Transcript Beyond Surviving & on to success

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Epilepsy and School:
Beyond Surviving & on to success
Presented by:
Jessica Morales, BA
Director of Epilepsy Education
Epilepsy Foundation Metropolitan New York
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Objectives
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Knowing how best to communicate common seizure types and
their possible impact to teachers and staff
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Know how to teach appropriate first aid
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Set up guidelines to help staff recognize when a seizure is a
medical emergency
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How to best provide social and academic support
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How to talk about Epilepsy…
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Try to schedule a meeting with the staff that will be working
with your child.
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Be prepared with valid up to date information
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Always try to personalize to your child and his or her needs.
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What is a Seizure?
A brief, excessive discharge of electrical
activity in the brain that alters one or more
of the following:
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Movement
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Sensation
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Behavior
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Awareness
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What is Epilepsy?
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Epilepsy is a chronic neurological disorder that is
characterized by a tendency to have recurrent seizures.
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Epilepsy is also known as a “seizure disorder.”
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Epilepsy is Common
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2.7 million Americans have epilepsy
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300,000 people have a first convulsion each year
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326,000 children through age 14 have epilepsy
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45,000 children under 15 develop epilepsy each year
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Did You Know ……
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Most seizures are not medical emergencies
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Students may not be aware they they are having a seizure and
may not remember what happened
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Epilepsy is not contagious
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Epilepsy is not a form of mental illness
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Students almost never die or have brain damage during a
seizure
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A student can’t swallow his/her tongue during a seizure
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Common Causes of Epilepsy
 The
cause is unknown for c.70% of people with
epilepsy.
 For
the remaining 30%, some identifiable causes
are:
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Brain trauma (such as stroke, physical injury )
Brain tumors
Poisoning (lead)
Infections of the brain (meningitis, encephalitis)
Brain injury at birth
Abnormal brain development
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Seizure Types
 Generalized
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Involve the entire brain
Loss of consciousness
Symptoms may include convulsions, staring, muscle spasms and falls
 Partial
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Seizures
Seizures
Involve only part of the brain
Altered or no loss of consciousness
May spread & generalize
Symptoms are related to the part of the brain affected
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Absence Seizures
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Brief pause in activity with blank stare
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Brief lapse of awareness
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Possible chewing or blinking motions
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Usually lasts 1 to 10 seconds
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May occur many times a day and/or cluster
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Often confused with:
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Daydreaming
Lack of attention (ADD, ADHD)
Work avoidance
Difficulty learning
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Generalized Tonic-Clonic
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May begin with a sudden, hoarse cry
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Loss of consciousness and fall
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Convulsion with stiffening of arms & legs followed by rhythmic jerking
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May have shallow breathing and/or drooling
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Skin, nails, lips may turn blue
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Generally lasts less than 5 minutes
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May lose bowel or bladder control
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Usually followed by some confusion, headache, fatigue, soreness and/or
speech difficulty
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First Aid for Tonic-Clonic Seizures
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Stay calm & track time
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Check for medical ID
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Protect from hazards
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Turn student on side
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Cushion head
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Stay with the student until alert
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Provide emotional support
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Document seizure activity
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DO NOT……
 Put
anything in the student’s mouth during a
seizure
 Administer
CPR or Heimlich during seizure,
must wait until it is over.
 Hold
down or restrain during a seizure
 Attempt
to give oral medications, food or drink
during a seizure
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Tonic-Clonic Seizures as a
Medical Emergency
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First time seizure
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Convulsive seizure lasting longer than 5 minutes
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Repeated seizures
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Acute change in seizure pattern
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The student is injured, has diabetes or is pregnant
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The seizure occurs in water
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Normal breathing does not resume
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Parents have requested emergency evaluation
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Convulsive Seizure in a Wheelchair
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Do not remove from wheelchair unless absolutely necessary
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Secure wheelchair to prevent movement
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Fasten seatbelt (loosely) to prevent fall
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Protect & support head
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Ensure breathing is unobstructed & allow secretions to flow
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Pad wheelchair to prevent injuries to limbs
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Follow relevant seizure first aid protocol
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Convulsive Seizure on a School Bus
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Safely pull over & stop bus
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Place child on side across seat facing away from back seat or
in aisle if necessary
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Follow appropriate seizure first aid protocol for this student
until seizure ends and consciousness is regained
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Continue to destination or follow school policy
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Call for emergency assistance if seizure is longer than 5
minutes
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Seizures in Water
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Support head so that both the mouth & nose are always above
water
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Remove student from the water at once
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If the student is not breathing, begin rescue breathing after
seizure has passed.
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Always transport to emergency room
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Seizure Action Plan
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Establish a seizure action plan for each
student diagnosed with epilepsy
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Establish a seizure action plan for anyone
having a first time seizure
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Follow seizure emergency definition and
protocol as defined by the healthcare
provider in the seizure action plan
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Seizure Action Plan
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Simple Partial Seizures
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Full awareness is maintained
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May observe rhythmic movements (arm, face, leg twitching)
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Sensory symptoms (tingling, weakness, upset stomach,
hallucinations)
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Psychic symptoms (déjà vu, hallucinations, feeling of fear or anxiety,
or a feeling they can’t explain)
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Short duration
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Often confused with acting out, mystical experiences, psychosomatic
illness
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Complex Partial Seizures
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Awareness impaired with inability to respond
ℴ Short duration
ℴAggressive behavior
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Often begins with a blank, dazed stare
ℴMay be followed by fatigue, headache
or nausea
May observe repetitive, purposeless and/or disoriented movements
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ℴ May become combative if restrained
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Clumsy or disoriented movements, aimless walking, picking things up,
nonsensical speech or lip smacking
ℴ Often confused with:
ℴ Drunkenness or drug abuse
ℴ Aggressive behavior
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Complex Partial Seizure
First Aid
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Stay calm & reassure others
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Track time
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Check for medical ID
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Do not try to restrain
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Gently direct away from hazards
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Do not expect verbal instructions to be obeyed
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Stay with the student until fully alert
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If seizure last longer than 30 minutes, call EMS
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Seizure Triggers
Factors that may increase the likelihood of a seizure in students with a
diagnosis of epilepsy:
 Missed medication
 Overheating/overexertion
 dehydration
 Stress/anxiety
 Extreme fatigue
 Poor diet/missed meals
 Hormonal changes
 Illness
 Alcohol or drug use
 Drug interactions (OTC, prescribed, herbals or supplements)
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Treatment
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Medication
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Surgery
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Vagus Nerve Stimulation
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Ketogenic Diet
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Alternative Therapies
* It’s important to share with teachers and staff in direct contact
with your child what kind of treatment they are under or if
any new treatment is started.
