Comprehensive approach to an epileptic patient with oral complaints

Abstract

‹Case Report› A 47-year-old housewife had had attacks of consciousness loss towards dawn for 20 years, and for which she had been under treatment with massive doses of anticonvulsants (phenytoin 3, 000 mg, phenobarbital 1, 000 mg, sodium benzoate 2, 000 mg, and carbamazepine 800 mg/day) under a diagnosis of epilepsy at the department of neurology at another institution. One year previously, she began to have oral cavity complaints such as “moving teeth” after she received treatment for dental caries by a local dentist. Since then, various symptoms including a heavy feeling of the head, reduction in thinking ability, finger tip numbness and general malaise appeared, for which she was introduced to the out-patient clinic of our department.
At the initial examination, no abnormalities or pathological conditions were found in formation of her teeth, with no abnormal growth of the gingiva. However, she was found to have hypotension (90/60 mmHg) and pronounced intracellular fluid retention. The patient's condition was understood from the standpoint of a dental psychosomatic medical approach and problems of her condition were diagnosed. Detailed explanations were given to the patient repeatedly. Instead of anticonvulsants she has been receiving low dose of a minor tranguilizer (bromazepam 6 mg/day), a circulation-promoting agent (CoQ₁₀, etc) and Oriental herbal medicine (Sairei-to extract 9.0 g/day) were administered, with gradual decrease in symptoms such as general malaise and numbness. Her complaints of the oral cavity disappeared almost completely in about one month. Subsequently, the dose level of anticonvulsants was decreased gradually. Presently, she is well controlled with about one half of the initial dose levels of anticonvulsants (phenytoin 1, 200 mg, phenobarbital 1, 000 mg, sodium benzoate 2, 000 mg and carbamazepine 200 mg/day).
With Oriental Medicinal practices, it is frequently that intracellular fluid retention and Oketsu syndrome are found in patients with oral cavity complaints. We consider it important to take the comprehensive approach that these patients should be assessed both from local aspects, the oral cavity, and from the general aspects of the disease entity.