1. Epilepsy and Seizure Management
This product was developed with support from the Centers for Disease Control and Prevention under cooperative agreement number 5U58DP Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the CDC.

2. A Seizure is:
A symptom of abnormal brain function. The electrical system of the brain malfunctions. Instead of discharging electrical energy in a controlled manner, the brain cells keep firing

3. Seizures
Seizures may be caused by many different things. Causes include:
Brain malformation
Lack of oxygen to brain at some point in life
Fevers
Infections (meningitis)
Congenital Conditions (Downs Syndrome)
Low levels of blood sugar, blood calcium, blood magnesium or other electrolyte disturbances
Brain tumors
Head trauma
Poisons (such as lead)

4. Seizures A common cause of seizures is epilepsy –
Epilepsy (also known as a ‘seizure disorder’) is a chronic neurological disorder characterized by recurring seizures that are not otherwise provoked by an acute injury or health emergency.

5. Epilepsy is
Not contagious, it is not a mental illness, or a cognitive disability The neurological dysfunction seen in epilepsy can begin at birth, childhood, adolescence, or even in adulthood.

6. Epilepsy Over 3 million Americans of all ages have epilepsy.
There are many different types of epilepsy. People may experience just one type or more than one.
Approximately 200,000 new cases of seizures and epilepsy occur each year.
Ten percent of the American population will experience a seizure in their lifetime

7. Epilepsy may occur with:
Cerebral palsy
Cognitive impairments
ADD/ADHD
Developmental disabilities
Autism

8. Epilepsy
… but the majority of people who have epilepsy do not have other impairments and live very normal lives.

9. Seizures
In a generalized seizure the electrical disruption affect both cerebral hemispheres (sides of the brain)

10. Tonic-Clonic Seizure -“grand mal”
Loss of consciousness, fall and stiffening of limbs, followed by rhythmic shaking.
Breathing may stop temporarily skin, nails, lips may turn blue
Loss of bladder/bowel control may occur
Generally lasts 1 to 3 minutes
Followed by confusion, sleepiness

11. First Aid for Tonic-Clonic Seizure -“grand mal”
First Aid for Generalized Tonic-Clonic Seizures
• Prevent further injury. Place something soft under the head, loosen tight clothing and clear the area of sharp or hard objects.
• Do not force objects into the person's mouth.
• Do not restrain the person's movements, unless they place him or her in danger.
• Turn the person on his or her side to open the airway and allow secretions to drain.

12. Cont. First Aid for Tonic-Clonic Seizure “Grand mal”
• Stay with the person until the seizure ends. • Do not pour any liquids into the person's mouth or offer any food, drink or medication until he or she is fully awake. • If the person does not resume breathing after the seizure, start cardiopulmonary resuscitation (CPR). • Let the person rest until he or she is fully awake. • Be reassuring and supportive when consciousness returns.

13. Cont. First Aid for Tonic-Clonic Seizure “grand mal”
A convulsive seizure is usually not a medical emergency unless it lasts longer than five minutes, or a second seizure occurs soon after the first, or the person is pregnant, injured, diabetic or not breathing easily. In these situations the person should be taken to an emergency medical facility.

14. Myoclonic Seizures
rapid, brief contractions of bodily muscles, which usually occur at the same time on both sides of the body
People usually think of them as sudden jerks or clumsiness (like sudden jerk of foot in sleep)
May be mild and affect only part of the body, or be strong enough to throw the child abruptly to the floor
May occur as a single seizure or a cluster of seizures

15. Myoclonic Seizures
First aid is usually not needed. However, a person having a myoclonic seizure for the first time should receive a thorough medical evaluation.

16. Atonic Seizures
Other names for this type of seizure include drop attacks, astatic or akinetic seizures
Produce an abrupt loss of muscle tone (head drops, loss of posture or sudden collapse)
They seizures tend to be resistant to drug therapy

17. Atonic Seizures
Because they are so abrupt—without any warning—and because the people who experience them fall with force, atonic seizures can result in injuries to the head and face. Children and adults may need to use protective headgear to prevent injury. These types of seizures do not usually need first aid care, unless a person is injured from falling or if it their first time experiencing this type of seizure.

