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


• 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


• 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


• 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


• 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


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


• 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.


• 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


• 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


• 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


• 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


• 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


• 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


• 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…


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

http://www.massgeneral.org/Childhood-Epilespy

http://www.acnn.org/

http://www.epilepsy.com/

management of seizures in the school...

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