Fact: The school nurse plays a significant role in the life of a student with epilepsy. An involved nurse can positively impact the future of a student with epilepsy.

Today we will talk about: Seizure types. Epilepsy syndromes. Treatments. Common medications. Medication Side Effects. Epilepsy and the IEP. Accommodations Diastat in school. Seizure plans.

Early Detection – Why?

Generalized Tonic-Clonic Also known as Grand-Mal. Begin w/stiffening of the limbs (tonic phase). Followed by jerking of limbs and face (clonic phase). In some cases will require Diastat.

Myoclonic Seizures Rapid brief jerking movements. Typically occur on both sides of the body. Often confused as clumsiness. Typically do not require first aid.

Atonic Seizures Also known as drop seizures. Causes abrupt loss of muscle tone. Often causes head and face injuries. Wearing of helmet recommended. Tough seizures to control. First aid needed if injury is caused.

Absence Seizures Also know as petit-mal seizures or “staring spells” Lapses of awareness the end abruptly. No warning and no after effect. More common in children than adults. Children can have per day. Affects school performance.

Simple Partial Seizures No loss of consciousness. Involves one side of the brain. Sudden jerk. Sensory phenomena. No first aid required, should be logged and timed.

Complex Partial Seizure Involves one side of the brain. May have aura. Repeated movements i.e. lip smacking, picking at clothes, fumbling. Unaware of environment/surroundings. May wander. Typically no first aid required, should be logged and timed.

Gelastic Epilepsy “Gelastic” is greek for laughter. Pediatric – seizures can begin at any age, often between 2-3 years of age. More often boys than girls. Laughter described as “empty” or “hollow”, not pleasant. Can be followed by complex partial seizure. Often caused by small tumor in hypothalamus.

Infantile Spasms Typically starts at 4-8 months of age. Most severe type of pediatric epilepsy. Seizures come in clusters/bending forward, arms flare out. Prognosis poor. Stops by age 5, often goes to another seizure type. Treatment – ACTH steroid injections.

Lennox-Gastaut Syndrome Severe form of childhood epilepsy. Multiple seizure types, i.e. atonic, myoclonic, tonic, atypical absence. Most children have impaired intellect. Can be caused from malformation of brain, TBI, metabolic disorder % cause unknown.

Dravet Syndrome Also called SMEI (severe myoclonic epilpesy in infancy). Begins in first year of life with frequent febrile seizures. Often causes status epilepticus. Hard to treat. Outcome poor. Caused by genetic defect.

Status Epilepticus Life threatening condition where the brain is in a constant state of seizures. Typically defined as constant state of seizures for 30 minutes +. Any type of seizure disorder can cause status epilepticus. Immediate medical attention needed!

Vagal Nerve Stimulator (VNS) Used in addition to AED’s. 80% of implanted patients experience fewer seizures. 75% of patients are able to reduce their AED’s. Improved seizure control w/o the medication side effects.

Ketogenic Diet High fat/low carb diet. Helps control seizures in up to 2/3 of children with refractory epilepsy. Medical Treatment – must be started under close medical supervision. Calories restricted to 75% of daily requirement, 90% from fat. Works well if followed properly.

Common Seizure Meds Banzel Carbatrol® Clonazepam Depakene® Depakote® Depakote ER® Diastat Dilantin® Felbatol® Felbamate Frisium Gabitril® Keppra® Keppra XR™ Klonopin Lamictal® Lyrica Mysoline® Neurontin® Phenobarbital Phenytek® Primidone Sabril Tegretol® Tegretol XR® Tiagabine Topamax® Trileptal® Valproic Acid Vimpat Zarontin® Zonegran®

Possible Side Effects Lethargy Hair Loss Processing/Word finding issues. Dental/Oral Anxious/irritable Rash IQ Decline

Common Side Effects Lethargy Hair Loss Processing/Word finding issues. Dental/Oral Anxious/irritable IQ Decline Rash

Switch Gears

OHI Definition Other health impairment means having limited strength, vitality, or alertness, including a heightened alertness to environmental stimuli, that results in limited alertness with respect to the educational environment, that— (i) Is due to chronic or acute health problems such as asthma, attention deficit disorder or attention deficit hyperactivity disorder, diabetes, epilepsy, a heart condition, hemophilia, lead poisoning, leukemia, nephritis, rheumatic fever, sickle cell anemia, and Tourette syndrome; and (ii) Adversely affects a child's educational performance. Source: ISBE Regulations & IDEA

Why does a student with epilepsy qualify for an IEP? HR 1350 Sec. 602(3) states as follows: (i) With mental retardation, hearing impairments speech or language impairments, visual impairmnts, serious emotional distrubance, orthopedic impairments, autism, traumatic brain injury, other health impairment, or specific learning disabilities and (ii) who, by reason thereof needs special education and related services. Source: Federal IDEA Law

Suggested Accommodations Extended Time for Tests/Quizzes Reduced Homework Assignments Reduced Spelling Words Tests/Quizzes taken in a quiet area Tests/Quizzes read out loud Use of a calculator Use of a number line Graphic organizer Outline of classroom Notes Extra set of books at home

Seizure Medication Administration No nurse on site (this cannot affect placement) ISBE Medication Regulations

Diastat A program for administration of medication to students in schools must be developed and managed by a certified school nurse or registered nurse in accordance with the Recommended Guidelines for Medication Administration in Schools. Each school district must determine who (e.g. superintendent, principal) is responsible for administering medication in the absence of a certified school nurse or registered nurse. Pursuant to section 105 ILCS 5/ b of the School Code, teachers and other non-administrative employees cannot be required to administer medication, although they may volunteer to do so. Source: ISBE Regulations - Medication

Diastat The Illinois Department of Professional Regulation (IDPR) issued a legal opinion which allows a school employee to stand in the place of a parent or guardian in administration of medication or supervision of self-medication in the school setting. School employees who do not hold a valid IDPR license must receive training in the correct procedure to be used to administer medication and/or provide a specific treatment. This does not prohibit any school employee from administering emergency assistance to a student. A certified school nurse or registered nurse must manage this medication administration program following the Recommended Guidelines for Medication Administration in Schools developed by the Illinois Department Human Services (IDHS) and the Illinois State Board of Education (ISBE), September A designated administer will be responsible for medication administration or supervision of self-medication when a nurse is not available. Teachers or other employees cannot be required to administer medication or supervise self-medication although they may volunteer to do so. Source: ISBE/IDHS

All seizures require a plan!

QUESTIONS