1. Epilepsy Awareness Epilepsy Nurse Specialists

2. Epilepsy Awareness Training Schedule Learning Outcomes What is Epilepsy? Epilepsy – Prognosis Classification of Seizures Epilepsy Management Plan Role of School Staff/Carer Observation of Seizure Activity Points to remember Plan of action/Emergency call sheet Evaluation and Close

3. Learning Outcomes Demonstrate an awareness of what Epilepsy is and recognition of different seizure types Be able to support children/young person experiencing seizures, ensuring their safety and dignity Demonstrate awareness of the importance in observing and recording seizure activity Recognise possible trigger factors

4. Learning Outcomes Demonstrate an understanding of the epilepsy/emergency management plan Raise awareness of the impact of epilepsy on a child/young person’s life Understand the need for balancing risk and achieving a quality of life Raise awareness of the possible educational implications of the condition

5. What is Epilepsy? Epilepsy has been defined as a tendency to have recurrent seizuresEpilepsy has been defined as a tendency to have recurrent seizures –Also referred to as “fits”, “convulsions” etc. The chemical balance in the brain is upset and there is abnormal firing of nerve cellsThe chemical balance in the brain is upset and there is abnormal firing of nerve cells –One seizure does not constitute epilepsy Common conditionCommon condition –Affects 1:242 School Age Children/young person (Epilepsy Action 2005 ) –More common in children/young person with learning disability Approximately 22% of people with learning disability have epilepsyApproximately 22% of people with learning disability have epilepsy

6. Important Points Common serious chronic condition Approximately 40 different types of seizures The type of seizure the child/young person experiences depends on which part of the brain it starts and how far or quickly it spreads Can develop at any age, however it is diagnosed most before the age of 20 Very individual/specific to the child/young person Never assume that all seizures are epileptic in nature !

7. Prognosis of Epilepsy 20% - 30% Excellent prognosis - Seizure free after AED withdrawal – cause no longer exists 20% - 30% Good prognosis – remission with AED treatment but cause remains 30% - 40% Seizures continue despite treatment - AED’s may only reduce frequency or severity (Kwan & Sander 2004)

8. What causes Epilepsy 60 - 70% of cases the cause is unknown60 - 70% of cases the cause is unknown Some known causes includeSome known causes include –Birth injury –Head injury –Stroke –Brain haemorrhage –Brain Tumour –Meningitis/encephalitis –Drugs –Alcohol

9. Potential Triggers Flickering lights/photosensitivity Lack of sleep/tiredness Stress Excitement Missed meals High Temperature Menstrual Missed or late medication

10. Classification of Seizures Seizures can be divided into two main groups Groups: Generalised Seizures Focal Seizures Temporal Frontal Occipital Parietal

11. Generalised Seizures These occur when powerful centrally positioned nerve cells behave abnormally The discharge spreads more or less simultaneously to all parts of the brain There is loss of consciousness – can be brief or longer

12. Generalised Seizure Types Tonic-Clonic Typical Absence Atonic Tonic Myoclonic

13. Tonic -Clonic Seizures Most common of the generalised seizure May have an aura leading into the tonic/clonic seizure Lose consciousness Usual duration 1-2 minutes May follow on from a focal seizure

14. Tonic Phase Muscles contract, body stiffens and child falls to the floor The child may become pale Their breathing may be irregular and around their lips may appear blue Saliva may dribble from mouth and can be blood stained if tongue has been bitten Incontinence may occur

15. Clonic Phase Consists of short sharp rhythmic jerks caused by alternate contraction and relaxation of muscles in the trunk and limbs Periods of relaxation become more frequent and prolonged Muscles relax and the body goes limp. At this stage the child will still be unconscious Slowly they will regain consciousness, but may be groggy and confusedSlowly they will regain consciousness, but may be groggy and confused

16. Management of Tonic-Clonic Seizures DO: Stay calm Assess danger to child- move if in danger Protect their head Loosen tight clothing, remove glasses Time seizure/observe and record

17. Management of Tonic-Clonic Seizures DO Once seizure has finished aid breathing by gently placing them in the recovery position Stay with the child until recovery is complete Reassure and re-orientate the child, tell them they have had a seizure Allow the child a period of rest /sleep afterwards if required

18. Management of Tonic-Clonic Seizures DON’T: Try to restrain or restrict the child's movements Put anything into their mouth Give the child anything to eat or drink until they are fully recovered

20. Typical Absence Seizures Generally a childhood disorder Brief lasting only seconds- begins and ends abruptly May look blank and stare, lasting a few seconds Eye lid fluttering/blinking may occur May have minor facial movements or head drop Able to continue normal activity almost immediately

21. Management of Absence Seizures Usually no help is needed Record the time of day and frequency Reassure if necessary Repeat information that the child may have missed If walking they may require guidance

23. Atonic Seizures (drop attack) Sudden loss of muscle tone Fall heavily to the ground Lasts only a few seconds Able to continue normal activity almost immediately

24. Tonic Seizures Muscles contract Body stiffens- trunk, facial muscles and limbs Results in falls Quick recovery

25. Management of Atonic and Tonic Seizures Over very quickly therefore little can be done during seizure Check for injuries which may need medical attention Stay with the child and reassure

