Epilepsy AwarenessEpilepsy Awareness

Epilepsy Nurse SpecialistsEpilepsy Nurse Specialists

Epilepsy AwarenessTraining Schedule

Learning Outcomes

What is Epilepsy?

Epilepsy – Prognosis

Classification of Seizures Epilepsy Management Plan

Role of School Staff/Carer

Observation of Seizure Activity Points to remember

Plan of action/Emergency call sheet

Evaluation and Close

Learning Outcomes• Demonstrate an awareness of what

Epilepsy is and recognition of different seizure types

• Be able to support children/young person experiencing seizures, ensuring their safety and dignity

• Demonstrate awareness of the importance in observing and recording seizure activity

• Recognise possible trigger factors

Learning Outcomes

• Demonstrate an understanding of the epilepsy/emergency management plan

• Raise awareness of the impact of epilepsy on a child/young person’s life

• Understand the need for balancing risk and achieving a quality of life

• Raise awareness of the possible educational implications of the condition

What is Epilepsy?

• Epilepsy has been defined as a tendency to have Epilepsy has been defined as a tendency to have recurrent seizuresrecurrent seizures– Also referred to as “fits”, “convulsions” etc.Also referred to as “fits”, “convulsions” etc.

• The chemical balance in the brain is upset and there is The chemical balance in the brain is upset and there is abnormal firing of nerve cellsabnormal firing of nerve cells– One seizure One seizure does notdoes not constitute epilepsy constitute epilepsy

• Common condition Common condition – Affects 1:242 School Age Children/young person Affects 1:242 School Age Children/young person (Epilepsy Action (Epilepsy Action

20052005))

– More common in children/young person with learning disabilityMore common in children/young person with learning disability• Approximately 22% of people with learning disability have epilepsyApproximately 22% of people with learning disability have epilepsy

Important Points

• Common serious chronic condition

• Approximately 40 different types of seizures The type of seizure the child/young person experiences depends on

which part of the brain it starts and how far or quickly it spreads

• Can develop at any age, however it is diagnosed most before the age of 20

• Very individual/specific to the child/young person

Never assume that all seizures are epileptic in nature !

Prognosis of Epilepsy

• 20% - 30% Excellent prognosis - Seizure free after AED withdrawal – cause no longer exists

• 20% - 30% Good prognosis – remission with AED treatment but cause remains

• 30% - 40% Seizures continue despite treatment - AED’s may only reduce frequency or severity

(Kwan & Sander 2004)

What causes Epilepsy

• 60 - 70% of cases the cause is unknown60 - 70% of cases the cause is unknown• Some known causes includeSome known causes include

– Birth injuryBirth injury– Head injuryHead injury– StrokeStroke– Brain haemorrhageBrain haemorrhage– Brain TumourBrain Tumour– Meningitis/encephalitisMeningitis/encephalitis– DrugsDrugs– AlcoholAlcohol

Potential Triggers

• Flickering lights/photosensitivity• Lack of sleep/tiredness• Stress• Excitement• Missed meals• High Temperature• Menstrual• Missed or late medication

Classification of Seizures

Seizures can be divided into two main groups

Groups:• Generalised Seizures

• Focal Seizures

Temporal Temporal

FrontalFrontal

OccipitalOccipital

ParietalParietal

Generalised Seizures

• These occur when powerful centrally positioned nerve cells behave abnormally

• The discharge spreads more or less

simultaneously to all parts of the brain

• There is loss of consciousness – can be

brief or longer

Generalised Seizure Types

• Tonic-Clonic

• Typical Absence

• Atonic

• Tonic

• Myoclonic

Tonic -Clonic Seizures

• Most common of the generalised seizure

• May have an aura leading into the tonic/clonic seizure

• Lose consciousness

• Usual duration 1-2 minutes

• May follow on from a focal seizure

Tonic Phase

• Muscles contract, body stiffens and child falls to the floor

• The child may become pale

• Their breathing may be irregular and around their lips may appear blue

• Saliva may dribble from mouth and can be blood stained if tongue has been bitten

• Incontinence may occur

Clonic Phase

• Consists of short sharp rhythmic jerks caused by alternate contraction and relaxation of muscles in the trunk and limbs

• Periods of relaxation become more frequent and prolonged

• Muscles relax and the body goes limp. At this stage the child will still be unconscious

• Slowly they will regain consciousness, but may Slowly they will regain consciousness, but may be groggy and confusedbe groggy and confused

Management of Tonic-Clonic Seizures

DO:

• Stay calm

• Assess danger to child- move if in danger

• Protect their head

• Loosen tight clothing, remove glasses

• Time seizure/observe and record

Management of Tonic-Clonic Seizures

DO• Once seizure has finished aid breathing by

gently placing them in the recovery position• Stay with the child until recovery is complete• Reassure and re-orientate the child, tell them

they have had a seizure

• Allow the child a period of rest /sleep afterwards if required

Management of Tonic-Clonic Seizures

DON’T:

• Try to restrain or restrict the child's movements

• Put anything into their mouth

• Give the child anything to eat or drink until they are fully recovered

Typical Absence Seizures

• Generally a childhood disorder• Brief lasting only seconds- begins and ends

abruptly• May look blank and stare, lasting a few seconds• Eye lid fluttering/blinking may occur• May have minor facial movements or head drop• Able to continue normal activity almost

immediately

Management of Absence Seizures

• Usually no help is needed

• Record the time of day and frequency

• Reassure if necessary

• Repeat information that the child may have missed

• If walking they may require guidance

Atonic Seizures(drop attack)

