management of seizures in the school...

Management of Seizures in the School Setting

Patricia Bruno, BSN, RN

Pediatric Epilepsy Nurse Coordinator

Massachusetts General Hospital

Boston, MA

Management of Seizures in the School Setting

• When the Seizure Occurs

» Seizure first aid

» When is a seizure an emergency?

• Epilepsy and the Child

» Medications and their side effects

» Psychosocial and academic support

• Epilepsy and the Classroom

» How to help

Seizure First Aid:Generalized Seizures

• What to DO:

» Stay calm and remain with the child

» If possible, note the time the seizure begins and ends

» Try to cushion a fall - help the child to a flat surface

» Cushion the child’s head by placing a soft object or the palm of your hand below it

Seizure First Aid:Generalized Seizures

• What to DO:

» Try to position the child on his or her side with the head in a neutral position (looking forward) - this keeps the tongue from blocking the airway and allows excess saliva to drain from the mouth

» Move objects away from the child that he or she may be in danger of striking (ie: chairs, tables, sharp objects)

» Remove eyeglasses

» Loosen any tight clothing at the neck

Seizure First Aid:Generalized Seizures

• What NOT to do:

» Do NOT put anything in the child’s mouth

» Do NOT try to restrain the child

» Do NOT attempt to give any oral medications, food

or drink during a seizure

When is a Generalized Seizure an Emergency?

• First time seizure

• Convulsive seizure lasting more than 5 minutes

• Repeated seizures without regaining consciousness

• Student is injured, has diabetes or is pregnant

• Seizure occurs in the water

• Normal breathing does not resume when the seizure

stops

In these situations, medical intervention is warranted

Seizure First Aid:Focal Seizures

• What to DO:

» Note the time the seizure begins and ends

» Speak in a normal tone of voice and reassure the child

» Understand that the child may not be able to obey verbal instructions even if it appears that he / she can hear you

» Gently direct the student away from any hazards

» If the seizure lasts for more than 10 minutes, call for medical help

Seizure First Aid:Focal Seizures

• What NOT to do:

» Do NOT restrain the student as this can invoke an

aggressive response

» Do NOT leave the student unattended until he /

she is fully alert and aware

Treatment of Seizures in the Classroom

• A pre-planned treatment regime or “Seizure Action

Plan” should be in place for each child who has

seizures

• The emergency plan should be acceptable to all

involved in the child’s care:

» physician

» parent

» school personnel

Treatment of Seizures in the Classroom

• The Seizure Action Plan may include:

» Use of Emergency Medications such as:

– rectal diazepam (Diastat):*convenient pre-dosed delivery system

*generally slows/stops seizures within 5-10 minutes

*82% of children treated with rectal diazepam avoid emergency room trips1

– oral or sublingual lorazepam (Ativan)

– buccal or intranasal midazolam

» 1 O’Dell C,et al. 2003 Epilepsia, 44 (suppl): 115

Treatment of Seizures in the Classroom

Seizure Action Plan (continued)

» Vagal Nerve Stimulator (VNS) Magnet

- swipe magnet across the VNS device implanted in the upper left chest – activates an extra VNS stimulation for 60 seconds

- Procedure can be repeated every 60 seconds until the seizure stops- VNS won’t recognize another magnet induced stimulation until the previous dose cycle has finished

- If the seizure does not stop within 5 minutes (or other pre-designated time frame) then proceed to the next step in the seizure emergency action plan such as rectal diazepam

» Call 911 / emergency room visit

» or simply rest after a seizure

Seizure Triggers or Precipitants

Factors that might increase the likelihood of a seizure in children with epilepsy include:

» Missed or late medication (#1 reason)

» Overheating / overexertion

» Stress / anxiety

» Lack of sleep / fatigue

» Poor diet / missed meals / alteration in special diets being use to treat the child’s epilepsy

Seizure Triggers or Precipitants

Continued…

» Hormonal changes

» Illness

» Allergies

» Alcohol or drug use

» Drug interactions (from prescribed and over the counter medications)

» Flashing / strobe lights

Impact of Epilepsy on the Child

• School difficulties are common in children with epilepsy

• Seizures may cause short-term memory problems

• After a seizure, class work may have to be taught again

Impact of Epilepsy on the Child

• Social stigmata of having a seizure in front

of peers

» This is a big source of anxiety for many

children: worries of urinary incontinence,

type of seizure (sometimes unusual

behaviors with CPS), etc.

