Before a dental procedure, levels of antiepileptic drugs (AEDs) should be measured and adjusted based on the individual patient's history. The dental team should be informed about the patient's seizure type and first aid.

Seizure-precipitating factors, such as sleep deprivation or alcohol intake, should be avoided before the procedure.

Methohexital was compared to local anesthetic in conservative dental procedures. Although a seizure occurred in only 1 out of 200 patients, the main disadvantage of its use over local anesthetic is side effects, including tongue movements, coughing, hiccoughs, and prolonged lethargy after the procedure.105

Seizures that occur during or after a dental procedure can occur with N2O104 and methohexital.51 In these studies, seizures most often occurred in patients with undiagnosed epilepsy or those who missed a dose of their antiepileptic medications on the day of the dental procedure.

Other studies demonstrate that N2O and propofol in subanesthetic doses for conscious sedation are safe for mentally handicapped epilepsy patients who undergo dental procedures.45 N2O and propofol are almost always safe in epilepsy patients who are adequately treated with AEDs.

Adapted from: Najjar S, Devinsky O, Rosenberg AD, et al. Procedures in epilepsy patients. In: Ettinger AB and Devinsky O, eds. Managing epilepsy and co-existing disorders. Boston: Butterworth-Heinemann; 2002;499–513. With permission from Elsevier (www.elsevier.com).

Authored By: 
Orrin Devinsky MD
Souhel Najjar MD
Andrew D Rosenberg MD
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Reviewed By: 
Steven C. Schachter MD
on: 
Thursday, April 1, 2004