Workbook # 51. Epilepsy and Seizure Management for Home Health Care Providers

Transcription

1 2010 Home Care Community Forum Series Audio Conference designed for trainers and paraprofessionals. Workbook # 51 Epilepsy and Seizure Management for Home Health Care Providers Community Health Care Services Foundation, Inc. 99 Troy Road, Suite 200, East Greenbush, NY (Tel.) (Fax)

2 Welcome! Home Care Community Forums are free educational programs specifically designed for paraprofessionals delivering care in a home or community-based setting. These one-hour audio programs and corresponding workbooks provide essential training and information on a wide variety of clinical, professional and life issues topics. In addition to paraprofessionals, Forums are also attended by supervisors and trainers who use these programs for in-house training programs and to meet in-service requirements for paraprofessionals. This will be CHC s 51 st Forum produced since All of the workbooks and audio presentations for past Forums can be found at Forum 51: Epilepsy and Seizure Management for Home Health Care Providers Presenter: Julie Eisele PhD Julie Eisele is the Community Educator for the Epilepsy Foundation of Northeastern NY where her responsibilities include information and referral, community education and advocacy. She is a Developmental Psychologist whose research has focused on children with early brain injury. Previously, she was an Assistant Professor of Biopsychology at Skidmore College and the Director of the NYS Traumatic Brain and Spinal Cord Injury Surveillance Program funded by the Centers for Disease Control and Prevention. Community Health Care Services Foundation, Inc. 99 Troy Road, Suite 200 East Greenbush, NY (Tel) 518/ (Fax) 518/

3 Home Care Community Forum Certificate of Attendance Awarded to For Participating in Forum 51: Epilepsy and Seizure Management for Home Health Care Providers A training program provided by Community Health Care Services Foundation, Inc. Date Signed

4 Home Care Community Forum #51 Epilepsy and Seizure Management for Home Health Care Providers Agency Evaluation Form Please let us know how you liked today's audio conference and help us better meet your educational needs by completing this evaluation and return it to CHC. Strongly Agree Agree Undecided Disagree Strongly Disagree Overall this program met its objectives. The information presented was useful to our staff. The material was presented in a manner that was easy to understand. The trainer was knowledgeable and easy to understand. The workbook is a valuable tool. Our agency will use the workbook to train additional staff. The topic was adequately covered in the time allotted. This Forum will positively impact employee retention at my agency. What type of agency are you from? LHCSA CHHA LTHHCP Hospice Long Other: (please specify) What area is your agency located? Central New York Finger Lakes Hudson Valley Island Mohawk Valley New York City Northeastern New York Western New York Other Number of paraprofessional staff participating: Number of professional staff participating: How often do you visit the CHC website? Name of Agency Contact Person Address Phone Address Weekly Bi-monthly Monthly Rarely Never What do you use the CHC website for? (please mark all that apply) Educational session information Download training materials Grants information Resources for paraprofessionals CHC Organization/Staff Information Review past issues of Focus Other (please specify) Comments/ Suggestions for Future Forums: Community Health Care Services Foundation, Inc. 99 Troy Road, Suite 200 East Greenbush, NY Phone: Fax:

5 Home Care Community Forum #51 Epilepsy and Seizure Management for Home Health Care Providers Individual Evaluation Form We hope you enjoyed today's program. Please fill out this evaluation and return it to your training coordinator. Strongly Agree Undecided Disagree Strongly Agree Disagree Overall this program met its objectives. The material was presented in a manner that was easy to understand. The workbook is a valuable resource tool. This program will help me to perform my job better. This program will increase my satisfaction with my job. I will attend other educational seminars offered by CHC. What type of agency are you from? LHCSA CHHA LTHHCP Hospice Long Other: (please specify) What area is your agency located? Central New York Finger Lakes Hudson Valley Island Mohawk Valley New York City Northeastern New York Western New York Other How long have you worked in home care? less than 1 year Where did you listen to this program? Work 1-3 years Home 4-6 years Other 7-10 years (please specify) more than 10 years What is your job title? We need this demographic data to fund future training sessions. Please complete the following section. required to provide your name. You are not Gender: Male Age: Under 21 Female Over 55 Ethnicity : White non Hispanic Hispanic Black non Hispanic Education completed: Less than 8th grade Completed 8th grade High School diploma GED American Indian/Alaska National Asian/Pacific Islander Other (please specify) Associates degree Bachelor's degree Post graduate degree Community Health Care Services Foundation, Inc. 99 Troy Road, Suite 200 East Greenbush, NY Phone: Fax:

