Presentation on theme: "NOTES: Introduce yourself."— Presentation transcript:
1NOTES:Introduce yourself.Ask, “How many of you have experience with students or other people who have seizures? Would you be willing to briefly share your experience with the group?”Keep total sharing time to about two minutes.If implementing the optional certification process, notify participants that they will be tested on the training content.
2ObjectivesRecognize common seizure types and their possible impact on studentsKnow appropriate first aidRecognize when a seizure is a medical emergencyProvide social and academic supportNOTES:All materials presented in the PowerPoint slides are covered in the written materials in your handout packets.If implementing the certification process, review the following with training participants:At the conclusion of this training, you will be asked to take a brief learning assessment to help determine the effectiveness of the training.A certificate of participation will also be issued.Receipt of your certificate is not dependent on the results of your learning assessment.
3What is a Seizure?A brief, excessive discharge of electrical activity in the brain that alters one or more of the following:MovementSensationBehaviorAwarenessNOTES:There are more than 20 different kinds of seizures.Seizure symptoms depend on where in the brain the excessive electrical activity occurs and how much of the brain is affected during the seizure.Seizures are temporary and episodic.
4What is Epilepsy?Epilepsy is a chronic neurological disorder characterized by a tendency to have recurrent seizuresEpilepsy is also known as a “seizure disorder”NOTES:Most seizures occur spontaneously and unpredictably.
5Epilepsy is More Common Than You Think 2.7 million Americans315,000 students in the United StatesMore than 45,000 new cases are diagnosed annually in children1 in 100 people will develop epilepsy1 in 10 people will have a seizure in their lifetimeEpilepsy is more common than Cerebral Palsy, Parkinson’s Disease and Multiple Sclerosis combinedNOTES:Before reviewing the next overhead, say:There are many prevalent misconceptions about epilepsy. Here are some of the facts you should know.
6Did You Know That… Most seizures are NOT medical emergencies Students may NOT be aware 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 NOT swallow his/her tongue during a seizureNOTES:You should never put anything in the mouth of a person having a seizure.
7Common Causes of Epilepsy For seventy percent (70%) of people with epilepsy the cause is unknownFor the remaining thirty percent (30%) common identifiable causes include:Brain traumaBrain lesions (e.g. tumors)Poisoning (lead)Infections of the brain (e.g. meningitis, encephalitis, measles)Brain injury at birthAbnormal brain developmentNOTES:Brain trauma is the major identified cause of epilepsy in teens and adults.
8Seizure Types Generalized Seizures Partial Seizures Involve the whole brainCommon types include absence and tonic-clonicSymptoms may include convulsions, staring, muscle spasms and fallsPartial SeizuresInvolve only part of the brainCommon types include simple partial and complex partialSymptoms relate to the part of the brain affectedNOTES:Seizure symptoms in a specific person are generally the same each time a seizure occurs.All about auras:Some students will have a definite sign that a seizure is about to happen. This is called an aura.An aura may include, but is not limited to, an odd taste or smell, a feeling of fear, a visual or auditory experience or a tingling sensation.In some cases an aura may allow the student to prepare for the oncoming seizure and warn others that a seizure is about to occur.
9Absence Seizures Pause in activity with blank stare Brief lapse of awarenessPossible chewing or blinking motionUsually lasts 1 to 10 secondsMay occur many times a dayMay be confused with:DaydreamingLack of attentionADDNOTES:Previously called “petit mal.”Other symptoms may include eye fluttering, slight head movement and some mouth movement.As an absence seizure ends, a student will pick up where he/she left off and resume normal activities.No first aid is necessary for an absence seizure.Absence seizures may occur in clusters which may lead to a brief period of disorientation.Recording seizure frequency using a seizure observation record can help with identifying possible seizure triggers.
10Generalized Tonic-Clonic A sudden, hoarse cryLoss of consciousnessA fallConvulsions (stiffening of arms and legs followed by rhythmic jerking)Shallow breathing and drooling may occurPossible loss of bowel or bladder controlOccasionally skin, nails, lips may turn blueGenerally lasts 1 to 3 minutesUsually followed by confusion, headache, tiredness, soreness, speech difficultyNOTES:Previously called a “grand mal” seizure.This is the seizure most people think of when they hear the word epilepsy.Initially, the student loses consciousness and falls to the ground.As the diaphragm contracts, the student may produce a loud cry.Eyes may roll up or turn to the side.The body usually becomes very rigid before convulsions begin.The student may bite his/her tongue during the seizure.Several hours of rest may be needed after the seizure.
