Seizures can be Scary Introduce your self. You might ask if anyone has ever seen a person have a seizure. (Seizure stories can be helpful, but also lengthy.)

Goals for today Learn what a seizure is Recognize seizure activity Learn appropriate seizure first aid Learn about learning implications Consider the social ramifications Know when and when not to call 911 Seizures can be scary. They can be rare or they can happen very frequently. The best way to help this student is to be prepared and to know what to do.

What is a Seizure The term "seizure" refers to a transitory disturbance in consciousness or in motor function due to uncontrolled electrical discharges in the brain. Epilepsy or Seizure Disorder, refers to a variety of disorders characterized by recurrent seizures. The type of seizure depends on the part of the brain where the abnormal electrical discharge originates. A seizure is a symptom of the disorder just as fever is a symptom of infection. Seizures are temporary, but tend to happen repeatedly.

The brain is a complex organ... Anything the brain can do, can also be seen in a seizure. Movements Sensations Thoughts Emotions The brain is a complex, sensitive organ that controls and regulates all our motor movements, sensations, thoughts, and emotions. Brain cells work together, communicating by means of electric signals. Occasionally a group of cells discharge abnormal signals and the result is a seizure. One in 10 people will have a seizure at some point in their lives.

Seizure disorders are not contagious and not a sign of mental illness or mental retardation. There are huge privacy issues, however. Most people who suffer from a seizure disorder are sensitive about others knowing. Parents have been known to hide the fact from schools. They do not want the student treated differently from other students. There is still some stigma attached with epilepsy, but parents are mainly concerned with the safety and well being of their child at school. However, BEFORE ANY DISCLOSURE IS MADE TO THE CLASS AT LARGE, GET PARENT AND STUDENT PERMISSION.

Common Causes of Seizures Brain injury (at birth or accidental) Tumors Infections Poisonings (lead) Unknown Cause... 70% Brain trauma is the major identified cause of epilepsy in teens and adults, but you can see a large majority of seizures have an unknown cause.

Types of Seizures Generalized Absence Partial and Partial Complex There are many different types of seizures (over 20 types). Today we are going to focus on the 3 main types seen at school. Most teachers, at some point in their career, will have a student with a seizure disorder. Knowing what to do and how to react will profoundly influence the outcome, not just for the student having the seizure, but for everyone in the room as well.

Generalized (Sometimes called Grand Mal) This disorder is characterized by: Loss of consciousness Followed by stiffening for a few seconds (tonic phase) then followed a by period of jerking (clonic phase). Usually last a minute to three minutes. After the seizure, a period of deep sleep occurs (postictal stage) lasting from a few minutes to hours. This can be a very frightening experience to watch! My first suggestion is to take your own pulse, because the way you react will dramatically effect the outcome for this student. If we can remain calm and follow a few simple rules everything will be fine. It may look like this child is going to die... They may look like they are not breathing (it is hard to breathe when all this is going on)... There may be color changes in the face and nail beds. But, I can assure you that it will be over fairly quickly (within 1-2 minutes) and things will improve. The chances of anyone actually dying from a seizure are very remote.

AURA If you see a seizure is starting, attempt to prevent injury by easing the student to the floor. Keep hard, sharp or hot objects out of the way. Some students can tell you that they are going to have a seizure or their behavior tells you. This is called an aura. It might be just a feeling (like a tingling sensation), an odd taste or smell, maybe a visual or auditory experience. They may start to cry or sit down. Other seizures have no warning. They may cry out and then fall to the ground. If you can remain calm from here on out it will be very helpful for everyone around you. Certainly the child having the seizure is our main concern, but everyone’s reaction can and will affect the outcome as well. Do not attempt tp remove them from a wheelchair unless it is absolutely necessary. Secure the wheelchair to prevent movement. Support and protect their head.

First Aid for a Generalized Seizure Turn the student on their side to allow saliva to drain and to prevent choking. Some people are worried or have heard that a person having a seizure may swallow their tongue. The tongue is attached to the floor of the mouth and cannot be swallowed, but it can fall back and block the airway. Simply turning the student to their side will prevent this and will help the student with breathing.

Look at the eyes. Note if the child’s eyes roll up or turn to the side. Try to remember which way the eyes turned.

Comfort Do not restrain. You may place a thin, soft towel or item under the head if the floor is hard. During the jerking movements of the seizure a student can injure their head or extremities. Do not try and control the jerking, but do prevent injury. Talk to them. Tell them they are going to be OK and that the seizure will be over in a few minutes. It may seem like an hour to you, but, again, your response will set the tone for others around you.