6 Community Health Care Services Foundation, Inc. 99 Troy Road, Suite 200 East Greenbush, NY Phone: 518/ Fax: 518/ Home Care Community Forum WORKBOOK #51 Epilepsy and Seizure Management for Home Health Care Providers QUIZ ANSWERS True or False 1. False 6. True 2. True 7. False 3. True 8. False 4. False 9. True 5. True 10. False Multiple choice 1. B 6. D 2. D 7. A 3. B 8. C 4. C 9. A 5. A 10. D

7 Forum 51- Epilepsy and Seizure Management for Home Health Care Providers Learning Objectives: At the completion of this program, participants will be able to understand: 1. What epilepsy is, its symptoms and causes 2. Different types of seizures, their signs and symptoms 3. Current treatment options and side-effects 4. How and when to administer Seizure First Aid 5. The need for a Seizure Emergency Plan Glossary Conscious Consciousness Having awareness of one's self, acts, and surroundings. The state of being conscious. Electroencephalogram (EEG) Epilepsy Epileptologist A device that measures the electrical activity of the brain by recording from external electrodes. A chronic neurological disorder characterized by a tendency to have recurrent, unprovoked seizures. A neurologist that specializes in the treatment of epilepsy. Neurological Seizure Status epilepticus Vagus nerve Relating to the nervous system. A brief change in the electrical activity of the brain. 30 minutes of either continuous seizure activity or repetitive seizures without a return of consciousness. A large nerve in the neck that leads directly to the brain. Prepared by Julie Eisele, Ph.D., Community Educator, Epilepsy Foundation of Northeastern New York. The Epilepsy Foundation of America, Inc. provided much of the material in this workbook. Reprinted with permission. Community Health Care Services Foundation, Inc. 1

8 Forum 51- Epilepsy and Seizure Management for Home Health Care Providers I. An Introduction to Epilepsy A. What is a Seizure? A brief change in the electrical activity of the brain that alters one or more of the following: Movement Sensation Behavior Awareness Emotions Seizure symptoms depend on where in the brain the electrical activity occurs and how much of the brain is affected during the seizure. Most seizures occur spontaneously and unpredictably. Brain cells use tiny electrical signals to send information to other brain cells. During a seizure, too many brain cells send these signals at the same time. The result may be a change in consciousness, movement and/or behavior. Seizures that affect the entire brain usually result in a loss of consciousness. If only part of the brain is affected, it may cloud awareness, block normal communication, and produce a variety of undirected, uncontrolled, unorganized movements. Most seizures last only a minute or two, and end naturally. After a seizure, the person may feel sick, tired and disoriented. In these cases, caregivers should follow basic seizure first aid, keep the individual safe during the seizure and monitor for a return to baseline after the seizure ends. Sometimes, seizures can last longer than expected. Seizures lasting longer than five minutes require emergency action. For this reason, all caregivers must have access to a seizure emergency plan. B. What is Epilepsy? Epilepsy is a chronic neurological disorder characterized by a tendency to have recurrent, unprovoked seizures. Epilepsy is diagnosed when a person has two or more unprovoked seizures. By unprovoked we mean a seizure that isn t caused by a fever, low blood sugar, drug or alcohol intoxication, etc. Epilepsy is also known as a seizure disorder. Community Health Care Services Foundation, Inc. 2