11First Aid - Generalized Tonic-Clonic Seizure Stay calm and track timeCheck for epilepsy or seizure disorder I.D. (bracelet, necklace)Protect student from possible hazards (chairs, tables, sharp objects, etc.)Turn student on his/her sideCushion headAfter the seizure, remain with the student until awareness of surroundings is fully regainedProvide emotional supportDocument seizure activityNOTES:Tracking time is important because a seizure lasting longer than 5 minutes will require an emergency intervention.Reassure other students and explain what is happening if necessary.Turning the student to one side keeps the tongue from blocking the airway and allows saliva to drain from the mouth.The palm of the hand or other soft object can be used to cushion the head.Be sure that any object cushioning the head is not covering the mouth or nose and hampering breathing.If necessary, remove eyeglasses and loosen tight neckwear.To establish that student has regained full awareness of surroundings after the seizure, ask simple questions like, “What is your name?”IMPORTANT! - If your school district has emergency seizure protocols, please explain them to the training participants now.
12Dangerous First Aid!!!DO NOT put anything in the student’s mouth during a seizureDO NOT hold down or restrainDO NOT attempt to give oral medications, food or drink during a seizureNOTES:It is physically impossible to swallow your tongue.Inserting something in the student’s mouth during a seizure will potentially break teeth, injure their jaw or block the airway.Restraining or holding someone down during a convulsive seizure can cause spraining or breaking of body parts.
13When is a Seizure an Emergency? First time seizure (no medical ID and no known history of seizures)Convulsive seizure lasting more than 5 minutesRepeated seizures without regaining consciousnessMore seizures than usual or change in typeStudent is injured, has diabetes or is pregnantSeizure occurs in waterNormal breathing does not resumeParents request emergency evaluationFollow seizure emergency definition and protocol as defined by the healthcare provider in the seizure action planNOTES:If the student is not breathing after the seizure, begin rescue breathing until the ambulance arrives.
14Simple Partial Seizures Full awareness maintainedRhythmic movements (isolated twitching of arms, face, legs)Sensory symptoms (tingling, weakness, sounds, smells, tastes, feeling of upset stomach, visual distortions)Psychic symptoms (déjà vu, hallucinations, feeling of fear or anxiety, or a feeling they can’t explain)Usually lasts less than one minuteMay be confused with: acting out, mystical experience, psychosomatic illnessNOTES:A student remains conscious and responsive during a simple partial seizure.Typical symptoms may include ringing in ears, odd smells, metallic taste, nausea, tingling, sweating, dilation of pupils, emotional changes such as fear, joy or anxiety, visual hallucinations and distortions of how the student views his or her environment.No particular first aid is needed other than emotional support and reassurance.
15Complex Partial Seizures Awareness impaired/inability to respondOften begins with blank dazed stareAUTOMATISMS (repetitive purposeless movements)Clumsy or disoriented movements, aimless walking, picking things up, nonsensical speech or lip smackingOften lasts one to three minutesOften followed by tiredness, headache or nauseaMay become combative if restrainedMay be confused with:Drunkenness or drug abuseAggressive behaviorNOTES:Complex partial seizures typically involve automatic behaviors (automatisms), including hand wringing, picking at clothing, lip smacking and wandering.An aura (actually a simple partial seizure) often precedes a complex partial seizure.Complex partial seizures usually begin before age 18 and are the most common seizure type in teens and adults.A complex partial seizure can progress to a generalized tonic-clonic seizure.
16First Aid - Complex Partial Seizure Stay calm, reassure othersTrack timeCheck for medical I.D.Do not restrainGently direct away from hazardsDon’t expect student to obey verbal instructionsStay with student until fully alert and awareIf seizure lasts 5 minutes beyond what is routine for that student or another seizure begins before full consciousness is achieved, follow emergency protocolNOTES:If this is a first seizure, inform the school nurse or parent.Restraint during a seizure can cause an aggressive response – brain perceives unwanted restraint as an attack.Before reviewing the next overhead:Sometimes a specific seizure trigger is discovered. Avoiding that activity may decrease the frequency of seizures. Here is a list of possible seizure triggers.
17Seizure Triggers or Precipitants Flashing lights and hyperventilation can trigger seizures in some students with epilepsyFactors that might increase the likelihood of a seizure in students with epilepsy include:Missed or late medication (#1 reason)Stress/anxietyLack of sleep/fatigueHormonal changesIllnessAlcohol or drug useDrug interactions (from prescribed or over the counter medicines)Overheating/overexertionPoor diet/missed mealsNOTES:A student’s environment or activities may need to be modified to reduce exposure to situations that trigger seizures.A school safety evaluation can help determine any changes that need to be made.Consider flashing lights in MOVIES, TELEVISION and COMPUTERS, all of which can be seizure triggers.In many cases there is no identifiable trigger or precipitating factor.Before reviewing the next overhead:When teaching students with epilepsy, there are several important things to keep in mind.
