Presentation on theme: "Epilepsy and School: Beyond Surviving & on to success"— Presentation transcript:
1Epilepsy and School: Beyond Surviving & on to success Presented by: Jessica Morales, BA Director of Epilepsy Education Epilepsy Foundation Metropolitan New York
2ObjectivesKnowing how best to communicate common seizure types and their possible impact to teachers and staffKnow how to teach appropriate first aidSet up guidelines to help staff recognize when a seizure is a medical emergencyHow to best provide social and academic support
3How 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 informationAlways try to personalize to your child and his or her needs.
4What is a Seizure? A brief, excessive discharge of electrical activity in the brain that alters one or moreof the following:MovementSensationBehaviorAwareness
5What 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.”
6Epilepsy is Common 2.7 million Americans have epilepsy 300,000 people have a first convulsion each year326,000 children through age 14 have epilepsy45,000 children under 15 develop epilepsy each year
7Did You Know …… Most seizures are not medical emergencies Students may not be aware they they are having a seizure and may not remember what happenedEpilepsy is not contagiousEpilepsy is not a form of mental illnessStudents almost never die or have brain damage during a seizureA student can’t swallow his/her tongue during a seizure
8Common 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 tumorsPoisoning (lead)Infections of the brain (meningitis, encephalitis)Brain injury at birthAbnormal brain development
9Seizure Types Generalized Seizures Partial Seizures Involve the entire brainLoss of consciousnessSymptoms may include convulsions, staring, muscle spasms and fallsPartial SeizuresInvolve only part of the brainAltered or no loss of consciousnessMay spread & generalizeSymptoms are related to the part of the brain affected
10Absence Seizures Brief pause in activity with blank stare Brief lapse of awarenessPossible chewing or blinking motionsUsually lasts 1 to 10 secondsMay occur many times a day and/or clusterOften confused with:DaydreamingLack of attention (ADD, ADHD)Work avoidanceDifficulty learning
11Generalized Tonic-Clonic May begin with a sudden, hoarse cryLoss of consciousness and fallConvulsion with stiffening of arms & legs followed by rhythmic jerkingMay have shallow breathing and/or droolingSkin, nails, lips may turn blueGenerally lasts less than 5 minutesMay lose bowel or bladder controlUsually followed by some confusion, headache, fatigue, soreness and/or speech difficulty
12First Aid for Tonic-Clonic Seizures Stay calm & track timeCheck for medical IDProtect from hazardsTurn student on sideCushion headStay with the student until alertProvide emotional supportDocument seizure activity
13DO 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 seizureAttempt to give oral medications, food or drink during a seizure
14Tonic-Clonic Seizures as a Medical Emergency First time seizureConvulsive seizure lasting longer than 5 minutesRepeated seizuresAcute change in seizure patternThe student is injured, has diabetes or is pregnantThe seizure occurs in waterNormal breathing does not resumeParents have requested emergency evaluation
15Convulsive Seizure in a Wheelchair Do not remove from wheelchair unless absolutely necessarySecure wheelchair to prevent movementFasten seatbelt (loosely) to prevent fallProtect & support headEnsure breathing is unobstructed & allow secretions to flowPad wheelchair to prevent injuries to limbsFollow relevant seizure first aid protocol
16Convulsive Seizure on a School Bus Safely pull over & stop busPlace child on side across seat facing away from back seat or in aisle if necessaryFollow appropriate seizure first aid protocol for this student until seizure ends and consciousness is regainedContinue to destination or follow school policyCall for emergency assistance if seizure is longer than 5 minutes
17Seizures in WaterSupport head so that both the mouth & nose are always above waterRemove student from the water at onceIf the student is not breathing, begin rescue breathing after seizure has passed.Always transport to emergency room
18Seizure Action PlanEstablish a seizure action plan for each student diagnosed with epilepsyEstablish a seizure action plan for anyone having a first time seizureFollow seizure emergency definition and protocol as defined by the healthcare provider in the seizure action plan
20Simple Partial Seizures Full awareness is maintainedMay 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 durationOften confused with acting out, mystical experiences, psychosomatic illness
21Complex Partial Seizures Short durationAggressive behaviorMay be followed by fatigue, headache or nauseaMay become combative if restrainedOften confused with:Drunkenness or drug abuseAwareness impaired with inability to respondOften begins with a blank, dazed stareMay observe repetitive, purposeless and/or disoriented movementsClumsy or disoriented movements, aimless walking, picking things up, nonsensical speech or lip smacking
22Complex Partial Seizure First Aid Stay calm & reassure othersTrack timeCheck for medical IDDo not try to restrainGently direct away from hazardsDo not expect verbal instructions to be obeyedStay with the student until fully alertIf seizure last longer than 30 minutes, call EMS
23Seizure TriggersFactors that may increase the likelihood of a seizure in students with a diagnosis of epilepsy:Missed medicationOverheating/overexertiondehydrationStress/anxietyExtreme fatiguePoor diet/missed mealsHormonal changesIllnessAlcohol or drug useDrug interactions (OTC, prescribed, herbals or supplements)
24Treatment 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.