9 Forum 51- Epilepsy and Seizure Management for Home Health Care Providers C. Who Gets Epilepsy? 1. Epilepsy affects roughly one percent of the population, with an estimated 3 million Americans living with epilepsy. It occurs more often in young children, the elderly and developmentally disabled populations. Children and adults with autism, mental retardation, cerebral palsy and other developmental disorders are at increased risk for developing epilepsy. 2. Epilepsy is the leading neurological disorder in childhood and the third leading neurological disorder in adults. 3. One in ten people will have a seizure in their lifetime. D. Causes of Epilepsy The cause is unknown in 70% of cases Brain Trauma (ex. injury, stroke) Brain Lesions (ex. tumors) Poisoning (ex. lead) Infections of the brain (ex. meningitis, encephalitis, measles) Brain injury at birth Genetic causes Abnormal brain development Chronic alcohol/ drug abuse II. Diagnoses A. How is Epilepsy Diagnosed? 1. A physician can diagnosis epilepsy based on a medical history, physical examination, blood work, description of seizure activity, electroencephalogram (EEG), brain imaging such as a magnetic resonance imaging (MRI) or computed tomography (CT scan), and possibly genetic testing. An EEG measures the electrical activity of the brain by recording from electrodes placed on the head. Community Health Care Services Foundation, Inc. 3

10 Forum 51- Epilepsy and Seizure Management for Home Health Care Providers 2. People with epilepsy are treated by neurologists, family doctors or pediatricians. Epileptologists are neurologists with specialized training in epilepsy. B. Types of Seizures There are over 20 different types of seizures A person may experience just one type or more than one. The kind of seizure a person has depends on which part of the brain is affected and the amount of seizure activity. Seizures present in a variety of ways but often they present in the same way each time in an individual. Seizures can and do vary based on a number of factors. Seizures can be categorized based on whether they involve the whole brain or part of the brain. 1. Generalized Seizures In generalized seizures, abnormal electrical activity involves large areas of both sides of the brain and causes a loss of consciousness. Symptoms include convulsions, starring, muscle spasms and falls. Examples of generalized seizures include tonic-clonic, absence, atonic and myoclonic. i. Tonic-Clonic Seizures Previously referred to as Grand Mal. Generalized Tonic-Clonic seizures are the most common and best known type of generalized seizure. They have a sudden onset and render the person unconscious. They begin with stiffening of the arms and legs (tonic phase), followed by whole body convulsing (clonic phase). The person may fall to the ground and emit an involuntary cry. The person may lose bowel and/or bladder function. During the tonic phase, breathing may decrease or cease altogether, producing cyanosis (blueing) of the lips, nail beds, and face. Breathing typically returns during the clonic (jerking) phase, but it may be irregular. This clonic phase usually lasts less than a minute. Some people experience only the tonic, or stiffening phase of the seizure; others exhibit only the clonic or jerking movements; still others may have a tonic-clonictonic pattern. Most tonic-clonic seizures last one to three minutes. Following the seizure, the person will be lethargic, sore, possibly confused, and want to sleep. Headaches are common. Full recovery can takes minutes to hours. ii. Absence Seizure Previously referred to as Petit Mal. Community Health Care Services Foundation, Inc. 4

