SEIZURES

EPILEPSY What is epilepsy? It is a neurological condition that periodically interrupts the normal electrical functions of the brain. Epilepsy / Seizures: Seizures are a symptom of epilepsy. Having a single seizure does not necessarily mean a person has epilepsy. High fever, severe head injury, lack of oxygen—a number of factors can affect the brain enough to cause a single seizure. Epilepsy is an underlying conditions or (permanent brain injury) that affects the delicate systems which govern how electrical energy behaves in the brain making it susceptible to recurring seizures.

Causes About 7 out of 10 people with epilepsy, no cause can be found. With others, the cause may be any one of a number of things. Eg. Head injuries or lack of oxygen during birth. Other causes include brain tumors, genetic conditions, lead poisoning, problems in development of the brain before birth and infections like meningitis or encephalitis. Treatment Epilepsy is treated with drugs, surgery, special diets or a vagus nerve stimulator. Or a combination of these treatments. Drugs are usually the first treatment used. A dose of mediation will reach its peak, or maximum level in the blood about 30 minutes to 6 hours after it is taken. Eg. Liquids, tablets, capsules, or slow released medication will be absorbed by the body at different rates.

Medication Seizures medicines ar fully effective when their blood levels have reached a steady state or constant level in the blood stream. This is why it is important not to skip doses. When the medication levels in the blood stream fall or are to low, a seizure is more likely to occur Testing Blood tests are done once a person has been put on seizure medicine. The doctor will then decide how often blood tests will be repeated.

Triggers Some people with epilepsy discover that certain events or activities trigger a seizure. Some common triggers include: *Failure to take seizure medicine *Lack of sleep *Extreme stress *Illness or fever *Excessive alcohol use *Alcohol withdrawal *Use of illegal drugs Getting overheated or to cold To much stimulation environmental stimulation To much sugar or caffeine Getting upset In women it could be during a menstral cycle or hormonal changes and in some cases flashing or flickering lights

What is a seizure? An epileptic seizure is caused by brief uncontrolled electrical discharges in the brain that disrupts normal functioning of the brain’s electrical system, producing an alteration in……….. *Behavior *Consciousness *Movement *Perception *Sensation *Emotion

What is a seizure disorder? A seizure disorder is a condition (not a disease) of the central nervous system characterized by the tendency to have multiple seizures Who has seizure disorders? About 1 in every 6 (16%) of people with intellectual / developmental disabilities has a seizure disorder. Approximately 2.8 million of the population.

Seizure Classifications Generalized seizures: Involve electrical activity encompassing the entire brain. Most common generalized seizures include: *Absence seizures (petit mal) *Tonic-Clonic seizures (grand mal) Tonic-Clonic seizures involve convulsions and loss of consciousness and usually LAST 2-3 MINUTES. Also known as “Grand Mal” seizures. These are very intense and can often be frightening to witness. Partial seizures: Involve excessive electrical activity that is focused in only one part of the brain. Most common partial seizures include: *Simple Partial *Complex Partial

How a seizure can present An observer would likely see: *A sudden horse cry due to air being forced out of the lungs *A collapse or fall *Rigidity (the tonic phase) followed by a tensing and relaxing or rhythmic jerking of the muscles (clonic phase) which appears to be shaking or jerking. *Shallow breathing, drooling and possible loss of bowel or bladder *Skin may turn blue *Postictal stage (after the seizure) may include confusion, headache, tiredness, muscle soreness, speech difficulity. (The length of this stage is different for each person) May be confused with: Heart attack or stroke There are several types of seizures

First Aid for Seizures A few Guidelines to Follow The following information provides basic guidelines on what to do when someone is having a seizure. This information is not intended to replace specific agency policy. ALWAYS check with the medical professional at your agency to clarify agency requirements for seizure first aid and seizure documentation. As with any type of seizure you want to ensure the dignity of the person having the seizure. Here are a few things to remember.

Guidelines cont. Carefully explain to others about what is happing Speak calmly and reassuringly to the individual Guide person gently away from dangerous objects Be persistent, he/she is on “automatic pilot” and may struggle or lash out Stay with the person until they are completely aware and conscious Do not give them anything to drink for 30 to 60 minutes after a seizure Protect the person from nearby hazards (sharp objects, stairs etc) Time the seizure Loosen restrictive clothing If they are on the floor after the seizure is over you may turn them on their side. Place a soft object under their head Never restrain the person Look for medical ID Use the Agency seizure form to fill out the necessary information about the seizure. Report the event to the Agency nurse and coordinator

