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Staff Training: Seizures and Epilepsy

Swampscott Public Schools

There are 15 slides of material required for the quiz.

Supplemental information is available after the quiz slides.

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Objectives

At the conclusion of this training, the participant will:

Recognize the common types of seizures and their possible impact on students
List steps of first aid in helping students having a seizure
Recognize when a seizure is a medical emergency
Describe ways to academically and socially support students with seizures

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A Seizure is...

A seizure is a brief, excessive discharge of electrical activity in the brain that alters one or more:

Movement
Sensation
Behavior
Awareness

Seizures are temporary and episodic. The seizures are often symptoms of another health problem (diseases, fever, temporary medical illness). The type of seizure and the symptoms depend on where in the brain and how much of the brain is affected.

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Epilepsy is...

Epilepsy (also known as a “seizure disorder”) is a chronic neurological disorder characterized by recurrent seizures that are not otherwise provoked by an acute injury of health emergency.

In approximately 70% of people the cause is unknown, while the cause for the remaining 30% may be the result of developmental problems before birth, trauma at birth, head injury, brain tumor, vascular problems (i.e. stroke, abnormal blood vessels), metabolic conditions (i.e. low blood sugar, low calcium), infections (i.e. meningitis, encephalitis) and idiopathic causes.

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Epilepsy may occur with:

Cerebral palsy
Cognitive impairments
ADD/ADHD
Developmental disabilities
Autism

But the majority of people who have epilepsy do not have other impairments and live very normal lives.

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Types of Seizures

Seizures are classified by where in the brain the activity occurs:

In a generalized onset seizure the electrical disruption involves the entire brain.

Examples: absence or tonic-clonic seizure

In a partial seizure the electrical disruption involves only a part of the brain.

Examples: focal aware and focal impaired awareness

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Aura’s

Some people may experience feelings, sensations, or changes in behavior hours or days before a seizure. These feelings are generally not part of the seizure, but may warn a person that a seizure may come. Not everyone has these signs, but if they do, the signs can help a person change their activity, make sure to take their medication, use a rescue treatment, and take steps to prevent injury.

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People with epilepsy may still have seizures due to:

Failure to take medication correctly
Variation in medication effectiveness
Stress/anxiety
Lack of sleep
Illness
Hormonal changes
Alcohol/drug use
Poor diet/missed meals
Hypoglycemia/dehydration
Flashing lights or other triggers

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When is a seizure a medical emergency?

First time seizure (no medical history or identification bracelet)

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

Protocol as stated in the seizure action plan (MD, parents, nurse, staff)

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First Aid for Seizures

STAY

SAFE

SIDE

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First Aid for Seizures: Stay, Safe, Side

First line of action when someone is having a seizure is care and comfort and keep the person safe.

STAY with the person and start timing the seizure.

Remain calm – it will help others stay calm too. Talk calmly and reassuringly to the person during and after the seizure – it will help as they recover from the seizure.
Check for medical ID
Time the seizure from beginning to the end of the active seizure.Timing the seizure will help you determine if emergency help is needed.
While most seizures only last a few minutes, seizures can be unpredictable. Some may start with minor symptoms but lead to loss of consciousness or a fall that could cause injury. Other seizures may end in seconds.

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First Aid for Seizures: Stay

STAY with them until they are awake and alert after the seizure.

Most seizures end in a few minutes
Injury can occur during or after a seizure, requiring help from other people
If a person appears to be choking, turn them on their side and call for help. If they are not able to cough and clear their air passages on their own or are having breathing difficulties, call 911 immediately.
Be sensitive and supportive. Ask others to do the same.

Seizures can be frightening for the person having one, as well as for others. People may feel embarrassed or confused about what happened. Keep this in mind as the person wakes up.
Reassure the person that they are safe.
Once they are alert and able to communicate, tell them what happened in very simple terms.
Offer to stay with the person until they are ready to go back to normal activity or call someone to stay with them.