11 Forum 51- Epilepsy and Seizure Management for Home Health Care Providers Most common in children with an onset between 3 and 10 years of age. The person stares vacantly and experiences a very brief loss of consciousness, typically just a few seconds. May involve small involuntary movements of the face (twitching, blinking, etc.) and/or arm movements. The person does not talk and does not hear what is being said. Consciousness returns quickly and the person resumes previous activity. Absence seizures can occur in clusters, with up to 100 seizures in a single day. Up to 40% of patients can outgrow this type of seizure. Most children with typical absence seizures are otherwise normal. iii. Atonic seizures Atonic seizures cause a sudden loss of muscle tone. Motor symptoms include head drops, loss of posture, or sudden collapse. Because they occur without warning, atonic seizures can result in injuries to the head and face. Protective headgear is sometimes used by children and adults. Other names include drop attacks, astatic or akinetic seizures. iv. Myoclonic seizures 2. Partial Seizures The person experiences sudden jerks or muscle contractions, often both sides of the body at the same time Occasionally, they involve one arm or a foot. A similar but normal experience is the sudden jerk of a foot during sleep. Partial seizures are the most common type of seizure, also called focal seizures. The electrical disturbance begins in a specific area of one side of the brain. They typically do not involve a loss of consciousness but can result in an altered awareness. A person s symptoms depend on the specific part of the brain affected. Nearly any movement, sensory, or emotional symptom can occur as part of a partial seizure, including complex visual or auditory hallucinations. Partial seizures can spread to involve the whole brain resulting in a generalized seizure. i. Simple Partial Seizures Consciousness is maintained during a simple partial seizure. The person may be unable to speak or move during the seizure, but will often remember what happened during the seizure. Community Health Care Services Foundation, Inc. 5

12 Forum 51- Epilepsy and Seizure Management for Home Health Care Providers Symptoms can include emotional changes (fear, anxiety), isolated, involuntary movements, sensory sensations (tingling, weakness, sounds, smells, tastes, visual distortions) and psychic symptoms (déjà vu, hallucinations). Most partial seizures last less than a minute. Can result in a complex-partial seizure or generalized tonic-clonic seizure. ii. Complex Partial Seizures 3. Intractable Seizures Complex partial seizures result in a state of altered consciousness. Symptoms are variable, but often start with a blank stare followed by chewing, lip smacking or other purposeless repetitive movements. Aimless walking, random movements and incoherent speech are common. Some report an aura or warning sign, such as an abnormal taste or smell, sensation or emotion. Complex partial seizures typically last 30 seconds to 2 minutes. Longer seizures can occur and seizures can generalize to a tonic-clonic seizure. Complex partial seizures are the most common type of seizure. They frequently arise from the temporal lobe of the brain. Seizures of any kind that do not respond to medications. Twenty percent of people with epilepsy have seizures that are resistant to medication, otherwise known as refractory epilepsy. C. Status Epilepticus 1. Most seizures end after a few minutes. If seizures are prolonged, or occur in a series, there is an increased risk of status epilepticus, a true life threatening emergency. 2. Status epilepticus is usually defined as 30 minutes of uninterrupted seizure activity or repeat seizures without a return to consciousness. 3. The Epilepsy Foundation advises parents and the public to call for emergency assistance when a convulsive seizure lasts for more than five minutes without signs of stopping, or when successive seizures last more than five minutes without a return to consciousness. III. Treatment Options The goal of all epilepsy treatment is to stop the seizures with as few side effects as possible. The most common treatment is medication. If medication does not work, other options may include surgery, a medical device or a highly specialized diet. Community Health Care Services Foundation, Inc. 6

13 Forum 51- Epilepsy and Seizure Management for Home Health Care Providers A. Medication Anti-seizure medication is the first line of treatment for epilepsy and is effective in approximately 75% of patients. For 25% of patients, current medications are not effective at controlling their seizures. In these cases, other treatments such as surgery and diet need to be explored. Ideally, patients will gain adequate seizure control with one medication, but sometimes, multiple drugs are needed to control seizures. 1. Common Anti-Seizure Drugs Carbamazepine (Tegretol, Carbatrol) Clonazepam (Klonopin) Ethosuximide (Zarontin) Felbamate (Felbatol) Gabapentin (Neurontin) Lacosemide) Vimpat) Lamotrigine (Lamictal) Levetiracetam (Keppra) Oxcarbazepine (Trileptal) Phenobarbital Phenytoin (Dilantin, Phenytek) Pregabalin (Lyrica) Primidone (Mysoline) Rufinamide (Banzel) Tiagabine (Gabitril) Topiramate (Topamax) Valproate Vigabatrin (Sabril) Zonisimide (Zonegran) 2. Common Anti-Seizure Drug Side-effects Drug-related: Cognitive problems Fatigue Weight gain or loss Cosmetic acne, excessive hairiness or hair loss Hyperactivity excitable Hypoactivity - reduced activity Personality changes Mood changes, depression Community Health Care Services Foundation, Inc. 7

