1. STUDENTS WITH SEIZURES Marathon County Special Education Health Skills Day 1 Anne Faulks, RN Community Outreach Coordinator

2. What is Epilepsy? A seizure is a disturbance of electrical activity of the brain Epilepsy is a neurological disorder characterized by recurrent unprovoked seizures ‘Unprovoked’ means not caused by a temporary problem (such as high fever or hypoglycemia) It may also be known as a SEIZURE DISORDER 2

3. Epilepsy in Children Each year 45,000 new cases of epilepsy are diagnosed among children younger than 15 Approx. 1% of the general population has epilepsy, but it is higher in children with disabilities: 25.8 percent of children with a cognitive disability 13 percent of children with cerebral palsy 50 percent of children with both disabilities 3 It is important to rememb er that many people with epilepsy have normal intelligence.

4. Antiepileptic Medications 1 carbamazepine ethosuximide gabapentin lamotrigine levetiracetam oxcarbazepine 4 phenobarbital phenytoin topiramate valproic acid zonisamide 1 Pharmacy and Therapeutics 2010 July (35) 7:392-415. Vimpat ® - lacosamide Onfi ® - clobazam Banzel ® - rufinamide Are the most common treatment in children and young people

5. Other Treatment Options Surgery – considered when there is an identified seizure focus Ketogenic diet – high fat and protein; monitored by a dietician Vagus Nerve Stimulation (VNS) - a programmable pulse generator implanted in left chest - which can be triggered externally by a magnet 5

6. What is a Seizure? A brief, excessive discharge of electrical activity in the brain that alters one or more of the following: Awareness Sensations Emotions Movements 6

7. Facts About Seizures Most seizures are NOT medical emergencies Students may not be aware they are having a seizure and may not remember what happened Seizures do not cause brain damage. Death due to a seizure is rare 7

8. 8 Seizure Types Partial onset- begin in one hemisphere of brain Simple no change in level of consciousness Complex conscious- ness impaired Generalized onset - begin in both hemispheres of brain Absence brief staring spell Tonic- Clonic unconscious ness, convulsions

9. Absence Seizure Brief lapse of awareness Pause in activity with blank stare Possible chewing or blinking movements Usually lasts 1-10 seconds Often occur frequently throughout day Mistaken for: daydreaming inattentiveness ADHD 9

10. Partial Seizure May resemble absence seizures but last longer (30 seconds or more) Student unable to hear/respond Often accompanied by ‘repetitive, purposeless behaviors’ (automatisms) Automatisms may be the same movements each seizure Post-ictal (post-seizure) confusion is very common 10

11. Responding to a Partial Seizure Stay calm, reassure other students 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 much longer than normal for that student, contact family 11

12. Tonic-Clonic Seizure A sudden cry, loss of consciousness and fall Rigidity, posturing (tonic) Rhythmic jerking (clonic) Irregular breathing - lips may turn blue Drooling, vomiting, loss of bowel/bladder control may occur Typically lasts 1 to 3 minutes Followed by confusion, headache, extreme fatigue, amnesia for events before/after 12

13. Responding to a Tonic-Clonic Seizure Have someone keep track of the time Turn student on his/her side Cushion head Protect student from possible injury After the seizure, remain with the student until awareness of surroundings is fully regained Follow guidelines on Seizure Action Plan 13

14. When to Call EMS - Epilepsy Foundation recommendations: First time seizure Convulsive seizure lasting more than 5 minutes Repeated seizures without regaining consciousness Regular breathing does not resume after Student has diabetes or is pregnant Student has been injured 14

15. Seizure Emergencies Most seizures stop on their own in <3 minutes If a seizure lasts more than 5 minutes, the person is at risk for: acute repetitive seizures (ARS) - an emergency characterized by rapidly repeating seizures status epilepticus (SE) - prolonged, continuous epileptic activity 15

16. Rescue Medications Prescribed for students who have seizure clusters or seizure emergencies FDA-approved: Diazepam (rectal gel) In process of approval: Lorazepam - oral, nasal and buccal forms (inside cheek) Midazolam (nasal, buccal or injection 16

17. Diastat Concerns Rectal administration and concerns about respiratory side effects led some local school districts to regulate administration. KNOW your district’s guidelines! If prescribed by a health care provider, regulations and impact on the student must be discussed with parents to come to a workable solution. 17

18. Resources for Staff Training Questionaire for Parents Seizure Observation Record Seizure Action Plan Where to learn more about rescue medication administration 18

19. Epilepsy Foundation Contact Information Heart of Wisconsin – f or staff trainings, school programs www.epilepsywisconsin.org afaulks@epilepsywisconsin.org National Epilepsy Foundation – www.epilepsy.com 19