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.