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CURRENT THERAPY
J Oral Maxillofac Surg 63:996-1005, 2005

Epilepsy in the Oral and Maxillofacial Patient: Current Therapy
Michael D. Turner, DDS, MD,* and Robert S. Glickman, DMD†
Epilepsy is a common disease often encountered in the practice of oral and maxillofacial surgery. The worldwide prevalence has been estimated to range from 0.5% to 0.9% in the general population, affectingapproximately 50 million individuals.1 The periods of highest incidence occur in patients younger than 1 year and in patients older than 75 years.2 Using antiepileptic medications, 50% to 65% of these patients become seizure free. Oral and maxillofacial surgeons treat patients on a regular basis for routine dentoalveolar surgery, as well as managing facial trauma sustained secondary to falls duringseizures. The pathophysiology, classification, and treatment of seizures are discussed here, as are alterations in management for the oral and maxillofacial surgeon. A seizure is defined as an episodic disturbance of movement, feeling, or consciousness that can be caused by sudden synchronous, inappropriate, and excessive electrical discharges that interfere with the normal function of the brain.3 Theterm epilepsy is defined as a disease of frequent seizures that do not have a reversible metabolic cause.4 Epilepsy can be caused by either abnormal neuronal membrane function or an alteration between the excitatory and inhibitory neurons. The postictal period is the time immediately following the seizure when there is a depression in the neurologic function. The interictal period refers to the timewhen the individual is at baseline neurologic function. In approximately 70% of all epilepsy cases, the specific etiology cannot be determined. These cases
Received from New York University College of Dentistry, Bellevue Hospital, New York, NY. *Assistant Professor, Department of Oral and Maxillofacial Surgery, New York University College of Dentistry, New York, NY. †Professor and Chair, Departmentof Oral and Maxillofacial Surgery, New York University College of Dentistry, New York, NY. Address correspondence and reprint requests to Dr Turner: Department of Oral and Maxillofacial Surgery, NYU College of Dentistry, 345 East 24th Street, New York, NY 10010-4086; e-mail: mdt4@nyu.edu
© 2005 American Association of Oral and Maxillofacial Surgeons

0278-2391/05/6307-0019$30.00/0doi:10.1016/j.joms.2004.04.038

are classified as idiopathic or primary epilepsy.1 Seizures with known causes are termed acquired or secondary epilepsy. Secondary epilepsy can be a result of a wide range of metabolic, genetic, structural, and functional abnormalities.5 Metabolic disturbances that cause seizures include electrolyte imbalances, acidosis, hyperglycemia, hypoglycemia, hypoxia, alcohol andbarbiturate withdrawal, dehydration, and water intoxication.4 Systemic disorders that can cause seizures are sepsis, systemic lupus erythematosus, hypertension, and diabetes. The remaining cases are caused by cerebral blood vessel malformations, brain tumors and hamartomas, hypoxic-ischemic lesions, and infectious processes.6 The etiologies of seizures in adults are only identifiable in one third to onehalf of cases. Cerebrovascular disease is the most common cause and accounts for 40% of all cases. The second most common cause consists of primary and metastatic brain tumors.7 Pediatric epilepsies are normally idiopathic and are thought to be genetically determined. Most inheritable epilepsies are transmitted in a complex, multifactorial nature. Epilepsy genes are related to mutations thatresult in abnormal brain development, neurodegeneration, and abnormal function. Several hereditary epilepsies have been related to genes that encode ion channels or functionally related proteins. Three forms of autosomal dominantly inherited human epilepsy have been localized (Table 1). These are benign familial neonatal convulsions, generalized epilepsy with febrile seizures, and a partial epilepsy...