18. Tonic Seizures
Produce a stiffness or rigidity in all muscles, last 5–15 seconds, and if the person is standing, may also result in a fall with injuries
May occur during sleep
Also resistant to drug therapy
Seek medical care if first time experiencing this type of seizure

19. Absence Seizures Sometimes called “Petit-mal” seizures
Characterized by lapses of awareness, sometimes with staring, that begin and end abruptly, lasting only a few seconds
Frequently so brief that they escape detection
More common in children than in adults
May have lapses a day

20. Absence Seizures
No immediate first aid is usually necessary, but a medical evaluation is indicated to try to prevent these seizures from recurring

21. In a partial seizure
the electrical disruption is limited to a specific area of one cerebral hemisphere (side of the brain).

22. Partial Seizures Key things to remember about partial seizures are:
They don’t last long (recovery can take longer than the seizure)
They end naturally (except in rare cases)
You can’t stop them (let seizure run its course and just try to protect person from injury)
They are not dangerous to others (movements produced by a seizure are almost always too vague, too unorganized and too confused to threaten the safety of anyone else)

23. Simple Partial Seizure
Seizure activity in the brain causing:
Rhythmic movements - eyes move from side to side, blinking, unusual movement of the tongue, isolated twitching of arms, face, legs
Sensory symptoms - unpleasant tastes, tingling, weakness, unusual sounds, smells, feeling of upset stomach, visual distortions, sensation of goose bumps, sweating, flushing
Psychic symptoms déjà vu, hallucinations, feelings of fear or anxiety, anger, may feel like they are having an out body experience.

24. Simple Partial Seizures
People who have simple partial seizures do not lose consciousness
Can usually remember exactly what happened to them while it was going on
Usually last less than one minute
May precede a generalized seizure

25. Complex Partial Seizure
Complex partial seizures affect a larger area of the brain than simple partial seizures and they affect consciousness
Characterized by:
altered awareness
Confusion, inability to respond
Automatic, purposeless behaviors such as picking at clothes, chewing or mumbling.
Emotional outbursts

26. Complex Partial Seizures
May be confused with:
Drunkenness or drug use
Willful belligerence, aggressiveness
Typically starts with a blank stare and loss of contact with surroundings
The person may wonder around during
Seizure can last between 30 seconds to 2 minutes

27. Complex Partial Seizures
First Aid for:
• Do not restrain the person.
• Remove dangerous objects from the person's path.
• Calmly direct the person to sit down and guide him or her from dangerous situations. Use force only in an emergency to protect the person from immediate harm, such as walking in front of an oncoming car.
• Observe, but do not approach, a person who appears angry or combative.
• Remain with the person until he or she is fully alert.

28. Partial Seizures
Partial seizures take many forms and medical treatment does not always control them. People who live with frequent complex partial seizures may face many challenges. One involves personal safety.
Things like fire, heat, water, heights, certain machinery and sharp objects are all potential hazards when people are unaware of what they're doing and don't feel pain.

29. Partial Seizures
However, there may be ways to reduce obvious risks. For example:
Using a microwave oven for cooking instead of a gas or electric range
Taking plates to the oven or stove to serve oneself to avoid having to carry pans of hot food or liquid
Using a regular knife for carving, not an electric knife or, if possible, leaving the carving to someone else
Keeping electric mixers and other electric appliances far away from the sink or source of water

30. Partial Seizures
Setting the water heater low enough to prevent scalding during a seizure and taking sit down showers if drop attacks are frequent;
Making sure open fires have guards and that electric or other space heaters can't be tipped over;
Not smoking and not carrying lighted candles or hot ashes from the fireplace through the house;
Limiting ironing as much as possible;
Padding sharp corners and carpeting floors

31. Seizures
Exposure to flashing lights at certain intensities or to certain visual patterns can trigger seizures. This condition is known as photosensitive epilepsy. Photosensitive epilepsy is more common in children and adolescents, especially those with generalized epilepsy, in particular juvenile myoclonic epilepsy. It becomes less frequent with age, with relatively few cases in the mid twenties.