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First aid for seizures: Safe

Keep the person SAFE.

Move or guide away from harmful or sharp objects.
If a person is wandering or confused, help steer them clear of dangerous situations.
Encourage people to step back and give the person some room. Waking up to a crowd can be embarrassing and confusing for a person after a seizure.
Ask someone to stay nearby in case further help is needed.

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First aid for seizures: Safe

Do NOT put anything in their mouth.

Jaw and face muscles may tighten during a seizure, causing the person to bite down. If this happens when something is in the mouth, the person may break and swallow the object or break their teeth!
Don’t worry – a person can’t swallow their tongue during a seizure.
Don’t give water, pills or food to swallow until the person is awake. Food, liquid or pills could go into the lungs instead of the stomach if they try to drink or eat when not fully aware.

Do NOT restrain.

Trying to stop movements or forcibly hold person down doesn’t stop a seizure.
Restraining a person can lead to injuries and make the person more confused, agitated, or aggressive. People don’t fight on purpose during a seizure. Yet if they are restrained when they are confused, they may respond aggressively.
If a person tries to walk around, let them walk in a safe, enclosed area if possible.

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First aid for seizures: Side

Turn the person onto their SIDE if they are not awake and aware.

Make the person as comfortable as possible.
Loosen tight clothes around neck.
If they are aware, help them sit down in a safe place.
If they are at risk of falling or having a convulsive seizure:

lay them down on the floor
put something small and soft under the head.
Turn them on their side with their mouth pointing toward the ground. This prevents saliva from blocking their airway and helps the person breathe more easily.

During a convulsion, it may look like the person has stopped breathing. This happens when the chest muscles tighten during the tonic phase of a seizure. As this part of a seizure ends, the muscles will relax and breathing will resume normally.

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How might seizures impact learning?

36% of students (age 6-17) with epilepsy were more likely to have missed 11 or more days of school in the past year, compared with students with other health concerns. Additionally:

Seizures often cause short-term memory problems
After a seizure event, coursework might have to be re-taught
Seizure activity in the brain, without obvious physical symptoms, can still affect learning
Learning will occur more easily on some days than on others.
Medication may cause drowsiness, inattention, concentration difficulties and behavior changes.
Children with epilepsy are more likely to suffer from depression, low self-esteem than children with other chronic conditions. Also, students report being bullied.
Students may have activity limitations (less participation in sports or clubs)
Students use special education services
Students may have accommodations; seizure action plan, IHP, 504 Plan and/or IEP to address these issues.

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Click here to take the Quiz

Additional information follows if you would like but is not required for the quiz.

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Additional information

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Epilepsy is more common than you think

Over 3 million Americans of all ages have epilepsy

Epilepsy is the 4th most common neurological problem, behind migraines, strokes and Alzheimer’s disease

About 460,000 children aged 0 - 17 have epilepsy (2013)

In a school of 1000 students, that’s 6! 5
1.5/1000 in preschool-aged children

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Basic functions of the brain

The cerebral cortex (“the brain”) is divided into several lobes:

Frontal lobes: Responsible for high level cognitive function, personality, memory, anxiety, alertness, and awareness

Temporal Lobe: Responsible for receptive and expressive speech

Frontal and temporal lobes are the most epileptogenic

Parietal Lobe: Responsible for bringing all perception together; called the association cortex, rarely the source of seizures

Occipital Lobe: Responsible for vision, uncommon origin of seizures

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Myths of Epilepsy

Epilepsy is not contagious
Epilepsy is not a form of mental illness
Most seizures are not medical emergencies
Students may not be aware they are having a seizure and may not remember what happened
A student can not swallow his/her tongue during a seizure

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Generalized Onset Absence Seizures

First Aid not required.

Characteristics of absence seizures:

May appear as a pause in activity with blank stare or brief lapse of awareness

Symptoms may include chewing or blinking

May occur many times a day

May be confused with daydreaming, lack of attention, ADD

Lasts 1 - 10 seconds

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Generalized Onset Tonic Clonic Seizures

This type of seizure requires First Aid.

