The effects of antiepileptic drugs in relation to dentistry

Abstract

Epilepsy is the most chronic neurological disorder with an incidence of approximately 45/100,000 per year and point prevalence of 0.5-1%. It is important to distinguish between seizures and epilepsy (see Figure 1) and epilepsy is currently defined as a tendency to have recurrent seizures (sometimes called fits). A seizure is caused by a sudden burst of excess electrical activity in the brain, causing a temporary disruption in the normal message passing between brain cells. 'This disruption results in the brain's messages becoming halted or mixed up. It is more accurate to refer to epilepsies. The International Bureau for Epilepsy classifies epilepsy in over forty different types and conditions. Epilepsy is classified "generalized" when the discharge affects the entire brain cortex. The main seizures types in this group are tonic-clonic (grand mal) and absence (petit mal). An epilepsy is called "partial" when the electrical discharge causing it occurs in a specific area of the brain. Simple partial seizures result in no loss of consciousness, while complex partial seizures are characterized by automatisms. Based on the cause, epilepsy can be symptomatic (caused by a developmental mal-formation), idiopathic (when a genetic condition is responsible) or cryptogenic (when the cause is unknown). There are various possible etiologies of seizures and epilepsy across various ages: prenatal or birth injury, inborn error of metabolism, or congenital malformation, idiopathic/genetic syndrome, CNS infection, or trauma, head trauma, drug intoxication and withdrawal or stroke, brain tumor, and neurodegenerative conditions. Despite huge medical advances which have resulted in 70% of persons with epilepsy being seizure free due to the availability of pharmacological therapy, epilepsy is surrounded by social stigma, superstitions and is rarely discussed in media. In Malta it is colloquially known as "tal-qamar", a term associated with a huge stigma and large efforts are being made to replace it with the term epilepssija. It is a condition which has a significant negative impact on the quality of a patient's life and the treatment goal of epilepsy is to make the patient be completely seizure-free without significant side effects.