32. Photosensitive Seizures
May be triggered by:
exposure to television screens due to the flicker or rolling images
to computer monitors
to certain video games or TV broadcasts containing rapid flashes or alternating patterns of different colors
intense strobe lights like visual fire alarms.
by natural light, such as sunlight, especially when shimmering off water, flickering through trees or through the slats of Venetian blinds.

33. Seizures Other types of seizures include:
Non-epileptic seizures which are episodes that briefly change a person's behavior and may look like epileptic seizures (aka pseudoseizures)
Gelastic seizures are called the “laughing seizure” because they may look like bouts of uncontrolled laughter or giggling.
Dacrystic seizures are called the “crying seizure.” The vocalization has a crying quality and the facial contraction resembles a grimace.
Gelastic and dacrystic seizures are most commonly found in people with hypothalamic hamartomas
HH is a rare benign brain tumor or lesion of the hypothalamus

34. Status Epilepticus
Prolonged or clustered seizures sometimes develop into non-stop seizures (seizure lasting longer than 30 minutes)
It is a medical emergency
It requires hospital treatment to bring the seizures under control.
Can lead to brain damage or possibly even death if unable to stop seizure activity

35. Epilepsy Syndromes
Epileptic syndromes include hypothalamic hamartomas; febrile convulsions; West syndrome (infantile spasms); Lennox-Gastaut syndrome; childhood absence epilepsy; juvenile myoclonic epilepsy; Benign Rolandic epilepsy; Landau-Kleffner syndrome; Rasmussen's encephalitis (syndrome); progressive myoclonic epilepsy; temporal lobe epilepsy, and frontal lobe epilepsy

36. Anti-epileptic Medications
Depakote (Valproic acid)
Felbatol (felbamate)
Gabatril (tiagabine)
Keppra (levetiracetam)
Lamictal (lamotrigine)
Dilantin (phenytoin)
phenobarbitol
Neurontin (gabapentin)
Tegretol (carbamezepine)
Trileptal (oxcarbazepine)
Topamax (topiramate)
Zonegran (zonisamide)
Lyrica (pregabalin)

37. Vagus Nerve Stimulator
An implanted device that sends regular, mild electrical pulses to the brain via the vagus nerve
May also be activated by an external magnet
Functioning of the VNS may be affected by the use of a taser device.
More information about the VNS can be found at:

38. Patients with epilepsy may still have seizures due to:
Failure to take medication correctly
Variation in medication effectiveness
Sleep deprivation
Stress/ Illness
Hypoglycemia/dehydration
Alcohol/drug use or withdrawal
Hormonal fluctuations
Flashing lights or other triggers

39. Some epilepsy patients never achieve effective seizure control and may experience varying degrees of financial, social and legal problems.

40. Diastat
The only FDA-approved treatment currently for acute repetitive seizures at schools is rectal Diastat

41. Diastat
Diastat comes in a prefilled, rectal delivery system
Dosage is based on weight in kilograms and age
It is recommended that Diazepam rectal gel be used to treat no more than five episodes per month and no more than one episode every five days
Follow the physician orders for when appropriate to give Diastat

42. Diastat Mild side effects include: Drowsiness Dizziness Diarrhea
Unsteadiness

43. Diastat Serious, but unlikely side effects include:
Slow/shallow/difficult breathing
Mental/mood changes (e.g. anxiety, restlessness)
Slurred speech
Trouble walking
Also watch for symptoms of an allergic reaction (e.g. rash, itching/swelling, trouble breathing)

44. Diastat
Important information about Diastat: If you don’t see the green “ready” band it means that the medicine in your Diastat Acudial is not properly locked in. If you notice this please contact parent immediately. They will need to take back to pharmacy immediately to be corrected. Do not use! It means that the correct dose is not properly locked in.

45. Or Click Here to Contact your Local Epilepsy Foundation Affiliate
Contact the Epilepsy Foundation for more information:
Or Click Here to Contact your Local Epilepsy Foundation Affiliate