1. Epilepsy and School: Beyond Surviving & on to success
Presented by: Jessica Morales, BA Director of Epilepsy Education Epilepsy Foundation Metropolitan New York

2. Objectives
Knowing how best to communicate common seizure types and their possible impact to teachers and staff
Know how to teach appropriate first aid
Set up guidelines to help staff recognize when a seizure is a medical emergency
How to best provide social and academic support

3. How to talk about Epilepsy…
Try to schedule a meeting with the staff that will be working with your child.
Be prepared with valid up to date information
Always try to personalize to your child and his or her needs.

4. What is a Seizure? A brief, excessive discharge of electrical
activity in the brain that alters one or more
of the following:
Movement
Sensation
Behavior
Awareness

5. What is Epilepsy?
Epilepsy is a chronic neurological disorder that is characterized by a tendency to have recurrent seizures.
Epilepsy is also known as a “seizure disorder.”

6. Epilepsy is Common 2.7 million Americans have epilepsy
300,000 people have a first convulsion each year
326,000 children through age 14 have epilepsy
45,000 children under 15 develop epilepsy each year

7. Did You Know …… Most seizures are not medical emergencies
Students may not be aware they they are having a seizure and may not remember what happened
Epilepsy is not contagious
Epilepsy is not a form of mental illness
Students almost never die or have brain damage during a seizure
A student can’t swallow his/her tongue during a seizure

8. Common Causes of Epilepsy
The cause is unknown for c.70% of people with epilepsy.
For the remaining 30%, some identifiable causes are:
Brain trauma (such as stroke, physical injury )
Brain tumors
Poisoning (lead)
Infections of the brain (meningitis, encephalitis)
Brain injury at birth
Abnormal brain development

9. Seizure Types Generalized Seizures Partial Seizures
Involve the entire brain
Loss of consciousness
Symptoms may include convulsions, staring, muscle spasms and falls
Partial Seizures
Involve only part of the brain
Altered or no loss of consciousness
May spread & generalize
Symptoms are related to the part of the brain affected

10. Absence Seizures Brief pause in activity with blank stare
Brief lapse of awareness
Possible chewing or blinking motions
Usually lasts 1 to 10 seconds
May occur many times a day and/or cluster
Often confused with:
Daydreaming
Lack of attention (ADD, ADHD)
Work avoidance
Difficulty learning

11. Generalized Tonic-Clonic
May begin with a sudden, hoarse cry
Loss of consciousness and fall
Convulsion with stiffening of arms & legs followed by rhythmic jerking
May have shallow breathing and/or drooling
Skin, nails, lips may turn blue
Generally lasts less than 5 minutes
May lose bowel or bladder control
Usually followed by some confusion, headache, fatigue, soreness and/or speech difficulty

12. First Aid for Tonic-Clonic Seizures
Stay calm & track time
Check for medical ID
Protect from hazards
Turn student on side
Cushion head
Stay with the student until alert
Provide emotional support
Document seizure activity

13. DO NOT…… Put anything in the student’s mouth during a seizure
Administer CPR or Heimlich during seizure, must wait until it is over.
Hold down or restrain during a seizure
Attempt to give oral medications, food or drink during a seizure

14. Tonic-Clonic Seizures as a Medical Emergency
First time seizure
Convulsive seizure lasting longer than 5 minutes
Repeated seizures
Acute change in seizure pattern
The student is injured, has diabetes or is pregnant
The seizure occurs in water
Normal breathing does not resume
Parents have requested emergency evaluation

15. Convulsive Seizure in a Wheelchair
Do not remove from wheelchair unless absolutely necessary
Secure wheelchair to prevent movement
Fasten seatbelt (loosely) to prevent fall
Protect & support head
Ensure breathing is unobstructed & allow secretions to flow
Pad wheelchair to prevent injuries to limbs
Follow relevant seizure first aid protocol

16. Convulsive Seizure on a School Bus
Safely pull over & stop bus
Place child on side across seat facing away from back seat or in aisle if necessary
Follow appropriate seizure first aid protocol for this student until seizure ends and consciousness is regained
Continue to destination or follow school policy
Call for emergency assistance if seizure is longer than 5 minutes

17. Seizures in Water
Support head so that both the mouth & nose are always above water
Remove student from the water at once
If the student is not breathing, begin rescue breathing after seizure has passed.
Always transport to emergency room

18. Seizure Action Plan
Establish a seizure action plan for each student diagnosed with epilepsy
Establish a seizure action plan for anyone having a first time seizure
Follow seizure emergency definition and protocol as defined by the healthcare provider in the seizure action plan

19. Seizure Action Plan

20. Simple Partial Seizures
Full awareness is maintained
May observe rhythmic movements (arm, face, leg twitching)
Sensory symptoms (tingling, weakness, upset stomach, hallucinations)
Psychic symptoms (déjà vu, hallucinations, feeling of fear or anxiety, or a feeling they can’t explain)
Short duration
Often confused with acting out, mystical experiences, psychosomatic illness

21. Complex Partial Seizures
Short duration
Aggressive behavior
May be followed by fatigue, headache or nausea
May become combative if restrained
Often confused with:
Drunkenness or drug abuse
Awareness impaired with inability to respond
Often begins with a blank, dazed stare
May observe repetitive, purposeless and/or disoriented movements
Clumsy or disoriented movements, aimless walking, picking things up, nonsensical speech or lip smacking

