Download Epilepsy and Seizure Mangament

Epilepsy and Seizure
Management
Presented by
Wendy Fahey RNC, BSN
Where it all begins…
Effective management begins with
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Recognizing
Observing
Documenting
This can be challenging because symptoms are
often:
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Subtle
Difficult to detect
Occur without warning
Confused with other behavioral or psychological
problems
What Is Epilepsy?
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Epilepsy is a chronic neurological disorder
characterized by a tendency to have recurrent
seizures
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Epilepsy is also known as a “seizure disorder”
 A seizure is the physical manifestation of a
sudden disruption of orderly communication
between neurons in the brain
 A seizure can take a variety of forms, depending
on where the disruption occurs and how far the
resulting abnormal electrical activity spreads
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The type of epilepsy a person has is determined
by their predominant seizure type and other
related signs and symptoms
Causes of epilepsy include:
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Stroke
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Brain tumor
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Brain infection
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Past head injury
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Metabolic problems
Other neurological conditions
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Genetic factors
A seizure is:
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A brief, excessive discharge of electrical
activity in brain that alters one or more of the
following:
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Movement
Sensation
Behavior
Awareness
Causes of Symptomatic Seizures
Brain trauma
 Brain lesions
 Poisoning
 Infections of the brain
 High fever
 Brain injury at birth
 Congenital malformations
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Did You Know That…
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Most seizures are NOT medical emergencies
Students may NOT be aware they are having
a seizure and may NOT remember what
happened
Students almost never die or have brain
damage during a seizure
A student can NOT swallow their tongue
during a seizure
Seizure Triggers or Precipitants
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Flashing lights and hyperventilation can trigger
seizures in some students with epilepsy
Factors that might increase the likelihood of a
seizure in students with epilepsy include:
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Missed or late medication (#1 reason)
Stress/Anxiety
Lack of Sleep
Hormonal changes
Illness
Alcohol or drug use
Drug interactions (from prescribed or over the
counter medicines)
Poor diet/missed meals
Different Seizure Types
Generalized seizures
Involve the whole brain
Common types include absence and
tonic-clonic
Symptoms can include blank stares,
falling to the floor, sudden muscle jerks,
and repetitive stiffening and relaxing of
muscles
Partial seizures
Involve only part of the brain
Common types include simple partial and
complex partial
Symptoms relate to the pat of the brain
affected
Generalized seizures
(Tonic-Clonic Seizure-“grand mal”)
 Occurs
in all age groups
 Previously
referred to as a
“grand mal” seizure
Simple Partial Seizure
Seizure activity in the brain causing:
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Rhythmic movements isolated twitching of arms, face, legs
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Sensory symptoms tingling, weakness, sounds, smells, tastes,
feeling of upset stomach, visual distortions
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Psychic symptoms déjà vu, hallucinations, feelings of fear or anxiety
Usually last less than one minute
May precede a generalized seizure
Factors that Impact the
Student with Seizures
Factors:
 Seizures
 Medication side
effects
 Underlying brain
abnormalities
Affect:
 Learning
 Behavior
 Self-concept
 Stigma
 Psychosocial
development
 Overall quality of life
Impact on Learning
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Most student have IQ’s within the normal
range
Risk of learning problems is 3x greater than
average
May have difficulty with memory, attention
and concentrations
Students who achieve seizure control quickly,
with few medication side effects, have the
best chance for normal educational
achievement
Factors that May Increase the Risk of
Learning, Behavioral and Psychosocial
Problems
Early age of onset
 Multiple lifetime seizures
 High seizure frequency
 Seizures in school memory deficit
 Slowed motor speed
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Status Epilepticus
Continuous state of seizure activity, or
prolonged seizures that occur in a
series
 Medical emergency
 Most common in the very young and
very old
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Routine First Aid: Care & Comfort
Most seizures are not medical
emergencies
 Basic first aid has many common
elements, but varies depending whether
there is:
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No change in consciousness
 Altered awareness
 Loss of consciousness
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No change in Consciousness
(Simple Partial Seizure)
Stay Calm
 Time Seizure
 Reassure student that they are safe
 Explain to others if necessary
 Protect student’s privacy
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Altered Awareness
(Complex Partial Seizure)
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Speak softly and calmly
Guide away from potentially harmful objects
Allow for wandering in a contained area
If lasts 5 minutes beyond what is routine for
that student or another seizure begins before
full awareness is regained, follow emergency
protocol
DO NOT restrain or grab
DO NOT shout or expect verbal instructions
to be obeyed
Loss of Consciousness
(Generalized Tonic-Clonic Seizure)
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Stay calm and track time
Protect student from possible hazards
Turn the student on their side to allow saliva to
drain and to prevent choking.
Cushion and Protect head may place a thin, soft
towel or item under the head if the floor is hard.
Loosen restrictive clothing and remove glasses
Remain with student until fully conscious
Dangerous First Aid!!!
DO NOT put anything in the student’s
mouth during a seizure
 DO NOT hold down or restrain
 DO NOT attempt to give oral
medications, food or drink during a
seizure
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When to Call 911
The National Epilepsy Foundation recommends that you
seek emergency medical care immediately if:
 A seizure lasts 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
Follow seizure emergency definition and protocol as defined by
the healthcare provider in the seizure action plan
Options for Treating Repetitive
Seizures
The only FDA-approved treatment for
acute repetitive seizures is rectal Diastat,
but nasal or buccal midazolam have
been shown to be equally effective.
Some services make arrangements to
use alternate forms.*
These alternate methods are currently in a Phase 1 FDA
clinical trial. (www.clinical trials.gov) with an estimated
completion date of April 2012.
*
DVD:
A Guide to
Seizure Management for
Emergency Medical
Responders
Buccal Midazolam
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Student in side lying position
Place syringe into the side of students
mouth, between gums and teeth
If possible, ½ of dose in one cheek and
remaining in other cheek
Slowly push the plunger of the syringe down
until the syringe is empty
Watch for any breathing difficulties
Confirm that the seizure has stopped
Thank You
If you have any questions please contact
Wendy Fahey RNC, BSN
School District of Belleville Nurse