STUDENTS WITH SEIZURES

Marathon County Special Education Health Skills Day

•1

Anne Faulks, RN

Community Outreach Coordinator

What is Epilepsy?

• A seizure is a disturbance of electrical activity of the brain

• Epilepsy is a neurological disorder characterized by recurrent unprovoked seizures

• ‘Unprovoked’ means not caused by a temporary problem (such as high fever or hypoglycemia)

It may also be known as a SEIZURE DISORDER

•2

Epilepsy in ChildrenEach year 45,000 new cases of epilepsy are diagnosed among children younger than 15

Approx. 1% of the general population has epilepsy, but it is higher in children with disabilities:

•25.8 percent of children with a cognitive disability•13 percent of children with cerebral palsy•50 percent of children with both disabilities

•3

It is important to remember that many people with

epilepsy have normal intelligence.

Antiepileptic Medications1

carbamazepine ethosuximide gabapentin lamotrigine levetiracetam oxcarbazepine

•4

phenobarbital phenytoin topiramatevalproic acid zonisamide

1Pharmacy and Therapeutics 2010 July (35) 7:392-415.

Vimpat ® - lacosamideOnfi ® - clobazamBanzel® - rufinamide

Are the most common treatment in children and young people

Other Treatment Options

• Surgery – considered when there is an identified seizure focus

• Ketogenic diet – high fat and protein; monitored by a dietician

• Vagus Nerve Stimulation (VNS) - a programmable pulse generator implanted in left chest - which can be triggered externally by a magnet

•5

What is a Seizure?

A brief, excessive discharge of electrical activity in the brain that alters one or

more of the following:

• Awareness• Sensations• Emotions• Movements

•6

Facts About Seizures• Most seizures are NOT medical emergencies

• Students may not be aware they are having a seizure and may not remember what happened

• Seizures do not cause brain damage.

• Death due to a seizure is rare

•7

•8

Absence Seizure

• Brief lapse of awareness• Pause in activity with blank stare• Possible chewing or blinking movements• Usually lasts 1-10 seconds• Often occur frequently throughout day

Mistaken for: daydreaming

inattentivenessADHD

•9

Partial Seizure

• May resemble absence seizures but last longer (30 seconds or more)

• Student unable to hear/respond

• Often accompanied by ‘repetitive, purposeless behaviors’ (automatisms)

• Automatisms may be the same movements each seizure

• Post-ictal (post-seizure) confusion is very common

•10

Responding to a Partial Seizure

• Stay calm, reassure other students• Do not restrain• Gently direct away from hazards• Don’t expect student to obey verbal

instructions• Stay with student until fully alert and

aware• If seizure lasts much longer than

normal for that student, contact family

•11

Tonic-Clonic Seizure• A sudden cry, loss of consciousness and fall

• Rigidity, posturing (tonic)

• Rhythmic jerking (clonic)

• Irregular breathing - lips may turn blue

• Drooling, vomiting, loss of bowel/bladder control may occur

• Typically lasts 1 to 3 minutes

• Followed by confusion, headache, extreme fatigue, amnesia for events before/after

•12

Responding to a Tonic-Clonic Seizure

• Have someone keep track of the time

• Turn student on his/her side

• Cushion head

• Protect student from possible injury

• After the seizure, remain with the student until awareness of surroundings is fully regained

• Follow guidelines on Seizure Action Plan•13

When to Call EMS - Epilepsy Foundation

recommendations:• First time seizure • Convulsive seizure lasting more than

5 minutes • Repeated seizures without regaining

consciousness• Regular breathing does not resume after• Student has diabetes or is pregnant• Student has been injured

•14

Seizure Emergencies

Most seizures stop on their own in <3 minutes

If a seizure lasts more than 5 minutes, the person is at risk for:

acute repetitive seizures (ARS) - an emergency characterized by rapidly repeating seizures

status epilepticus (SE) - prolonged, continuous epileptic activity

•15

Rescue Medications

Prescribed for students who have seizure

clusters or seizure emergencies

FDA-approved: Diazepam (rectal gel)

In process of approval: Lorazepam - oral, nasal and buccal forms (inside cheek)

Midazolam (nasal, buccal or injection

•16

Diastat ConcernsRectal administration and concerns about respiratory side effects led some local school districts to regulate administration.

KNOW your district’s guidelines!

If prescribed by a health care provider, regulations and impact on the student must be discussed with parents to come to a workable solution.

•17

Resources for Staff Training

• Questionaire for Parents

• Seizure Observation Record

• Seizure Action Plan

• Where to learn more about rescue medication administration

•18

Epilepsy Foundation Contact

Information

Heart of Wisconsin –

for staff trainings, school programs

• www.epilepsywisconsin.org

• afaulks@epilepsywisconsin.org

National Epilepsy Foundation –

www.epilepsy.com

•19