ECSE 641 Jessica Ward Epilepsy

Epilepsy Seizure- “…results from an excessive discharge of a large population of cortical neurons.” Interrupts normal brain activity Epilepsy- “…two unprovoked seizures that occur at least 24 hours apart.” Batshaw, Roizen, Lotrecchiano , (2013)

Epilepsy Factors that may predispose a child toward seizure activity: Brain injury (prenatal or postnatal, tumors) Malformations in brain development Genetics The type of seizure a child experiences and how it looks will depend on where it originates in the brain and how much the epileptic discharge spreads. Batshaw, Roizen, & Lotrecchiano (2013)

Epilepsy and Developmental Disability Prevalence of epilepsy in children with developmental disabilities is higher than in the general population. The more significant the brain disturbance and resulting developmental disability, the more likely the child will have epilepsy. Treatment goal is control of the seizure activity with the fewest medication side effects as possible and good quality of life. Depositario-Cabacar & Zelleke (2010)

Epilepsy and Developmental Disability Epilepsy is more common in children with CP compared to typically developing children. Children with CP are more likely to: experience refractory seizures require polydrug treatment to control the seizures have an increased incidence of status epilepticus Also more common in children with intellectual disability (ID) Depositario-Cabacar & Zelleke (2010)

Epilepsy Classification Classification (many types of classification systems) Generalized Simultaneous onset in both cerebral hemispheres Partial Localized area of the brain May spread and become generalized Syndromes Infantile spasms Lennox-Gestaut Unclassified Batshaw, Roizen, & Lotrecchiano (2013)

Epilepsy and AEDs Optimal control of seizures with medications is often difficult in children with cerebral palsy and developmental problems. Medications used to control seizure activity are referred to as AED’s – Antiepileptic Drugs

Epilepsy and AEDs Children may or may not receive AEDs during the school day. Most children with epilepsy who already receive medications to control their seizures have “rescue medication” at school for breakthrough seizures or bouts of increased seizure activity. A care plan will be in place. Rectal Diazepam (Diastat) is commonly maintained at school if prescribed by the child’s doctor. Not for children younger than 2 years old.

Epilepsy and AEDs AED side effects may be Cognitive or Behavioral Depositario-Cabacar & Zelleke (2010)

Epilepsy and AEDs AED’s often have side effects and include: Sleepiness Decreased attention Decreased memory Difficulty producing speech Unstable gait Double vision

Epilepsy Other treatments Surgery to remove the area of the brain where the seizure activity is focused VNS – Vagus Nerve Stimulation Considered when there is poor response to medications Considered when seizures are generalized (no focal point) Hemispherectomy in extreme cases – involves removal of a larger section of the brain Special diets (ketogenic diet) Ensure adequate rest, avoid illness/infection, avoid “triggers”

Epilepsy and Vagus Nerve Stimulator VNS (Cyberonics)

Specialized Procedures -Seizures A child with a known seizure disorder should have a care plan in place with instructions specific to that child. Some children wear lightweight protective helmets. Intervention will depend on seizure type and duration. Once seizure activity has ended, document length of seizure and what occurred before and during the seizure.

Specialized Procedures During a Seizure In general: Place child on floor and turn to one side Do not tightly restrain Loosen clothing, especially around the neck Do not insert anything in the mouth Call EMS if: Seizure lasts longer than 5 minutes There is no history of seizures A second seizure quickly occurs Child does not regain consciousness

Specialized Procedures - Seizures After the seizure activity has ended: Monitor breathing- if breathing has stopped, activate EMS and begin resuscitation efforts. if student is breathing, roll to side and monitor

Specialized Procedures - Seizures Students with significant musculoskeletal or neuromuscular involvement who use a wheelchair with specialized seating may need to remain in their wheelchair when experiencing a seizure for their own safety. The student’s seizure care plan should specify what to do during and after the seizure.

General Guidelines for Student’s who use Wheelchairs Apply the brakes to prevent the chair from moving. Allow the student to remain seated in the chair during the seizure (unless they have a care plan which says to move them). Moving them could possibly lead to injuries for both you and them. Leave seatbelts and positioning straps fastened. Ensure that the student is not injuring themselves on the wheelchair frame and tubing. Cushion their head and support it gently. A head rest, cushion or rolled up coat can be helpful Adapted from: https://www.epilepsy.org.uk/info/firstaid and www.epilepsy.com

References Batshaw, M. L., Roizen, N. J., & Lotrecchiano, G. R. (2013). Children with disabilities (7th ed.). Baltimore: Paul H. Brookes Publishing Co. Depositario-Cabacar , D.F. T. & Zelleke, T-G. (2010). Treatment of epilepsy in children with developmental disabilities. Developmental Disabilities Research Reviews,16, 239-247. doi: 10.1002/ddrr.116 Snell, M. & Brown, F. (2006). Instruction of students with severe disabilities (6th ed.) New Jersey: Pearson Publishing.