Management of Seizures in the School Setting. Patricia Bruno, BSN, RN Pediatric Epilepsy Nurse Coordinator Massachusetts General Hospital Boston, MA

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1 Management of Seizures in the School Setting Patricia Bruno, BSN, RN Pediatric Epilepsy Nurse Coordinator Massachusetts General Hospital Boston, MA

2 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

3 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

4 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

5 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

6 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

7 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

8 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

9 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

10 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 Epilepsia, 44 (suppl): 115

11 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 predesignated 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

12 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

13 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

14 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

15 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.

16 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

17 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

18 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

19 Impact of Epilepsy Treatment on the Child Non medicine therapies for epilepsy may also impact the psychosocial 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

20 Ketogenic Diet Halloween Party

21 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

22 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

23 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

24 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

25 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

26 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

27 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

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29 Management of Seizures in the School Setting Informational Web Sites Growing Up With Epilepsy Child Neurology Telephone Encounter Guidelines / Pocket Guides (link to ordering on line) (topics: epilepsy, headache, alteration in consciousness, tic disorder, developmental delay, paroxysmal involuntary movements) General Information on Epilepsy