18The Impact on Learning & Behavior Seizures may cause short-term memory problemsAfter a seizure, coursework may have to be re-taughtSeizure activity, without obvious physical symptoms, can still affect learningMedications may cause drowsiness, inattention, concentration difficulties and behavior changesStudents with epilepsy are more likely to suffer from low self-esteemSchool difficulties are not always epilepsy-relatedNOTES:
19Tips for Supporting Students with Epilepsy Stay calm during seizure episodesBe supportiveHave a copy of the child’s seizure action planDiscuss seizure the action plan in the student’s IEPKnow child’s medications and their possible side effectsEncourage positive peer interactionContinuedNOTES:Your behavior during a seizure episode can make a substantial difference in how students react and how the student with seizures copes with his/her condition.By reassuring other students that you know what to do and that everything will be all right, they will remain calm during seizure episodes.
20Tips for Supporting Students with Epilepsy Avoid overprotection and encourage independenceInclude the student in as many activities as possibleCommunicate with parents about child’s seizure activity, behavior and learning problemsNOTES:Promptly address teasing behaviors and help educate other students about epilepsy.Each teacher should receive a seizure action plan or some type of detailed instructions from the school nurse about how to manage seizures in the classroom.This document should include the student’s seizure type(s), frequency of seizures, emergency contact information, basic first aid and emergency response protocol.BEFORE PLAYING THE DVD SAY:We are going to watch a DVD that reviews some of what we’ve learned thus far in the training and shows footage of actual seizures.PLAY DVD HERE
21Information and Referral Contact InformationEpilepsy FoundationInformation and Referral(800)NOTES:If you need contact information for your local affiliate or would like additional information about epilepsy, please call this number or visit the Epilepsy Foundation website.Ask participants to take a few minutes to complete the Learning Assessment and a Participant Satisfaction Survey.When participants are finished, review the correct answers for the learning assessment.If implementing the certification process provide a Certificate of Participation to each participant.
22Optional Topics Convulsive seizure in a wheelchair Convulsive seizure on a school busConvulsive seizure in the waterKetogenic dietDiazepam rectal gelVagus Nerve StimulatorNOTES:Slides can be added to your training for special audiences such as, bus drivers or special education classroom personnel.
23Convulsive Seizure in a Wheelchair Do not remove from wheelchair unless absolutely necessarySecure wheelchair to prevent movementFasten seatbelt (loosely) to prevent student from falling from wheelchairProtect and support headEnsure breathing is unobstructed and allow secretions to flow from mouthPad wheelchair to prevent injuries to limbsFollow relevant seizure first aid protocolNOTES:In some cases it may be necessary to loosen or remove a seat belt strap that goes across the chest of a student in a wheelchair. These can sometimes restrict airflow and breathing. Backpack style harnesses and lap belts do not cause these same breathing restriction problems and may be left on during a seizure.
24Convulsive Seizure on a School Bus Safely pull over and stop busPlace student on his/her side across the seat facing away from the seat back (or in aisle if necessary)Follow standard seizure first aid protocol until seizure abates and child regains consciousnessContinue to destination or follow school policyNOTES:The bus driver’s decision to return to school or proceed to his final destination should be based on school policy and the seizure action plan.
25Convulsive Seizure in the Water Support head so that both the mouth and nose are always above the waterRemove the student from the water as soon as it can be done safelyIf the student is not breathing, begin rescue breathingAlways transport the student to the emergency room even if he/she appears fully recoveredNOTESWhen a student has a seizure in water, there is a high likelihood that he/she will have aspirated water and, as a safety precaution, it is important to always have a medical evaluation.
26Ketogenic DietBased on a finding that burning fat for energy has an antiseizure effectUsed primarily to treat severe childhood epilepsy that has not responded to standard antiseizure drugsDiet includes high fat content, no sugar and low carbohydrate and protein intakeRequires strong family, school and caregiver commitment – no cheating allowedIt is a medical treatment – not a fad dietNOTES:The Ketogenic diet is usually initiated when medication has been ineffective.The student usually remains on the diet for two years then is gradually weaned back to a regular, healthy diet.Students on the diet often lose weight.Some students will still require antiseizure medications while on the diet.
27Vagus 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 effectiveUse of special magnet to activate the device may help student prevent or reduce the severity of an oncoming seizureStudent may still require antiseizure medicationNOTES:The most common side effect is a change in vocal quality (hoarseness) when VNS pulse goes off.School personnel may be trained to activate the VNS device using a magnet in the event the student cannot.
28Diazepam Rectal GelUsed in acute or emergency situations to stop a seizure that will not stop on its ownApproved by FDA for use by parents and non-medical caregiversState/school district regulations often govern use in schoolsNOTES:If your school district has specific protocols regarding the use of this medication, you (the presenter) should be prepared to explain them to the audience.An additional training session may be necessary to provide specific instruction in the administration and use of this medication as per your state’s nurse practice act, school district regulations and school policy.