• Sudden loss of muscle tone

• Fall heavily to the ground

• Lasts only a few seconds

• Able to continue normal activity almost immediately

Tonic Seizures

• Muscles contract

• Body stiffens- trunk, facial muscles and limbs

• Results in falls

• Quick recovery

Management of Atonic and Tonic Seizures

• Over very quickly therefore little can be done during seizure

• Check for injuries which may need medical attention

• Stay with the child and reassure

Myoclonic Seizures

• Quick muscle jerks usually of limbs however head and shoulders may jerk forward

• May be one or both sided• Usually seen in specific childhood epilepsy

syndromes• Frequent soon after waking• Short lived so difficult to tell if consciousness is

impaired

Management of Myoclonic Seizures

• Usually so short lived little can be done other than reassure when over

• May be unsteady and if they fall check for injuries

• Stay with the child until they recover

• Reassure

Focal Seizures

•These seizures have a starting point in a particular area of the brain. The type of seizure activity seen is dependant on where the focus point is.•Focal seizures can spread to the rest of the brain resulting in a secondary generalised seizure

Focal Seizures

Symptoms can last from seconds to 1 – 3 minutes can

present as:• mumbling or uncontrolled laughter• Sucking, chewing or swallowing movements• Plucking at or removing clothing• May wander around as if confused

Management of Focal Seizures

DO

• Stay calm

• Guide the child from danger

• Stay with the child until recovery is complete

• Reassure and explain anything they have missed

Management of Focal Seizures

DON’T

• Restrain the child

• Act in a way that could frighten them, such as making abrupt movements or shouting at them

• Give the child anything to eat or drink until they are fully recovered

Call an Ambulance if ……

• You think the child needs urgent medical assistance

• The child has any breathing difficulties following a seizure

• It is a first seizure• The seizure continues for longer than

normal• One seizure follows another without the

child regaining consciousness

Following a Seizure

After a seizure the child may be…..– Confused– Have no memory of what has occurred– Subdued– Tired & sleepy– Have a headache– Concentration impaired– Hyperactivity

Care following a Seizure

• Clear understanding of what has occurred• Observe:

– Breathing & colour– Any injuries

• Be aware of post-ictal state• Offer support and counselling as

appropriate

SUDEP (sudden unexpected death in epilepsy

• Sudden death with no obvious cause

• Can occur with/without evidence of a seizure

• It is estimated that approx 1 per 1000 people with epilepsy in the UK die as a result.

Description of Seizure

Why?•Informs care staff of what is normal for child/young person •Assists with establishing a diagnosis •Observe changes in frequency and type of seizures•Helps monitor effects of treatment •Important to review recordings otherwise changes may go unnoticed.

Observation of Seizures –Before - During - After

• How did the person feel before the event?

• In what environment/activity?

• Time of day or night?• Anything ‘trigger’ the

event?• Was there a warning? • What was the event like?

– Standing / Sitting / Lying?– Was there a fall?– Parts of body

effected/movements?– Eyes open/closed?

Were they unconscious –fully or vaguely?

If unconscious – How long? Behaviour? Incontinence / tongue bite

/excess saliva? Any injury or bruising? Length of time in seizure? What were they like after the event? Recovery time? How did care staff cope with

event – anxious/debriefing?

Seizure Management Plan

• Seizure Management Plan should be in place & available agreed by:– Parent/carer – Children’s Epilepsy Nurse Specialist

• Updated yearly or more often if required• Be aware of who is responsible for first aid• Parent/carer should be informed of seizure

ASAP• Record seizure

Seizure Management Plan

WILL PROVIDE: Description of seizureTriggersManagement of the seizuresWhat to do in an emergency Any other relevant information

Emergency Seizure Management Plan

WILL PROVIDE:

• Description of seizure/duration

• Indications for use of emergency medication

• Initial dose of emergency medication

• Usual response to emergency medication (if known)

Emergency Seizure Management Plan

WILL PROVIDE

• Who is trained to administer

• Consent

Educational Implications

A change in behaviour can be observed:

• Seizure activity• Side effects of medicationBehaviour can be independent of seizures/medication?

Memory:

Can experience some loss or difficulty retaining

information

Role of School Staff/Carer

• Be aware of children with epilepsy• Have as much information as possible

about specific seizures from parent/carer• Observe any unusual behaviour & liaise

with parent/carer• School staff may be first to pick up on the

seizure– Absences/day dreaming

Role of School Staff/Carer

• Positive attitude to condition

• Avoid treating condition as an illness

• Recognise/record changes in mood/behaviour/academic achievement/social interaction

• Risk assess for particular activities

Role of the School Staff/Carer

• Promote communication with parents

• Minimise embarrassment

• Observe and record details of seizures

Care of other Pupils

• Reassure other pupils present• The type of seizure they witness will have

a direct impact on how they cope• Do not keep epilepsy a secret

Sport

• Most children with epilepsy should be able to fully participate in most activities ensuring adequate supervision is provided

• Each activity & each child should be considered individually

• Special considerations & precautions should be discussed with the parent

Social Life

The following increase the risk of seizures

– Excess alcohol

– Lack of sleep

– Disturbed sleep patterns

– Missing meals

– Forgetting to take medication

– Recreational drugs

Points to remember

• Do I know about the child’s/young person’s epilepsy?• Is there a Seizure Management Plan in place?• Is the child/young person prescribed emergency

medication?

if so are relevant staff trained to administer?• Has the person’s epilepsy been reviewed recently? • Lifestyle and impact on Epilepsy• Are any Risk assessment required?• Are all relevant staff aware?

Points to Remember

• Normally seizures run their course and the child recovers without need for medical intervention.

• Children should be given the opportunity to participate in the same activities as their peers promoting independence, confidence and self-esteem.

Further Information

WEBSITES•WWWYoung Epilepsy.org.uk• Epilepsy Action Northern Ireland