Abstract
Paroxysmal kinesigenic choreoathetosis (PKC) is a type of seizure disorder in which involuntary abnormal movements lasting a short time are triggered by a sudden, voluntary movement. Such seizures could be extremely dangerous if they were to occur during dental treatment. Here, a good outcome after tooth extraction under conscious sedation is reported for a patient with PKC-like seizures.
The patient was a 34-year-old woman. At the age of 21 years, her involuntary movement seizures had begun to occur more frequently. Her electroencephalogram was normal, and her symptoms abated after the prescription of oral carbamazepine. Accordingly, she was diagnosed as having PKC-like seizures. Her presently treated illness was periodontitis of the lower left wisdom tooth. Taking into account the patient’s dental anxiety and the risk of a seizure, she was referred to our hospital for the administration of general anesthesia during the procedure. However, since the patient’s seizures had abated and the tooth extraction was considered to be a minorly invasive procedure, a decision was made to perform the extraction under intravenous sedation. Anesthesia was induced with midazolam and propofol, and the patient was sedated to a level of 3-4 on the Ramsay Sedation Scale (RSS) ; at this level, the patient was spoken to and the inside of her mouth was touched, triggering an immediate seizure. After the seizure disappeared, treatment was recommenced under conscious sedation at RSS 2. No further seizures occurred, and the surgical procedure was completed without incident.
Since PKC occurs when a subject experiences excessive strain or fear, anesthesia was initially induced to a sedation level of RSS 3-4 in the present patient. However, speaking to the patient and touching her, even at this level of sedation, triggered a seizure. By continuing to perform the procedure under conscious sedation, allowing the patient to respond when spoken to, the procedure was completed safely.