25Medication Side Effects Slow motor responseLow self-esteemHyperactivityUnresponsivenessStaringAttention and memory deficitsPoor reading skillsImpaired auditory-perceptual and language processing abilitiesMood swingsMedication Side Effects
26Prescription 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.KeppraLyrica (pregabalin)Trileptal (oxcarbazepine)Keppra (levetiracetam)Zonegran (zonisamide)Topamax (topiramate)Gabitril (tiagabine hydrochlorine)Lamictal (lamotrigine)Diastat (diazepam rectal gel)
27Brain SurgeryLobectomy- 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.
28Vagus Nerve Stimulator Device implanted just under the skin in the chest with wires that attach to the vagus nerve in the neckDelivers intermittent electrical stimulation to the Vagus Nerve in the neck that relays impulses to widespread areas of the brainUsed primarily to treat partial seizures when medication is not effectiveUses a special magnet to activate the device that may help student to prevent or reduce the severity of an oncoming seizureStudent usually still requires antiseizure medication
29The Ketogenic DietBased on a finding that burning fat for energy has an antiseizure effectUsed primarily to treat childhood epilepsy that has not responded to antiseizure medicationsIncludes high fat content, no sugar and low carbohydrate & protein intakeRequires strong family, school & caregiver commitment – no cheating allowed!Is a medical treatment – not a fad diet (Atkins)
30Diazepam Rectal GelUsed in acute or emergency situations to stop a seizure that will not stop on its ownApproved by FDA for use by parents & non-licensed personnelState/school district regulations often govern use in schoolsSchool nurse decides whether administration can be delegated based on local policy and assessment of safety issues
31Impact on LearningMost students with epilepsy have IQ’s within the normal rangeRisk of learning problems is 3X greater than averageMay have difficulty with learning, memory, attention & concentrationMay be eligible for special education and related servicesStudents who achieve seizure control quickly, with few medication side effects, have the best chance for normal educational achievement
32Impact on Learning, cont. Seizures and medication side effects may cause short-term memory problemsAfter a seizure, coursework may need to be re-taughtSeizure activity, without physical symptoms, may still affect learningMedication side effect include fatigue, an inability to maintain attention and concentration difficultiesStudents with epilepsy are more likely to suffer from low self- esteem and depressionSchool difficulties are not always related to epilepsy
33Impact on Psychosocial Development There is an association between seizures/epilepsy and:- Impaired self-image/self-confidence(shame/embarrassment)- Low self-esteem- Anxiety- Delayed social developmentOnce seizures are under control, the psychosocial impact may be more significant than the medical impact.
34Impact on BehaviorBehavior problems are more frequent possibly due to:- Underlying brain damage- Medication side effects- Anxiety and low self-esteem- Parental overprotection, indulgence
35Assessment Strategies Standardized intelligence testsNeuropsychological testingRequest more frequent reevaluation, particularly after stabilization of newly diagnosed student
36Being Supportive Stay calm during seizure events Keep a copy of the student’s seizure action planInclude the seizure action plan in the student’s IEPKnow student’s medications and their possible side effectsCommunicate with parents
37Parent-School Communication Set up a log for communicating with parent/guardian on a daily or weekly basisRegularly note physical, emotional or cognitive changesCreate a “substitute” folder with seizure action plan and other relevant information.
38The Other StudentsEducate peers -- encourage them to tell their friends – it’s the best way to prevent feelings of alienation. They are…Your best allies to reduce stigmaYour best allies to increase acceptanceYour best allies to create a safe environment for your students with epilepsy
39Tips For Teachers Avoid overprotection Encourage independence Include the student in as many activities as possibleEncourage positive peer interaction
40Contact InformationEpilepsy Foundation Metropolitan New York Jessica Morales / Director of Epilepsy Education 257 Park Avenue South, Suite 302 New York, NY