Do not force anything between teeth or place any object in mouth. There was a time when people were taught to put a spoon or a pencil in the mouth of a person having a seizure. This is absolutely harmful and wrong. PUT NOTHING IN THE MOUTH! The student may bite his/her tongue during the seizure, but this causes less damage than trying to put something in the mouth.

Do not give fluids or food during or immediately after seizure. Loosen restrictive clothing and remove glasses. Keep talking to them and stressing that everything is going to be fine.

Observe for: Injury from a fall Breathing Color of lips, face and skin What is happening There is a lot happening in a short amount of time. Remember that you need to recall what you have seen and what you did.

Check the clock at the beginning of the seizure and at the end. Note the length of the seizure. It is important to actually look at a clock because a seizure will seem much longer than the real time. The length of the seizure is important in determining the first aid.

After the Seizure When the seizure is finished, your student may be sleepy- which is normal. Provide a comfortable, private place for rest where he/she can be observed. Tell the student where he/she is, what time it is and what happened. This is called the Postictal Stage, It can last for a few minutes or a couple of hours depending on the length and type of seizure. Careful observation is important in the event another seizure should start before they are fully awake.

Document all seizure activity in the seizure log. Include: When the seizure occurred How long the seizure lasted What you saw and any injury or unusual occurrence What you did When you notified the parent It is a good idea, if you have the presence of mind, to note if there was there any aura or warning that a seizure was about to happen. What was the student doing before the seizure started? Did they fall and were there any injuries from that fall? Next, note where the seizure started (on the face, or maybe on the left side, or in the lower extremities) and how many of the extremities were involved in the seizure (is it all four extremities or just one?) Did you notice if he eyes were looking to one side? These are important observations for the health care provider to determine what part of the brain is involved. Notify parent and school nurse of any seizure activity or injury.

When to call 911 If the seizure lasts longer than 5 minutes If he/she does not resume normal breathing If another seizure starts before the student is fully awake If this is a first seizure, or if the student is pregnant or has diabetes. If an injury occurred during the seizure or it happened in water. Notify the principal and the school nurse if prolonged seizure or injury occurred.

Things to consider... Supervision to prevent falls and other injury. May need to avoid heights (such as swings and jungle gyms). Supervision may be required for transportation, classroom and recess, and/or toileting. Participating in a swimming program requires physician and parent written permission and one-on-one supervision. Safety equipment, such as helmets and pads might be helpful. Activity restrictions should be reassessed at least annually. Safety is the main concern, but over protection can also be a concern.

Quiz Time... What is a generalized seizure? What should you do? When do you call 911? Any questions? Generalized seizures, which are also known as grand mal seizures, are characterized by loss of consciousness followed by stiffening for a few seconds (tonic phase) then followed by period of jerking (clonic phase). First, and foremost, stay calm. As a rule, these seizures last from 1-2 minutes. After the seizure a period of deep sleep occurs (postictal stage) lasting from minutes to hours. You call 911 only if the seizure lasts longer than 5 minutes, a second seizure starts before they are fully awake, an injury occurred with the fall or during the seizure that requires medical attention, or if this student has no known history of seizures.

Absence Seizure Sometimes referred to as Petit Mal Brief and lasts only a few seconds. Seizure activity often mistaken for daydreaming may include staring spells, eye blinking or fluttering, and mild facial twitching. Often teachers are the first to notice this type of seizure. Absence seizures are the most common type of seizure disorder in children and can occur frequently throughout the day. If frequent, it can severely affect a student's learning... and should not be considered “petit” or small just because there is not a lot of jerking. Students can be sleepy after… but usually can pick up where they left off.

First Aid for Absence Seizure Avoid known triggers. School staff should offer patience and understanding. No emergency intervention is required for these seizures. It is helpful to repeat questions. A gentle reminder of the task at hand can be helpful. Document all seizure activity. People often jump to conclusions that students experiencing absence seizures are bored or maybe they are on “drugs”. If an individual’s seizures are increasing, notify parent and school nurse. School staff should document all observed seizure activity in the seizure log. If student becomes sleepy after the seizure, notify parent and school nurse.

Quiz Time What is an Absence Seizure? How long do they last? What is the most important thing to remember? Remember these seizures are like daydreaming... They are very short, but can happen many times a day... We are talking up to 50- 60 times a day. They become an issue at school mainly because while the student is having a seizure they are not hearing the instruction and cannot respond. Repeating the information and documenting the seizures are very important.