Impact of Epilepsy on the Child

• Lifestyle / activities may need to be restricted at certain times:

» Water activities: swimming and bathing in a bathtub- should occur only when there is another person present and within close reach

» If seizures are active the child should not engage in climbing activities beyond a few feet off the ground without a harness

» Driving: must be seizure free for 6 months MA, 12 months NH, 18 months RI, ME 3 months

Impact of Epilepsy Treatment on the Child

• Anticonvulsant medication is the first line of treatment for those with epilepsy.

• Anticonvulsant medications all act on the brain, therefore…

» Possible cognitive side effects

» Possible behavioral side effects or alteration in mood

Impact of Epilepsy Treatment on the Child

• Some anticonvulsant medications may also have systemic side effects:

» Weight gain or loss, skin rash, upset stomach, tiredness, appetite changes, dizziness

» Side effects may cause students to not feel well, thus impacting self esteem, attention and learning

Impact of Epilepsy Treatment on the Child

• Non medicine therapies for epilepsy may also impact the psycho-social aspects of the child:

» Ketogenic Diet / Low Glycemic Index Diet

– Food and drink choices need to be limited

» Vagus Nerve Stimulator

– Contact sports contraindicated

– No heavy backpacks on left shoulder

» Epilepsy Surgery

– Pre-surgical evaluation is a long process and can be very emotionally tiring for a family

– Post-surgery- no contact sports

Ketogenic Diet Halloween Party

Epilepsy and the Classroom

• Epilepsy education of child’s peers important

• Peer groups should know that:

» Epilepsy is not contagious

» Epilepsy is not a form of mental illness

» A child having a seizure may not be aware they are

having one, and may not remember what

happened

Epilepsy and the Classroom

• Peer groups should know that (continued):

» Seizures may involve unusual behavior or

movement, over which the child does not

have control

» Following a seizure a child may be tired or

dazed, but then will return to their baseline

Tips for Supporting Students and Their Families with Epilepsy

• If you have a student with epilepsy in your class:

» Ask the parents for a description of their child’s seizure, frequency, provoking stimuli

» Be aware of the child’s seizure treatment plan

» Communicate with parents any concerns about the student with regard to seizure activity, behavior, or learning

Tips for Supporting Students and Their Families with Epilepsy

• If you have a student with epilepsy in your class:

» Familiarize yourself with the student’s medications and their possible side effects

» Stay calm and be supportive during seizure episodes

–Your behavior during a seizure can make a substantial difference in how classmates react and how the student with seizures copes with their condition

Tips for Supporting Students and Their Families with Epilepsy

• If you have a student with epilepsy in your

class:

» Avoid overprotection and encourage

independence

» Include the student in as many activities as

possible- our ultimate and collective goal is

to allow the child with epilepsy to live a

normal lifestyle within the bounds of safety

Management of Seizures in the School Setting

• Summary - Epilepsy in the schools:

» First aid and safety is of utmost importance

» Epilepsy may affect cognition and behavior

» Epilepsy often affects the psychosocial aspects of children

» School personnel play an important role in helping to direct the impact of epilepsy on a child and his / her peers

Management of Seizures in the School Setting

• Children with epilepsy are still children…

• We thank you for partnering with us to help

students with epilepsy live a safe, normal and

enriching lifestyle as possible…

Management of Seizures in the School Setting

Informational Web Sites

Growing Up With Epilepsy

www.MassGeneral.org/Childhood-Epilepsy

Child Neurology Telephone Encounter Guidelines / Pocket Guides

www.ACNN.org (link to ordering on line)

(topics: epilepsy, headache, alteration in consciousness, tic disorder, developmental delay, paroxysmal involuntary movements)

General Information on Epilepsy

www.epilepsy.com