14 Forum 51- Epilepsy and Seizure Management for Home Health Care Providers Dose-related/toxicity: Double vision, blurry vision Dizziness, lightheadedness Sedation Slowed thinking Feels drunk Coordination problems Unsteady walking 3. Drug Reaction Warning Signs 1. Rash 2. Prolonged fever 3. Severe sore throat 4. Mouth ulcers 5. Easy bruising 6. Weakness 7. Excessive fatigue 8. Swollen glands 9. Lack of appetite 10. Increased seizures 4. Emergency Medication Diazepam rectal gel (Diastat), a form of Valium, is a common emergency medication prescribed for patients who tend to have poorly controlled seizures, cluster seizures or status epilepticus. Diastat has been approved by the FDA for use by family members and other non-medical caregivers. Training is required for proper administration and safety. For more information and a free video on administration, visit B. Vagus Nerve Stimulator (VNS) 1. A small battery powered device is implanted under the skin in the chest wall. The device sends small, regular bursts of electrical energy to the vagus nerve, a large nerve in the neck that leads directly to the brain. A programmable pulse generator implanted under the skin in left chest Electrode is surgically wrapped around the left vagus nerve Sends bursts of electrical energy to the brain via the vagus nerve Exact mechanism of action not known Can be activated or turned off with an external magnet Side effects may include hoarseness, coughing and shortness of breath and occur during stimulation only Community Health Care Services Foundation, Inc. 8

15 Forum 51- Epilepsy and Seizure Management for Home Health Care Providers C. Surgery 2. VNS Magnet Use Typically worn on wrist or belt If the person has a seizure warning sign (aura) s/he or a trained observer may swipe the magnet over the VNS device to activate it and help abort a seizure Magnet may be swiped during an actual seizure to shorten seizure length Magnet may be used as often as needed with at least a minute between swipes Magnet held in place over VNS can turn it off if unit malfunctions For a free video and more information visit Surgery is a treatment option when the area of the brain causing the seizures is small and focal and when the area can be safely removed without a loss of function. In certain cases, surgery can significantly reduce or eliminate seizure activity. D. Ketogenic Diet IV. Seizure Triggers A. Breakthrough Seizures A medically supervised diet comprised of a high proportion of fat and very little protein and carbohydrates. By forcing the body to burn fat, the body enters a state of ketosis which somehow works to reduce seizures in some people with epilepsy. Strict adherence to the diet is necessary as deviation from the diet can cause breakthrough seizures. Modified Atkins diet as alternative. Even when an individual s seizures are well controlled, breakthrough seizures can and do occur. Below is a list of the leading causes of breakthrough seizures. Seizure triggers are highly individual and most individuals might not have any recognizable triggers. B. Possible Seizure Triggers 1. Missed or late medication (#1 reason) 2. Change in medication 3. Change from brand name medication to generic and vice versa 4. Lack of sleep/fatigue 5. Illness/fever 6. Poor diet/missed meals 7. Low blood sugar / high blood sugar 8. Hunger / Dehydration 9. Flashing lights (rare) Community Health Care Services Foundation, Inc. 9