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Medication Side Effects
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Slow motor response
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Low self-esteem
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Hyperactivity
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Unresponsiveness
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Staring
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Attention and memory deficits
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Poor reading skills
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Impaired auditory-perceptual and language processing abilities
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Mood swings
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Prescription Medication
Medications (New Medication for Epilepsy)
Although AEDs do not cure epilepsy, they do, in many cases, help to keep the seizures
controlled, thus enabling the patient to have a better quality of life.
Keppra
Lyrica (pregabalin)
Trileptal (oxcarbazepine)
Keppra (levetiracetam)
Zonegran (zonisamide)
Topamax (topiramate)
Gabitril (tiagabine hydrochlorine)
Lamictal (lamotrigine)
Diastat (diazepam rectal gel)
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Brain Surgery
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Lobectomy- All or part of the left or right lobe (Frontal, Temporal,
Occipital, Parietal) may be surgically removed. These areas are
common sites for simple and complex partial seizures.
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Hemispherectomy – Removal of one half of the brain.
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Corpus Callosotomy- Separating the Corpus Callosum ( a nerve
bridge that connect the two halves of the brain).
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Sub-pial Transection- Instead of removing affected tissue, the surgeon
severs the parallel connection between cells in the affected area.
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Vagus Nerve Stimulator
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Device implanted just under the skin in the chest with wires
that attach to the vagus nerve in the neck
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Delivers intermittent electrical stimulation to the Vagus Nerve
in the neck that relays impulses to widespread areas of the
brain
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Used primarily to treat partial seizures when medication is not
effective
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Uses a special magnet to activate the device that may help
student to prevent or reduce the severity of an oncoming
seizure
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Student usually still requires antiseizure medication
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The Ketogenic Diet
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Based on a finding that burning fat for energy has an
antiseizure effect
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Used primarily to treat childhood epilepsy that has not
responded to antiseizure medications
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Includes high fat content, no sugar and low carbohydrate &
protein intake
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Requires strong family, school & caregiver commitment – no
cheating allowed!
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Is a medical treatment – not a fad diet (Atkins)
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Diazepam Rectal Gel
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Used in acute or emergency situations to stop a seizure
that will not stop on its own
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Approved by FDA for use by parents & non-licensed
personnel
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State/school district regulations often govern use in
schools
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School nurse decides whether administration can be
delegated based on local policy and assessment of
safety issues
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Impact on Learning
 Most
students with epilepsy have IQ’s within the
normal range
 Risk
of learning problems is 3X greater than average
 May
have difficulty with learning, memory, attention &
concentration
 May
be eligible for special education and related
services
 Students
who achieve seizure control quickly, with few
medication side effects, have the best chance for
normal educational achievement
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Impact on Learning, cont.
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Seizures and medication side effects may cause short-term
memory problems
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After a seizure, coursework may need to be re-taught
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Seizure activity, without physical symptoms, may still affect
learning
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Medication side effect include fatigue, an inability to maintain
attention and concentration difficulties
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Students with epilepsy are more likely to suffer from low selfesteem and depression
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School difficulties are not always related to epilepsy
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Impact on Psychosocial
Development
 There
is an association between seizures/epilepsy and:
- Impaired self-image/self-confidence
(shame/embarrassment)
- Low self-esteem
- Anxiety
- Delayed social development
Once seizures are under control, the psychosocial impact may be more
significant than the medical impact.
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Impact on Behavior
 Behavior
problems are more frequent possibly due to:
- Underlying brain damage
- Medication side effects
- Anxiety and low self-esteem
- Parental overprotection, indulgence
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Assessment Strategies
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Standardized intelligence tests
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Neuropsychological testing
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Request more frequent reevaluation, particularly after
stabilization of newly diagnosed student
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 Stay
Being Supportive
calm during seizure events
 Keep
a copy of the student’s seizure action plan
 Include
 Know
the seizure action plan in the student’s IEP
student’s medications and their possible side effects
 Communicate
with parents
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Parent-School Communication
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Set up a log for communicating with parent/guardian on a
daily or weekly basis
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Regularly note physical, emotional or cognitive changes
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Create a “substitute” folder with seizure action plan and
other relevant information.
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The Other Students
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Educate peers -- encourage them to tell their friends – it’s
the best way to prevent feelings of alienation. They are…
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Your best allies to reduce stigma
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Your best allies to increase acceptance
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Your best allies to create a safe environment for your students
with epilepsy
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Tips For Teachers
Avoid
overprotection
Encourage independence
Include the student in as many
activities as possible
Encourage positive peer interaction
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Contact Information
Epilepsy Foundation Metropolitan New York
www.efmny.org
www.epilepsyfoundation.org
Jessica Morales / Director of Epilepsy Education
[email protected]
257 Park Avenue South, Suite 302
New York, NY 10010
212-677-8550