1. ECSE 641
Jessica Ward
Epilepsy

2. 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)

3. 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)

4. 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)

5. 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)

6. 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)

7. 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

8. 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.

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

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

11. 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”

12. Epilepsy and Vagus Nerve Stimulator
VNS (Cyberonics)

13. 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.

14. 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

15. 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

16. 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.

17. 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: and

18. 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, doi: /ddrr.116
Snell, M. & Brown, F. (2006). Instruction of students with severe disabilities (6th ed.) New Jersey: Pearson Publishing.