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NOTES: Introduce yourself.

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Presentation on theme: "NOTES: Introduce yourself."— Presentation transcript:

1 NOTES: 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.

2 Objectives Recognize common seizure types and their possible impact on students Know appropriate first aid Recognize when a seizure is a medical emergency Provide social and academic support NOTES: 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.

3 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 NOTES: 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.

4 What is Epilepsy? Epilepsy is a chronic neurological disorder characterized by a tendency to have recurrent seizures Epilepsy is also known as a “seizure disorder” NOTES: Most seizures occur spontaneously and unpredictably.

5 Epilepsy is More Common Than You Think
2.7 million Americans 315,000 students in the United States More than 45,000 new cases are diagnosed annually in children 1 in 100 people will develop epilepsy 1 in 10 people will have a seizure in their lifetime Epilepsy is more common than Cerebral Palsy, Parkinson’s Disease and Multiple Sclerosis combined NOTES: Before reviewing the next overhead, say: There are many prevalent misconceptions about epilepsy. Here are some of the facts you should know.

6 Did You Know That… Most seizures are NOT medical emergencies
Students may NOT be aware 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 NOT swallow his/her tongue during a seizure NOTES: You should never put anything in the mouth of a person having a seizure.

7 Common Causes of Epilepsy
For seventy percent (70%) of people with epilepsy the cause is unknown For the remaining thirty percent (30%) common identifiable causes include: Brain trauma Brain lesions (e.g. tumors) Poisoning (lead) Infections of the brain (e.g. meningitis, encephalitis, measles) Brain injury at birth Abnormal brain development NOTES: Brain trauma is the major identified cause of epilepsy in teens and adults.

8 Seizure Types Generalized Seizures Partial Seizures
Involve the whole brain Common types include absence and tonic-clonic Symptoms may include convulsions, staring, muscle spasms and falls Partial Seizures Involve only part of the brain Common types include simple partial and complex partial Symptoms relate to the part of the brain affected NOTES: 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.

9 Absence Seizures Pause in activity with blank stare
Brief lapse of awareness Possible chewing or blinking motion Usually lasts 1 to 10 seconds May occur many times a day May be confused with: Daydreaming Lack of attention ADD NOTES: 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.

10 Generalized Tonic-Clonic
A sudden, hoarse cry Loss of consciousness A fall Convulsions (stiffening of arms and legs followed by rhythmic jerking) Shallow breathing and drooling may occur Possible loss of bowel or bladder control Occasionally skin, nails, lips may turn blue Generally lasts 1 to 3 minutes Usually followed by confusion, headache, tiredness, soreness, speech difficulty NOTES: 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.

11 First Aid - Generalized Tonic-Clonic Seizure
Stay calm and track time Check for epilepsy or seizure disorder I.D. (bracelet, necklace) Protect student from possible hazards (chairs, tables, sharp objects, etc.) Turn student on his/her side Cushion head After the seizure, remain with the student until awareness of surroundings is fully regained Provide emotional support Document seizure activity NOTES: 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.

12 Dangerous First Aid!!! DO NOT put anything in the student’s mouth during a seizure DO NOT hold down or restrain DO NOT attempt to give oral medications, food or drink during a seizure NOTES: 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.

13 When is a Seizure an Emergency?
First time seizure (no medical ID and no known history of seizures) Convulsive seizure lasting more than 5 minutes Repeated seizures without regaining consciousness More seizures than usual or change in type Student is injured, has diabetes or is pregnant Seizure occurs in water Normal breathing does not resume Parents request emergency evaluation Follow seizure emergency definition and protocol as defined by the healthcare provider in the seizure action plan NOTES: If the student is not breathing after the seizure, begin rescue breathing until the ambulance arrives.

14 Simple Partial Seizures
Full awareness maintained Rhythmic 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 minute May be confused with: acting out, mystical experience, psychosomatic illness NOTES: 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.

15 Complex Partial Seizures
Awareness impaired/inability to respond Often begins with blank dazed stare AUTOMATISMS (repetitive purposeless movements) Clumsy or disoriented movements, aimless walking, picking things up, nonsensical speech or lip smacking Often lasts one to three minutes Often followed by tiredness, headache or nausea May become combative if restrained May be confused with: Drunkenness or drug abuse Aggressive behavior NOTES: 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.

16 First Aid - Complex Partial Seizure
Stay calm, reassure others Track time Check for medical I.D. Do not restrain Gently direct away from hazards Don’t expect student to obey verbal instructions Stay with student until fully alert and aware If seizure lasts 5 minutes beyond what is routine for that student or another seizure begins before full consciousness is achieved, follow emergency protocol NOTES: 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.

17 Seizure Triggers or Precipitants
Flashing lights and hyperventilation can trigger seizures in some students with epilepsy Factors that might increase the likelihood of a seizure in students with epilepsy include: Missed or late medication (#1 reason) Stress/anxiety Lack of sleep/fatigue Hormonal changes Illness Alcohol or drug use Drug interactions (from prescribed or over the counter medicines) Overheating/overexertion Poor diet/missed meals NOTES: 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.

18 The Impact on Learning & Behavior
Seizures may cause short-term memory problems After a seizure, coursework may have to be re-taught Seizure activity, without obvious physical symptoms, can still affect learning Medications may cause drowsiness, inattention, concentration difficulties and behavior changes Students with epilepsy are more likely to suffer from low self-esteem School difficulties are not always epilepsy-related NOTES:

19 Tips for Supporting Students with Epilepsy
Stay calm during seizure episodes Be supportive Have a copy of the child’s seizure action plan Discuss seizure the action plan in the student’s IEP Know child’s medications and their possible side effects Encourage positive peer interaction Continued NOTES: 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.

20 Tips for Supporting Students with Epilepsy
Avoid overprotection and encourage independence Include the student in as many activities as possible Communicate with parents about child’s seizure activity, behavior and learning problems NOTES: 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

21 Information and Referral
Contact Information Epilepsy Foundation Information 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.

22 Optional Topics Convulsive seizure in a wheelchair
Convulsive seizure on a school bus Convulsive seizure in the water Ketogenic diet Diazepam rectal gel Vagus Nerve Stimulator NOTES: Slides can be added to your training for special audiences such as, bus drivers or special education classroom personnel.

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

24 Convulsive Seizure on a School Bus
Safely pull over and stop bus Place 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 consciousness Continue to destination or follow school policy NOTES: 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.

25 Convulsive Seizure in the Water
Support head so that both the mouth and nose are always above the water Remove the student from the water as soon as it can be done safely If the student is not breathing, begin rescue breathing Always transport the student to the emergency room even if he/she appears fully recovered NOTES When 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.

26 Ketogenic Diet Based on a finding that burning fat for energy has an antiseizure effect Used primarily to treat severe childhood epilepsy that has not responded to standard antiseizure drugs Diet includes high fat content, no sugar and low carbohydrate and protein intake Requires strong family, school and caregiver commitment – no cheating allowed It is a medical treatment – not a fad diet NOTES: 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.

27 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 Use of special magnet to activate the device may help student prevent or reduce the severity of an oncoming seizure Student may still require antiseizure medication NOTES: 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.

28 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 and non-medical caregivers State/school district regulations often govern use in schools NOTES: 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.

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