Characteristics of Tonic- Clonic seizures:

Loss of consciousness, fall and stiffening of limbs, followed by rhythmic shaking
Breathing may stop temporarily, skin, nails, lips may turn blue
May lose control of bladder/bowel
Generally lasts 1 - 3 minutes
May be followed by confusion, sleepiness, headache, speech difficulties

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Focal Aware Seizures (Simple Partial Seizure)

First Aid not required. Emotional support required

Seizure activity in the brain causing:

Rhythmic movements (twitching of arms, face, legs)
Sensory symptoms (tingling, weakness, smells, sounds, upset stomach, visual distortions)
Psychic symptoms (deja vu, hallucinations, feeling fear or anxious or “feeling they can’t explain”)

Usually lasts less than a minute

May be confused with acting out, mystical experience or psychosomatic illness.

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Focal Impaired Awareness (Complex Partial Seizure)

First Aid required if seizure last > 5 minutes or beyond what is normal for that student

Characterized by altered awareness
Confusion, inability to respond.
Automatic, purposeless behaviors such as picking at clothes, chewing or mumbling
Emotional outbursts
May become combative if restrained (“contain don’t restrain”)
May be confused with drunkenness or drug use, willful belligerence, aggressiveness
Usually lasts 1 - 3 minutes
Followed by tiredness, headache, nausea

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Psychosocial effects of epilepsy

Stigma of epilepsy
Compromised quality of life
Lower self-esteem
“Vulnerable child”
High incidence of depression, anxiety, ADHD and learning problems (anxiety about having a seizure at school)
Adverse effects of medications
Parental/family stress
Financial burdens

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Ideas for supporting students with epilepsy

Set a tone of acceptance in your classroom

Stay calm during seizure episodes

Encourage positive peer interaction

Avoid over protection and encourage independence

Include students in as many activities as possible

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Ideas for supporting students with epilepsy

Have a copy of the student’s seizure action plan; be aware of medication/side effects

Not all students with epilepsy have an IEP or 504 plan

Be observant for signs of bullying and depression

Communicate with parents frequently about seizure activity, behavior and learning problems

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After a seizure: social and emotional aspects

Parents permission is required. Suggested language when a student has a seizure in class.

What happened is called a seizure. Having a seizure is part of a health condition called epilepsy.

No one knows exactly what causes epilepsy in some children. The seizure happened because, for just a very short time, the electrical impulses in the student’s brain did not work properly and sent mixed messages to the rest of the body. Now that the seizure is over, his/her brain is working properly again.

A person can’t control a seizure, just like you can’t control hiccups.

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Resources

Epilepsy Foundation www.epilepsyfoundation.org

The Epilepsy Foundation is the national voluntary agency dedicated to prevent, control and cure epilepsy through research, education, advocacy and services.

American Epilepsy Society www.aesnet.org

The American Epilepsy Society promotes research and education for professionals dedicated to the prevention, treatment and cure of epilepsy.

Epilepsy.com www.epilepsy.com

Online resource provided by The Epilepsy Project. Its mission is to inform and empower two groups of patients and their families: those facing newly diagnosed epilepsy and those struggling with epilepsy that has resisted the usual treatments.

American Epilepsy Society

Mass Department of Public Health

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Resources continued

Centers for Disease Control and Prevention Epilepsy Web Site www.cdc.gov/epilepsy/index.htm

The national Centers for Disease Control and Prevention is the lead federal agency for protecting the health and safety of people at home and abroad, providing credible information to enhance health decisions and promoting health through strong partnerships. Its epilepsy Web site details current partnerships and health promotion activities being supported by agency’s epilepsy programs.

Neuroscience for Kids faculty.washington.edu/chudler/neurok.html Neuroscience for Kids was created for all students and teachers who would like to learn about the nervous system.