26. Myoclonic Seizures Quick muscle jerks usually of limbs however head and shoulders may jerk forward May be one or both sided Usually seen in specific childhood epilepsy syndromes Frequent soon after waking Short lived so difficult to tell if consciousness is impaired

27. Management of Myoclonic Seizures Usually so short lived little can be done other than reassure when over May be unsteady and if they fall check for injuries Stay with the child until they recover Reassure

29. Focal Seizures These seizures have a starting point in a particular area of the brain. The type of seizure activity seen is dependant on where the focus point is. Focal seizures can spread to the rest of the brain resulting in a secondary generalised seizure

30. Focal Seizures Symptoms can last from seconds to 1 – 3 minutes can present as: mumbling or uncontrolled laughter Sucking, chewing or swallowing movements Plucking at or removing clothing May wander around as if confused

31. Management of Focal Seizures DO Stay calm Guide the child from danger Stay with the child until recovery is complete Reassure and explain anything they have missed

32. Management of Focal Seizures DON’T Restrain the child Act in a way that could frighten them, such as making abrupt movements or shouting at them Give the child anything to eat or drink until they are fully recovered

35. Call an Ambulance if …… You think the child needs urgent medical assistance The child has any breathing difficulties following a seizure It is a first seizure The seizure continues for longer than normal One seizure follows another without the child regaining consciousness

36. Following a Seizure After a seizure the child may be….. –Confused –Have no memory of what has occurred –Subdued –Tired & sleepy –Have a headache –Concentration impaired –Hyperactivity

37. Care following a Seizure Clear understanding of what has occurred Observe: –Breathing & colour –Any injuries Be aware of post-ictal state Offer support and counselling as appropriate

38. SUDEP (sudden unexpected death in epilepsy Sudden death with no obvious cause Can occur with/without evidence of a seizure It is estimated that approx 1 per 1000 people with epilepsy in the UK die as a result.

39. Description of Seizure Why? Informs care staff of what is normal for child/young person Assists with establishing a diagnosis Observe changes in frequency and type of seizures Helps monitor effects of treatment Important to review recordings otherwise changes may go unnoticed.

40. Observation of Seizures – Before - During - After How did the person feel before the event? In what environment/activity? Time of day or night? Anything ‘trigger’ the event? Was there a warning? What was the event like? –Standing / Sitting / Lying? –Was there a fall? –Parts of body effected/movements? –Eyes open/closed? Were they unconscious – fully or vaguely? If unconscious – How long? Behaviour? Incontinence / tongue bite /excess saliva? Any injury or bruising? Length of time in seizure? What were they like after the event? Recovery time? How did care staff cope with event – anxious/debriefing?

41. Seizure Management Plan Seizure Management Plan should be in place & available agreed by: –Parent/carer –Children’s Epilepsy Nurse Specialist Updated yearly or more often if required Be aware of who is responsible for first aid Parent/carer should be informed of seizure ASAP Record seizure

42. Seizure Management Plan WILL PROVIDE: Description of seizure Triggers Management of the seizures What to do in an emergency Any other relevant information

43. Emergency Seizure Management Plan WILL PROVIDE: Description of seizure/duration Indications for use of emergency medication Initial dose of emergency medication Usual response to emergency medication (if known)

44. Emergency Seizure Management Plan WILL PROVIDE Who is trained to administer Consent

45. Educational Implications A change in behaviour can be observed: Seizure activity Side effects of medication Behaviour can be independent of seizures/medication? Memory: Can experience some loss or difficulty retaining information

46. Role of School Staff/Carer Be aware of children with epilepsy Have as much information as possible about specific seizures from parent/carer Observe any unusual behaviour & liaise with parent/carer School staff may be first to pick up on the seizure –Absences/day dreaming

47. Role of School Staff/Carer Positive attitude to condition Avoid treating condition as an illness Recognise/record changes in mood/behaviour/academic achievement/social interaction Risk assess for particular activities

48. Role of the School Staff/ Carer Promote communication with parents Minimise embarrassment Observe and record details of seizures

49. Care of other Pupils Reassure other pupils present The type of seizure they witness will have a direct impact on how they cope Do not keep epilepsy a secret

50. Sport Most children with epilepsy should be able to fully participate in most activities ensuring adequate supervision is provided Each activity & each child should be considered individually Special considerations & precautions should be discussed with the parent

51. Social Life The following increase the risk of seizures –Excess alcohol –Lack of sleep –Disturbed sleep patterns –Missing meals –Forgetting to take medication –Recreational drugs

52. Points to remember Do I know about the child’s/young person’s epilepsy? Is there a Seizure Management Plan in place? Is the child/young person prescribed emergency medication? if so are relevant staff trained to administer? Has the person’s epilepsy been reviewed recently? Lifestyle and impact on Epilepsy Are any Risk assessment required? Are all relevant staff aware?

53. Points to Remember Normally seizures run their course and the child recovers without need for medical intervention. Children should be given the opportunity to participate in the same activities as their peers promoting independence, confidence and self-esteem.

54. Further Information WEBSITES WWWYoung Epilepsy.org.uk Epilepsy Action Northern Ireland