Management of patient with neurological disorders By:Dr.Suzan Hassan

Types of neurological disorders: Epilepsy . Seizures. Multiple sclerosis. Parkinson disease. Stroke.

Epilepsy Definition: a state of recurrent seizures.

Causes: 1/ genetic or congenital factors. 2/ Require factors: forgetting to take anticonvulsant Stress – emotional/physical Sleep disturbance Hypoglycemia Alcohol withdrawal Other medications

Most epileptic seizures are self-limited—i. e Most epileptic seizures are self-limited—i.e. they stop on their own, without medication intervention.

Questions should be asked ?

consideration in dental treatment: Take complete health history. Insure medications have been taken. Schedule proper frequency of oral hygiene and provide good oral hygiene instruction. Insure no light directly in eyes. Perform proper periodontal and surgical treatment of gingival hyperplasia to minimize damage to teeth and to maintain the aesthetics.

Steps to minimize risk of injury during the seizure in dental chair: 1. Clear all instruments away from the patient. 2. Place the dental chair in a supine position as near to the floor as possible. 3. Place the patient on his or her side (to decrease the chance of aspiration of secretions or dental materials in the patient’s mouth). 4. Do not restrain the patient.

5. Do not put your fingers in his or her mouth (you might be bitten). 6. Call emergency number if the seizure lasts longer than 3 minutes. 7. Call emergency number if the patient becomes cyanotic from the onset. 8. Administer oxygen at a rate of 6–8 L/minute.

9. If the seizure lasts longer than 1 minute or for repeated seizures, administer a 10-mg dose of diazepam (IM) or (IV).

Once the seizure is over : Do not undertake further dental treatment that day. 2. Try to talk to the patient to evaluate the level of consciousness . 3. Do not allow the patient to leave the office if his or her level of awareness is not fully restored. 4. Contact the patient’s family, if he or she is alone . 5. Do a brief oral examination for sustained injuries.

PART II

Multiple Sclerosis (MS): . Definition: is a chronic, progressive disease of the central nervous system characterized by the destruction of myelin. Myelin : is the fatty and protein material that covers certain nerve fibers in the brain and spinal cord. MS: Lead to disrupts ability of the nerve to conduct electrical impulses.

Causes: The cause of MS is unknown( genetic or environmental ). Lead to immune attack then loss of myelin & nerve fiber. Multiple Sclerosis primarily affects adults between 20 and 40 years of age.

MS signs and symptoms: (1) Weakness. (2) Visual disturbances. (3) Slurred speech. (4) Swallowing difficulty. (5) Abnormal reflexes (absent or hyperactive). (6) Ataxia. (7) Paraplegia. (8) Urinary and bowel incontinence/retention. (9) Emotional changes; (depressed). (10) Facial numbness.

Treatment plan: Midmorning scheduling . Modification of oral-hygiene aids(routine check up, plaque control).

Parkinson’s Disease: Definition: a movement disorder of unknown cause. Symptoms: slowness of movement Rigidity Tremor Patients must continue with their medications.

Treatment plan: 1.schedualing short morning appointment. 2.oral hygiene instruction ( use an electric tooth brush ). 3.placement of a bite prop during the procedure.

STROKE Cerebrovascular disease is the most common cause of neurologic disability. Stroke = ischemic lesions.

Risk factors of stroke: Hypertension Diabetes mellitus Cigarette smoking Alcohol Obesity Hyperlipidaemia Cardiac disease – esp. previous myocardial infarction. Hematologic factors.

Treatment plan: Good oral hygiene . Avoid procedure lead to increase blood pressure. Minimize stress (anti anxiety medication such as valium if pt is painful).

Thank you