phase)
- There may be frothing from mouth and urinary incontinence
- The seizure typically lasts a few minutes; the patient may then become flaccid but remain unconscious. After a variable time the patient regains consciousness but may remain confused for a while
During a convulsion try to ensure that the patient is not at risk from injury but make no attempt to put anything in the mouth or between the teeth (in mistaken belief that this will protect the tongue). Give oxygen to support respiration if necessary.
Do not attempt to restrain convulsive movements.
After convulsive movements have subsided place the patient in the coma (recovery) position and check the airway.
After the convulsion the patient may be confused (‘post-ictal confusion’) and may need reassurance and sympathy. The patient should not be sent home until fully recovered. Seek medical attention or transfer the patient to hospital if it was the first episode of epilepsy, or if the convulsion was atypical, prolonged (or repeated), or if injury occurred.
Medication should only be given if convulsive seizures are prolonged (convulsive movements lasting 5 minutes or longer) or repeated rapidly.
Midazolam oromucosal solution can be given by the buccal route in adults as a single dose of 10 mg [unlicensed]. For further details on the management of status epilepticus, including details of paediatric doses of midazolam, see Drugs used in status epilepticus (Epilepsy).
Focal seizures similarly need very little active management (in an automatism only a minimum amount of restraint should be applied to prevent injury). Again, the patient should be observed until post-ictal confusion has completely resolved.