Epilepsy Training by adss8UF

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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
+                              Objectives


       Knowing how best to communicate common seizure types and
        their possible impact to teachers and staff

       Know how to teach appropriate first aid

       Set up guidelines to help staff recognize when a seizure is a
        medical emergency

       How to best provide social and academic support
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            How to talk about Epilepsy…

       Try to schedule a meeting with the staff that will be working
        with your child.

       Be prepared with valid up to date information

       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:
   Movement
   Sensation
   Behavior
   Awareness
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          What is Epilepsy?

   Epilepsy is a chronic neurological disorder that is
    characterized by a tendency to have recurrent seizures.


   Epilepsy is also known as a “seizure disorder.”
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                  Epilepsy is Common

       2.7 million Americans have epilepsy

       300,000 people have a first convulsion each year

       326,000 children through age 14 have epilepsy

       45,000 children under 15 develop epilepsy each year
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             Did You Know ……
   Most seizures are not medical emergencies
   Students may not be aware they 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’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:
       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           Seizures
       Involve the entire brain
       Loss of consciousness
       Symptoms may include convulsions, staring, muscle spasms and falls

 Partial      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
   Brief pause in activity with blank stare
   Brief lapse of awareness
   Possible chewing or blinking motions
   Usually lasts 1 to 10 seconds
   May occur many times a day and/or cluster
   Often confused with:
       Daydreaming
       Lack of attention (ADD, ADHD)
       Work avoidance
       Difficulty learning
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             Generalized Tonic-Clonic

   May begin with a sudden, hoarse cry
   Loss of consciousness and fall
   Convulsion with stiffening of arms & legs followed by rhythmic jerking
   May have shallow breathing and/or drooling
   Skin, nails, lips may turn blue
   Generally lasts less than 5 minutes
   May lose bowel or bladder control
   Usually followed by some confusion, headache, fatigue, soreness and/or
    speech difficulty
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    First Aid for Tonic-Clonic Seizures

       Stay calm & track time

       Check for medical ID

       Protect from hazards

       Turn student on side

       Cushion head

       Stay with the student until alert

       Provide emotional support

       Document seizure activity
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                     DO NOT……


     Putanything in the student’s mouth during a
     seizure
     AdministerCPR or Heimlich during seizure,
     must wait until it is over.
     Hold   down or restrain during a seizure
     Attemptto give oral medications, food or drink
     during a seizure
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           Tonic-Clonic Seizures as a
             Medical Emergency
   First time seizure
   Convulsive seizure lasting longer than 5 minutes
   Repeated seizures
   Acute change in seizure pattern
   The student is injured, has diabetes or is pregnant
   The seizure occurs in water
   Normal breathing does not resume
   Parents have requested emergency evaluation
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    Convulsive Seizure in a Wheelchair

       Do not remove from wheelchair unless absolutely necessary
       Secure wheelchair to prevent movement
       Fasten seatbelt (loosely) to prevent fall
       Protect & support head
       Ensure breathing is unobstructed & allow secretions to flow
       Pad wheelchair to prevent injuries to limbs
       Follow relevant seizure first aid protocol
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    Convulsive Seizure on a School Bus

       Safely pull over & stop bus
       Place child on side across seat facing away from back seat or
        in aisle if necessary
       Follow appropriate seizure first aid protocol for this student
        until seizure ends and consciousness is regained
       Continue to destination or follow school policy
       Call for emergency assistance if seizure is longer than 5
        minutes
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                      Seizures in Water


       Support head so that both the mouth & nose are always above
        water

       Remove student from the water at once

       If the student is not breathing, begin rescue breathing after
        seizure has passed.

       Always transport to emergency room
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                 Seizure Action Plan

    •   Establish a seizure action plan for each
        student diagnosed with epilepsy
    •   Establish a seizure action plan for anyone
        having a first time seizure
    •   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

       Full awareness is maintained
       May observe rhythmic movements (arm, face, leg twitching)
       Sensory symptoms (tingling, weakness, upset stomach,
        hallucinations)
       Psychic symptoms (déjà vu, hallucinations, feeling of fear or anxiety,
        or a feeling they can’t explain)
       Short duration
       Often confused with acting out, mystical experiences, psychosomatic
        illness
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            Complex Partial Seizures

   Awareness impaired with inability to respond
                           ℴ Short duration
                               ℴAggressive behavior
   Often begins with a blank, dazed stare
                            ℴMay be followed by fatigue, headache
                            or nausea
   May observe repetitive, purposeless and/or disoriented movements
                           ℴ May become combative if restrained

   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
       Stay calm & reassure others
       Track time
       Check for medical ID
       Do not try to restrain
       Gently direct away from hazards
       Do not expect verbal instructions to be obeyed
       Stay with the student until fully alert
       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

       Medication

       Surgery

       Vagus Nerve Stimulation

       Ketogenic Diet

       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

   Slow motor response
   Low self-esteem
   Hyperactivity
   Unresponsiveness
   Staring
   Attention and memory deficits
   Poor reading skills
   Impaired auditory-perceptual and language processing abilities
   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

       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.

       Hemispherectomy – Removal of one half of the brain.

       Corpus Callosotomy- Separating the Corpus Callosum ( a nerve
        bridge that connect the two halves of the brain).

       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

       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
       Uses a special magnet to activate the device that may help
        student to prevent or reduce the severity of an oncoming
        seizure
       Student usually still requires antiseizure medication
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                     The Ketogenic Diet

       Based on a finding that burning fat for energy has an
        antiseizure effect
       Used primarily to treat childhood epilepsy that has not
        responded to antiseizure medications
       Includes high fat content, no sugar and low carbohydrate &
        protein intake
       Requires strong family, school & caregiver commitment – no
        cheating allowed!
       Is a medical treatment – not a fad diet (Atkins)
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                  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 & non-licensed
        personnel
       State/school district regulations often govern use in
        schools
       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.

   Seizures and medication side effects may cause short-term
    memory problems
   After a seizure, coursework may need to be re-taught
   Seizure activity, without physical symptoms, may still affect
    learning
   Medication side effect include fatigue, an inability to maintain
    attention and concentration difficulties
   Students with epilepsy are more likely to suffer from low self-
    esteem and depression
   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


       Standardized intelligence tests



       Neuropsychological testing



       Request more frequent reevaluation, particularly after
        stabilization of newly diagnosed student
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             Being Supportive

 Stay   calm during seizure events
 Keep   a copy of the student’s seizure action plan
 Include   the seizure action plan in the student’s IEP
 Know    student’s medications and their possible side effects
 Communicate     with parents
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    Parent-School Communication

   Set up a log for communicating with parent/guardian on a
    daily or weekly basis

   Regularly note physical, emotional or cognitive changes

   Create a “substitute” folder with seizure action plan and
    other relevant information.
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                       The Other Students


       Educate peers -- encourage them to tell their friends – it’s
        the best way to prevent feelings of alienation. They are…


           Your best allies to reduce stigma
           Your best allies to increase acceptance
           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
              www.jmorales@efmny.org
           257 Park Avenue South, Suite 302
                  New York, NY 10010
                     212-677-8550

								
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