When to call 911 Remember, calling an ambulance can be very embarrassing, and is not always needed. Keep the following guidelines in mind when calling an ambulance for someone who is having a seizure. Always call an ambulance under the following conditions: *When the seizure lasts for more than 5 minutes (unless there is a written order by their physician to allow a longer timeframe) When the person is injured When the person is pregnant or has diabetes When you know nothing about the person’s history with epilepsy and there is no Medical ID If they request one If a person has a flurry or recurrent seizures (this is when a person has multiple seizures in one day)

Medications Medications for seizures, or antiepileptic medications, work to control seizures. At this time there is no “cure” for epilepsy. But there are medications that help by keeping electrical impulses between nerves in the brain from firing too rapidly. Remember ! Medications must remain at a constant or steady level in the blood at all times. Missing a medication can trigger a seizure. Many medication to control seizures have side effects. Here are a few to take note of: Drowsiness, clumsiness, behavior changes, tremors, appetite loss, upset stomach, weight gain, motor twitching, dizziness etc.

Medications cont. Here are a few types of medications given for seizures: Tegretol Neurontin Keppra Lamictal Lyrica Topamax Ativan Depakote Dilantin Klonopin Phenobarbital Diastat Acudial (rectal gel)

Vagus Nerve Stimulator Pacemaker for the brain The device: was approved in July 1997 to market its implantable vagus nerve stimulation device. Size of a (hockey puck) It is implanted under the skin in the chest, the device helps control epileptic seizures by sending electric stimulations to the vagus nerve that passes through the neck. Many patients experience at least a 50% reduction in seizures. How it works: Once installed, the device can be programmed from the outside to deliver regular pulses to the vagus nerve. It appears to prevent seizures by changing the chemical balance in the brain. In addition to the programmed pulses, patients also can activate the device once a seizure begins, wheich often helps reduce the length and severity of seizures.

Ketogenic Diet The Ketogenic diet is one of the oldest treatments for epilepsy. The diet has been used mostly in children with difficult to control, generalized epilepsies—such as those with the Lennox-Gastaut syndrome. Lennox-Gastaut is a generalized epilepsy which is characterized by drop attacks or tonic-clonic attacks. This condition is often resistant to treatment. In this group of individuals, the diet can be as successful as medications. Thus, it is most often recommended for children ages 2 through10 or 12 years old who have been diagnosed with a generalized type of epilepsy and who have failed to respond to a variety of medications. Studies have shown that the diet may also be effective in those with partial seizures.

Strategies for managing Behaviors As staff, you have a vital role in seizure management and related behaviors. Here are a few guidelines that will help you work successfully with individual who have a seizure disorder. *Knowing the individual—their strengths, limitations, likes, dislikes *Knowing the social & seizure history—will help knowing the warning signs *Creating a stable environment—consistency is helpful, keeping it peaceful, calm and less stressful Ensure they get their daily medication Observe, document and report seizure activity Provide support empathy and understanding

FYI If you inter a room when an active seizure is going on, your time table should be as follows: Assume the seizure has been going on for at least 2 to 3 minutes, monitor the persona another 2 t 3 minutes to allow them to recover from the seizure. If they continue to seize then contact the nurse and call #911 (unless doctor’s orders state differently) Remember protocol is the full 5 minutes before calling #911 **This per the Epilepsy Foundation. 2007 HELMETS Any consumer who are required to wear a helmet per doctor’s order, must have the helmet on when walking. If you ask the consumer to wear the helmet and they refuse; make note in their file and have another staff witness your statement with their signature. Remember: to review the consumers file who is in your care to become familiar with their medical condition such as (seizures)

Forms and Handouts The Center for Life Enrichment has seizure forms in all their locations for staff to use in the event of a consumer having a seizure. After viewing this training stop by the nurse’s office to pick up the handouts for this training if this is your first time reviewing this topic If you have any questions regarding this seizure training you may also address this with the nurse First time staff should also watch the video on seizures let the nurse know this is the first time you have had this training.

Quiz # 1 SEIZURES Name________________________________ Date:____________ 1.When someone has come out of a seizure you can immediately give them something to drink True or False 2. How long should you wait to give them something to drink? 10 to 15 minutes 15 to 30 minutes 30 to 60 minutes 3. What are some of the side affects of seizure medications? List 2 1._______________________ 2.____________________ 4. Name 2 treatments for seizures. 5. Name 2 things a person might do while having a seizure? 1.______________________ 2.____________________ 6. A “Vegas Nerve Stimulator” helps stops or lessen the severity of a seizure. True or False 7. Recurrent or a Flurry of seizures are an indicator to call #911 8. Where does a seizure originate (start)? ________________________________________________________ 9. Epilepsy is another name for “Seizure Disorder”? 10. Name 3 triggers that can cause a seizure. 1_______________________ 2__________________________ 3________________________