16 Forum 51- Epilepsy and Seizure Management for Home Health Care Providers 10. Overheating/overexertion 11. Stress/anxiety 12. Hormonal changes 13. Alcohol / Recreational drug use 14. Drug interactions V. Seizure First Aid A. Good Communication is Key 1. Communication between the caregiver and parent/guardian is necessary to reduce seizure frequency and risk of injury 2. Communicate at the beginning and end of each shift 3. Use daily log and observation record to document seizure type and frequency 4. Discuss physical health as well as behavioral & emotional health 5. Be aware of potential side effects to medication 6. Discuss medication changes, including changes in medication formulation (e.g. brand name versus generic) 7. Discuss changes to seizure action plan, first aid and safety precautions B. Seizure First Aid 1. Most seizures are not medical emergencies. Basic first aid varies by seizure type and whether there is a change in consciousness (See Appendix A). Every individual with epilepsy should have a Seizure Action Plan for seizure emergencies. 2. Dangerous First Aid for All Seizure Types Don t put anything in the person s mouth Don t try to hold down or restrain the person Don t attempt to give oral anti-seizure medications 3. First Aid for Generalized Tonic-Clonic Seizures: (See Appendix B) Stay calm, note time seizure began and duration of event Lay person down and turn on side Place something soft under head Clear objects away from jerking extremities Loosen tight clothing Protect head and remove glasses Do not restrain Provide privacy if possible Stay with the person until the seizure ends and a full return to consciousness is observed Community Health Care Services Foundation, Inc. 10

17 Forum 51- Epilepsy and Seizure Management for Home Health Care Providers After the seizure ends, re-orient the person to their surroundings Activate Emergency Protocol after five minutes of continuous seizure activity, or if another seizure begins before a full return to consciousness. 4. First Aid for Complex Partial Seizures: (See Appendix C) Note time seizure began and duration of event Speak softly and calmly, reassure others Do not restrain or grab (may result in combativeness) Gently guide away from hazards Verbal instructions may not be obeyed Stay with the person until the seizure ends and a full return to consciousness is observed After the seizure ends, re-orient the person to their surroundings Activate Emergency Protocol if: Seizure lasts for five minutes beyond what is routine for that individual. If a second seizure begins before a full return to consciousness. If confusion or disorientation lasts for more than 30 minutes after the seizure ends. 5. Absence, Simple Partial, Myoclonic and Atonic Seizures: First aid is generally not needed for these types of seizures unless: Seizure progresses to a generalized tonic-clonic seizure Repeated seizures occur without a return to consciousness Confusion or altered state lasting 30 minutes or more after seizure ends Person is injured during the seizure 6. When is a Seizure an Emergency? First time seizure Convulsive seizure lasting more than 5 minutes Repeated seizures without a return to consciousness More seizures than usual or change in type Person is injured Person has trouble breathing after seizure Person has diabetes or is pregnant Seizure occurs in water 7. Use of Emergency Medications (Diastat) Prescribed for seizure clusters and prolonged seizures Must be fully trained in administration Emergency protocol should include: Medication name Details about exactly when it should be given Specific administration instructions Monitor responses and side effects Follow Seizure Action Plan emergency response protocol Community Health Care Services Foundation, Inc. 11

18 Forum 51- Epilepsy and Seizure Management for Home Health Care Providers 8. Tonic-Clonic Seizure in a Wheelchair Do not remove from wheelchair unless absolutely necessary Secure wheelchair to prevent movement Fasten seatbelt (loosely) to prevent person from falling out of wheelchair Protect and support head Ensure breathing is unobstructed and allow secretions to flow from mouth Pad wheelchair to prevent injuries to limbs Follow relevant seizure first aid protocol VI. Seizure Management Tools A. Seizure Action Plan (See Appendix D) A medical care plan to be used in cases of seizure emergencies. Should be approved by the treating physician and all caregivers should have access to the plan. B. Seizure Questionnaire (See Appendix E) Information on seizure history and treatment that is used to help design the Seizure Action Plan. C. Observation Record (See Appendix F) A log to record physical and behavioral changes related to seizure activity. Community Health Care Services Foundation, Inc. 12