22. Complex Partial Seizure First Aid
Stay calm & reassure others
Track time
Check for medical ID
Do not try to restrain
Gently direct away from hazards
Do not expect verbal instructions to be obeyed
Stay with the student until fully alert
If seizure last longer than 30 minutes, call EMS

23. Seizure Triggers
Factors that may increase the likelihood of a seizure in students with a diagnosis of epilepsy:
Missed medication
Overheating/overexertion
dehydration
Stress/anxiety
Extreme fatigue
Poor diet/missed meals
Hormonal changes
Illness
Alcohol or drug use
Drug interactions (OTC, prescribed, herbals or supplements)

24. Treatment Medication Surgery Vagus Nerve Stimulation Ketogenic Diet
Alternative Therapies
* It’s important to share with teachers and staff in direct contact with your child what kind of treatment they are under or if any new treatment is started.

25. Medication Side Effects
Slow motor response
Low self-esteem
Hyperactivity
Unresponsiveness
Staring
Attention and memory deficits
Poor reading skills
Impaired auditory-perceptual and language processing abilities
Mood swings
Medication Side Effects

26. Prescription Medication
Medications (New Medication for Epilepsy)
Although AEDs do not cure epilepsy, they do, in many cases, help to keep the seizures controlled, thus enabling the patient to have a better quality of life.
Keppra
Lyrica (pregabalin)
Trileptal (oxcarbazepine)
Keppra (levetiracetam)
Zonegran (zonisamide)
Topamax (topiramate)
Gabitril (tiagabine hydrochlorine)
Lamictal (lamotrigine)
Diastat (diazepam rectal gel)

27. Brain Surgery
Lobectomy- All or part of the left or right lobe (Frontal, Temporal, Occipital, Parietal) may be surgically removed. These areas are common sites for simple and complex partial seizures.
Hemispherectomy – Removal of one half of the brain.
Corpus Callosotomy- Separating the Corpus Callosum ( a nerve bridge that connect the two halves of the brain).
Sub-pial Transection- Instead of removing affected tissue, the surgeon severs the parallel connection between cells in the affected area.

28. Vagus Nerve Stimulator
Device implanted just under the skin in the chest with wires that attach to the vagus nerve in the neck
Delivers intermittent electrical stimulation to the Vagus Nerve in the neck that relays impulses to widespread areas of the brain
Used primarily to treat partial seizures when medication is not effective
Uses a special magnet to activate the device that may help student to prevent or reduce the severity of an oncoming seizure
Student usually still requires antiseizure medication

29. The Ketogenic Diet
Based on a finding that burning fat for energy has an antiseizure effect
Used primarily to treat childhood epilepsy that has not responded to antiseizure medications
Includes high fat content, no sugar and low carbohydrate & protein intake
Requires strong family, school & caregiver commitment – no cheating allowed!
Is a medical treatment – not a fad diet (Atkins)

30. Diazepam Rectal Gel
Used in acute or emergency situations to stop a seizure that will not stop on its own
Approved by FDA for use by parents & non-licensed personnel
State/school district regulations often govern use in schools
School nurse decides whether administration can be delegated based on local policy and assessment of safety issues

31. Impact on Learning
Most students with epilepsy have IQ’s within the normal range
Risk of learning problems is 3X greater than average
May have difficulty with learning, memory, attention & concentration
May be eligible for special education and related services
Students who achieve seizure control quickly, with few medication side effects, have the best chance for normal educational achievement

32. Impact on Learning, cont.
Seizures and medication side effects may cause short-term memory problems
After a seizure, coursework may need to be re-taught
Seizure activity, without physical symptoms, may still affect learning
Medication side effect include fatigue, an inability to maintain attention and concentration difficulties
Students with epilepsy are more likely to suffer from low self- esteem and depression
School difficulties are not always related to epilepsy

33. Impact on Psychosocial Development
There is an association between seizures/epilepsy and:
- Impaired self-image/self-confidence
(shame/embarrassment)
- Low self-esteem
- Anxiety
- Delayed social development
Once seizures are under control, the psychosocial impact may be more significant than the medical impact.

34. Impact on Behavior
Behavior problems are more frequent possibly due to:
- Underlying brain damage
- Medication side effects
- Anxiety and low self-esteem
- Parental overprotection, indulgence

35. Assessment Strategies
Standardized intelligence tests
Neuropsychological testing
Request more frequent reevaluation, particularly after stabilization of newly diagnosed student

36. Being Supportive Stay calm during seizure events
Keep a copy of the student’s seizure action plan
Include the seizure action plan in the student’s IEP
Know student’s medications and their possible side effects
Communicate with parents

37. Parent-School Communication
Set up a log for communicating with parent/guardian on a daily or weekly basis
Regularly note physical, emotional or cognitive changes
Create a “substitute” folder with seizure action plan and other relevant information.

38. The Other Students
Educate peers -- encourage them to tell their friends – it’s the best way to prevent feelings of alienation. They are…
Your best allies to reduce stigma
Your best allies to increase acceptance
Your best allies to create a safe environment for your students with epilepsy

39. Tips For Teachers Avoid overprotection Encourage independence
Include the student in as many activities as possible
Encourage positive peer interaction

40. Contact Information
Epilepsy Foundation Metropolitan New York Jessica Morales / Director of Epilepsy Education 257 Park Avenue South, Suite 302 New York, NY