Fact:The school nurse plays a significant role in the life of a student with epilepsy. An involved nurse can positively impact the future of a student with epilepsy.

Today we will talk about:Today we will talk about:Seizure types.Epilepsy syndromes.Treatments.Common medications.Medication Side Effects.Epilepsy and the IEP.AccommodationsDiastat in school.Seizure plans.

Early Detection – Why?Early Detection – Why?

Generalized Tonic-ClonicGeneralized Tonic-Clonic

Also known as Grand-Mal.Begin w/stiffening of the limbs (tonic

phase).Followed by jerking of limbs and face

(clonic phase).In some cases will require Diastat.

Myoclonic SeizuresMyoclonic SeizuresRapid brief jerking movements.Typically occur on both sides of

the body.Often confused as clumsiness.Typically do not require first aid.

Atonic SeizuresAtonic Seizures

Also known as drop seizures.Causes abrupt loss of muscle tone.Often causes head and face injuries.Wearing of helmet recommended.Tough seizures to control.First aid needed if injury is caused.

Absence SeizuresAbsence SeizuresAlso know as petit-mal seizures or

“staring spells”Lapses of awareness the end abruptly.No warning and no after effect.More common in children than adults.Children can have 50-100+ per day.Affects school performance.

Simple Partial SeizuresSimple Partial SeizuresNo loss of consciousness.Involves one side of the brain.Sudden jerk.Sensory phenomena.No first aid required, should be logged

and timed.

Complex Partial SeizureComplex Partial SeizureInvolves one side of the brain.May have aura.Repeated movements i.e. lip smacking,

picking at clothes, fumbling.Unaware of environment/surroundings.May wander.Typically no first aid required, should

be logged and timed.

Gelastic EpilepsyGelastic Epilepsy“Gelastic” is greek for laughter.Pediatric – seizures can begin at any age,

often between 2-3 years of age.More often boys than girls.Laughter described as “empty” or “hollow”,

not pleasant.Can be followed by complex partial seizure.Often caused by small tumor in

hypothalamus.

Infantile SpasmsInfantile SpasmsTypically starts at 4-8 months of age.Most severe type of pediatric epilepsy.Seizures come in clusters/bending

forward, arms flare out. Prognosis poor.Stops by age 5, often goes to another

seizure type.Treatment – ACTH steroid injections.

Lennox-Gastaut SyndromeLennox-Gastaut SyndromeSevere form of childhood epilepsy.Multiple seizure types, i.e. atonic,

myoclonic, tonic, atypical absence.Most children have impaired

intellect.Can be caused from malformation of

brain, TBI, metabolic disorder.30-35% cause unknown.

Dravet SyndromeDravet SyndromeAlso called SMEI (severe

myoclonic epilpesy in infancy).Begins in first year of life with

frequent febrile seizures.Often causes status epilepticus.Hard to treat.Outcome poor.Caused by genetic defect.

Status EpilepticusStatus EpilepticusLife threatening condition where the

brain is in a constant state of seizures.Typically defined as constant state of

seizures for 30 minutes +.Any type of seizure disorder can cause

status epilepticus.Immediate medical attention needed!

Vagal Nerve Stimulator Vagal Nerve Stimulator (VNS)(VNS)Used in addition to AED’s.80% of implanted patients

experience fewer seizures.75% of patients are able to

reduce their AED’s.Improved seizure control w/o the

medication side effects.

Ketogenic DietKetogenic DietHigh fat/low carb diet.Helps control seizures in up to 2/3

of children with refractory epilepsy.Medical Treatment – must be

started under close medical supervision.

Calories restricted to 75% of daily requirement, 90% from fat.

Works well if followed properly.

Common Seizure MedsCommon Seizure Meds Banzel Carbatrol® Clonazepam Depakene® Depakote® Depakote ER® Diastat Dilantin® Felbatol® Felbamate Frisium Gabitril® Keppra® Keppra XR™ Klonopin Lamictal®

Lyrica Mysoline® Neurontin® Phenobarbital Phenytek® Primidone Sabril Tegretol® Tegretol XR® Tiagabine Topamax® Trileptal® Valproic Acid Vimpat Zarontin® Zonegran®

Possible Side EffectsPossible Side EffectsLethargyHair LossProcessing/Word finding issues.Dental/OralAnxious/irritableRashIQ Decline

Common Side EffectsCommon Side Effects

LethargyHair LossProcessing/Word finding issues.Dental/OralAnxious/irritableIQ DeclineRash

Switch GearsSwitch Gears

OHI DefinitionOHI DefinitionOther health impairment means having limited strength, vitality, or alertness, including a heightened alertness to environmental stimuli, that results in limited alertness with respect to the educational environment, that—

(i) Is due to chronic or acute health problems such as asthma, attention deficit disorder or attention deficit hyperactivity disorder, diabetes, epilepsy, a heart condition, hemophilia, lead poisoning, leukemia, nephritis, rheumatic fever,sickle cell anemia, and Tourette syndrome; and

(ii) Adversely affects a child's educational performance.

Source: ISBE Regulations & IDEA

Why does a student with Why does a student with epilepsy qualify for an IEP?epilepsy qualify for an IEP?

HR 1350 Sec. 602(3) states as follows:(i) With mental retardation, hearing impairments

speech or language impairments, visual impairmnts, serious emotional distrubance, orthopedic impairments, autism, traumatic brain injury, other health impairment, or specific learning disabilities and (ii) who, by reason thereof needs special education and related services.

Source: Federal IDEA Law

Suggested Suggested AccommodationsAccommodationsExtended Time for Tests/QuizzesReduced Homework AssignmentsReduced Spelling WordsTests/Quizzes taken in a quiet areaTests/Quizzes read out loudUse of a calculatorUse of a number lineGraphic organizerOutline of classroom NotesExtra set of books at home

Seizure Medication Seizure Medication AdministrationAdministration

No nurse on site (this cannot affect placement)

ISBE Medication Regulations

DiastatDiastatA program for administration of medication to students in schools must be developed and managed by a certified school nurse or registered nurse in accordance with the Recommended Guidelines for Medication Administration in Schools. Each school district must determine who (e.g. superintendent, principal) is responsible for administering medication in the absence of a certified school nurse or registered nurse. Pursuant to section 105 ILCS 5/10-22.21b of the School Code, teachers and other non-administrative employees cannot be required to administer medication, although they may volunteer to do so.

Source: ISBE Regulations - Medication

DiastatDiastatThe Illinois Department of Professional Regulation (IDPR) issued a legal opinion which allows a school employee to stand in the place of a parent or guardian in administration of medication or supervision of self-medication in the school setting. School employees who do not hold a valid IDPR license must receive training in the correct procedure to be used to administer medication and/or provide a specific treatment. This does not prohibit any school employee from administering emergency assistance to a student.A certified school nurse or registered nurse must manage this medication administration program following the Recommended Guidelines for Medication Administration in Schools developed by the Illinois Department Human Services (IDHS) and the Illinois State Board of Education (ISBE), September 2000. A designated administer will be responsible for medication administration or supervision of self-medication when a nurse is not available. Teachers or other employees cannot be required to administer medication or supervise self-medication although they may volunteer to do so.

Source: ISBE/IDHS

All seizures require a plan!All seizures require a plan!

QUESTIONSQUESTIONS