+
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
+
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.
+
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
+
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.”
+
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
+
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
+
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
+
Seizure Types
 Generalized



Involve the entire brain
Loss of consciousness
Symptoms may include convulsions, staring, muscle spasms and falls
 Partial




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
+
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
+
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
+
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
+
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
+
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
+
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
+
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
+
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
+
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
+
Seizure Action Plan
+
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
+
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
+
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
+

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)
+
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.
+
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
+

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)
+
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.
+
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
+
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)
+
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
+
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
+
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 selfesteem and depression

School difficulties are not always related to epilepsy
+
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.
+
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
+
Assessment Strategies

Standardized intelligence tests

Neuropsychological testing

Request more frequent reevaluation, particularly after
stabilization of newly diagnosed student
+
 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
+
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.
+
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
+
Tips For Teachers
Avoid
overprotection
Encourage independence
Include the student in as many
activities as possible
Encourage positive peer interaction
+
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