Partial Seizures simple partial seizure occurs when only one part of the brain is involved. In this type of seizure, the student is aware of the seizure because consciousness is not impaired. Some symptoms include hand or mouth movement, head or eyes turned to the side, a “pins and needles” sensation, feeling of numbness, or hearing noises. This types of seizure can be mistaken for behavior problems. They may have ringing in the ears, odd smells, metallic taste, nausea tingling, sweating, dilation of pupils, emotional changes (such as fear, joy or anxiety), visual hallucinations and distortion of how the student views his or her environment.

Complex Partial Seizures Only one part of the brain is involved. The student generally will have impaired consciousness. Student may have a blank stare followed by purposeless activity. Student may seem unaware of surroundings and unresponsive to verbal commands. Student may mumble, pick at own or others clothing, run, struggle, especially if restrained. Afterwards there is no memory of actions. This type of seizure usually involves automatic behaviors such as hand-wringing, picking clothing, lip-smacking, and wandering. This type of seizure can progress to a generalized tonic-clonic seizure.

First Aid for Partial Seizures No first aid is required. Speak calmly and reassuringly. Guide gently away from hazard. Do not grab roughly or abruptly, unless there is immediate danger. Do not restrain. Do not shout or expect instruction to be followed. Stay with the student until he/she is aware of where and what is happening. School staff should document all observed seizure activity in a daily log. If an individual’s seizures are increasing, notify parent and school nurse. Sometimes a specific trigger is discovered. Avoiding that activity may decrease the frequency of seizures. Some triggers may include flashing lights or hyperventilation. Other factors include missing medication, stress and anxiety, fatigue, illness, or hormonal changes. If the student becomes sleepy after the seizure, notify parent and school nurse. The student should be allowed to participate in PE and other activities, as doctor allows.

Things to consider at school... Are there any known triggers? How can the triggers be avoided? (Consider flashing lights in movies, television and computers) Are there changes in the classroom needed to provide a safe environment?

Treatments Medications Surgery Vagus Nerve Stimulator Ketogenic Diet Most people achieve good seizure control with medications. Oral medication is by far the most common treatment. It is a good idea to be familiar with the medication your student is taking. Sometimes it takes more that one medication. We also need to remember that all medications have desired effects and they all also have unwanted side effects. This can have an academic impact. Surgery can be used only if there is a focal point in the brain identified and the student has not responded to medications. A Vagus Nerve Stimulator is a rare treatment. It is a small device surgically placed under the skin. It gives an electrical stimulation to the brain at regular intervals. A magnet is used to activate the stimulator. The Ketogenic Diet is another very rare treatment. The ketogenic diet is a high fat, adequate protein, low carbohydrate diet designed to mimic many of the biochemical changes associated with prolonged starvation. For some children whose epilepsy could not be controlled by medications, beneficial effects of prolonged fasting have been found.

At School... Have an up to date Classroom Health Care Plan Discuss the plan with all classroom helpers and the parents. Encourage positive peer interaction. Avoid overprotecting, but safety comes first. Planning is so very important. Be prepared.

Most important things to Remember! Stay Calm A student having a seizure is not going to die Follow the rules Document Again, do not be in the dark. Have a plan, follow that plan, and document.

Seizure Log… What did you see? Name: __________________ School Year: _________   *Star* where the seizure stated And how it progressed. Date/Time Where Activity Aura/ Fell/ Injury Eye/ Face Twitch-ing Eye Movement Jerking Rt. Arm Jerking Lt. Arm Rt. Leg Lt. Bladder/ Bowel Loss Responds To Name/ Length Sleepy/ Parent notified Seizure Log… What did you see? There is a place for the student’s name and the year. The date and time are important. Where the seizure occurred and what the student was doing is also helpful information. If the student had a warning or aura, or if the student fell Should also be noted in the seizure log. If you can, star where the seizure started and how it progressed. (For instance, the seizure may have stared with a facial twitching and then the student became stiff and the right hand started jerking.) If you see the student’s eyes look in a certain direction, note that. If the student looses bowel or bladder control there is a space to note that as well. A very important observation is how long did the seizure last and was the student sleepy after the seizure. Are they able to respond to their name? Lastly, how was the parent notified of the seiaure.

Ideal Treatment Goals for Epilepsy Complete freedom from seizures and adverse events Avoidance of drug interactions Improved compliance Minimal interference with daily activities. These are lofty goals, and for some unattainable. Our role is to be supportive and prepared. Any questions?

Prepared by: Mary Clark RN, NCSN Reviewed by: Paula Peterson APNP Primary Children’s Hospital Department of Neurology Salt Lake City, Utah JMJ Publishers 1156 Wilson Ave. Salt Lake City, Utah 84105 801 467-5083