2. Epilepsy and Seizure Management Presented by Wendy Fahey RNC, BSN

3. Where it all begins… Effective management begins with  Recognizing  Observing  Documenting This can be challenging because symptoms are often:  Subtle  Difficult to detect  Occur without warning  Confused with other behavioral or psychological problems

4. What Is Epilepsy?  Epilepsy is a chronic neurological disorder characterized by a tendency to have recurrent seizures  Epilepsy is also known as a “seizure disorder”  A seizure is the physical manifestation of a sudden disruption of orderly communication between neurons in the brain  A seizure can take a variety of forms, depending on where the disruption occurs and how far the resulting abnormal electrical activity spreads  The type of epilepsy a person has is determined by their predominant seizure type and other related signs and symptoms

5.  Stroke  Brain tumor  Brain infection  Past head injury  Metabolic problems  Other neurological conditions  Genetic factors Causes of epilepsy include:

6. A seizure is:  A brief, excessive discharge of electrical activity in brain that alters one or more of the following:  Movement  Sensation  Behavior  Awareness

7. Causes of Symptomatic Seizures  Brain trauma  Brain lesions  Poisoning  Infections of the brain  High fever  Brain injury at birth  Congenital malformations

8. Did You Know That…  Most seizures are NOT medical emergencies  Students may NOT be aware they are having a seizure and may NOT remember what happened  Students almost never die or have brain damage during a seizure  A student can NOT swallow their tongue during a seizure

9. Seizure Triggers or Precipitants  Flashing lights and hyperventilation can trigger seizures in some students with epilepsy  Factors that might increase the likelihood of a seizure in students with epilepsy include:  Missed or late medication (#1 reason)  Stress/Anxiety  Lack of Sleep  Hormonal changes  Illness  Alcohol or drug use  Drug interactions (from prescribed or over the counter medicines)  Poor diet/missed meals

10. Partial seizures  Involve only part of the brain  Common types include simple partial and complex partial  Symptoms relate to the pat of the brain affected Different Seizure Types Generalized seizures  Involve the whole brain  Common types include absence and tonic-clonic  Symptoms can include blank stares, falling to the floor, sudden muscle jerks, and repetitive stiffening and relaxing of muscles

11. (Tonic-Clonic Seizure Generalized seizures (Tonic-Clonic Seizure-“grand mal”)  Occurs in all age groups  Previously referred to as a “grand mal” seizure

12. Seizure activity in the brain causing:  Rhythmic movements - isolated twitching of arms, face, legs  Sensory symptoms - tingling, weakness, sounds, smells, tastes, feeling of upset stomach, visual distortions  Psychic symptoms - déjà vu, hallucinations, feelings of fear or anxiety Usually last less than one minute May precede a generalized seizure Simple Partial Seizure

13. Factors that Impact the Student with Seizures Factors:  Seizures  Medication side effects  Underlying brain abnormalities Affect:  Learning  Behavior  Self-concept  Stigma  Psychosocial development  Overall quality of life

14. Impact on Learning  Most student have IQ’s within the normal range  Risk of learning problems is 3x greater than average  May have difficulty with memory, attention and concentrations  Students who achieve seizure control quickly, with few medication side effects, have the best chance for normal educational achievement

15. Factors that May Increase the Risk of Learning, Behavioral and Psychosocial Problems  Early age of onset  Multiple lifetime seizures  High seizure frequency  Seizures in school memory deficit  Slowed motor speed

16. Status Epilepticus  Continuous state of seizure activity, or prolonged seizures that occur in a series  Medical emergency  Most common in the very young and very old

17. Routine First Aid: Care & Comfort  Most seizures are not medical emergencies  Basic first aid has many common elements, but varies depending whether there is:  No change in consciousness  Altered awareness  Loss of consciousness

18. No change in Consciousness No change in Consciousness (Simple Partial Seizure)  Stay Calm  Time Seizure  Reassure student that they are safe  Explain to others if necessary  Protect student’s privacy

19. Altered Awareness Altered Awareness (Complex Partial Seizure)  Speak softly and calmly  Guide away from potentially harmful objects  Allow for wandering in a contained area  If lasts 5 minutes beyond what is routine for that student or another seizure begins before full awareness is regained, follow emergency protocol  DO NOT restrain or grab  DO NOT shout or expect verbal instructions to be obeyed

20. Loss of Consciousness Loss of Consciousness (Generalized Tonic-Clonic Seizure)  Stay calm and track time  Protect student from possible hazards  Turn the student on their side to allow saliva to drain and to prevent choking.  Cushion and Protect head may place a thin, soft towel or item under the head if the floor is hard.  Loosen restrictive clothing and remove glasses  Remain with student until fully conscious

21. Dangerous First Aid!!!  DO NOT put anything in the student’s mouth during a seizure  DO NOT hold down or restrain  DO NOT attempt to give oral medications, food or drink during a seizure

22. When to Call 911 The National Epilepsy Foundation recommends that you seek emergency medical care immediately if:  A seizure lasts more than 5 minutes  Repeated seizures without regaining consciousness  More seizures than usual or change in type  Student is injured, has diabetes or is pregnant  Seizure occurs in water  Normal breathing does not resume Follow seizure emergency definition and protocol as defined by the healthcare provider in the seizure action plan

23. Options for Treating Repetitive Seizures The only FDA-approved treatment for acute repetitive seizures is rectal Diastat, but nasal or buccal midazolam have been shown to be equally effective. Some services make arrangements to use alternate forms. * * These alternate methods are currently in a Phase 1 FDA clinical trial. (www.clinical trials.gov) with an estimated completion date of April 2012.

24. DVD: DVD: A Guide to Seizure Management for Emergency Medical Responders

25. Buccal Midazolam 1. Student in side lying position 2. Place syringe into the side of students mouth, between gums and teeth 3. If possible, ½ of dose in one cheek and remaining in other cheek 4. Slowly push the plunger of the syringe down until the syringe is empty 5. Watch for any breathing difficulties 6. Confirm that the seizure has stopped

26. Thank You If you have any questions please contact Wendy Fahey RNC, BSN School District of Belleville Nurse