19 Forum 51- Epilepsy and Seizure Management for Home Health Care Providers RESOURCES Epilepsy Foundation: Centers for Disease Control: Epilepsy.com: National Library of Medicine: Project Access: Seizure Tracker: Community Health Care Services Foundation, Inc. 13

20 Forum 51- Epilepsy and Seizure Management for Home Health Care Providers True of False 1. Most seizures are medical emergencies. 2. Seizures result from changes in the electrical activity of the brain. 3. On average, one in ten people will have a seizure in their lifetime. 4. Brain injury is not a cause of epilepsy. 5. A person can be conscious during a seizure. 6. Seizures that last longer than five minutes can be considered a seizure emergency. 7. Anti-seizure medication is effective for 95% of people with epilepsy. 8. The Ketogenic Diet is comprised of a very low proportion of fat. 9. Placing any type of object in a person s mouth during a seizure is dangerous. 10. Restraining someone during a complex partial seizure is necessary for safety. Multiple Choice 1. Generalized seizures that affect the entire brain usually (a) result in no loss of consciousness (b) result in a loss of consciousness (c) result in a partial loss of consciousness (d) result in hallucinations 2. A seizure can affect which of the following? (a) Movement (b) Sensation (c) Emotions (d) All of the above 3. Epilepsy is defined by (a) predictable seizures (b) recurrent, unprovoked seizures (c) mental retardation (d) depression QUIZ 4. Which of the following is not a cause of epilepsy? (a) genetics (b) brain trauma (c) mental illness (d) poisoning 5. An EEG: (a) records brain activity (b) takes a picture of the brain (c) measures heart rate (d) measures pulse rate 6. Which of the following is not a symptom of a complex partial seizure? (a) wandering (b) altered consciousness (c) repetitive movements (d) coherent speech 7. Which of the following is not associated with a tonic-clonic seizure? (a) wandering (b) loss of consciousness (c ) whole body convulsions (d) abnormal breathing 8. Which of the following is not a common sideeffect of anti-seizure medication? (a) fatigue (b) cognitive problems (c) diabetes (d) depression 9. Why is it important to time seizures? (a) because seizures that continue for more than five minutes can be considered an emergency. (b) because seizures always end after five minutes. (c) because it s important to know what time of day the seizure occurred. (d) all of the above 10. Possible seizure triggers in someone that has epilepsy include: (a) illness (b) change of medication (c) hormonal changes (d) all of the above Community Health Care Services Foundation, Inc. 14

21 Seizure Recognition and First Aid Seizure Type What it Looks Like What it is Not What to Do Generalized Tonic Clonic (Also called Grand Mal) Sudden cry, fall, rigidity, followed by muscle jerks, shallow breathing or temporarily suspended breathing, bluish skin, possible loss of bladder or bowel control, usually lasts a couple of minutes. Normal breathing then starts again. There may be some confusion and/or fatigue, followed by return to full consciousness. Heart attack. Stroke. Look for medical identification. Protect from nearby hazards. Loosen shirt collars. Protect head from injury. Turn on side to keep airway clear unless injury exists. Reassure as consciousness returns. If single seizure lasted less than 5 minutes, ask if hospital evaluation wanted. Absence (Also called Petit Mal) A blank stare, beginning and ending abruptly, lasting only a few seconds, most common in children. May be accom panied by rapid blinking, some chewing movements of the mouth. Child or adult is unaware of what s going on during the seizure, but quickly returns to full awareness once it has stopped. May result in learning difficulties if not recognized and treated. Daydreaming. Lack of attention. Deliberate ignoring of adult instructions. No first aid necessary, but if this is the first observation of the seizure(s), medical evaluation should be recommended. Simple Partial Jerking may begin in one area of body, arm, leg, or face. Can t be stopped, but patient stays awake and aware. Jerking may proceed from one area of the body to another, and sometimes spreads to become a convulsive seizure. Partial sensory seizures may not be obvious to an onlooker. Patient experiences a distorted environment. May see or hear things that aren t there, may feel unexplained fear, sadness, anger, or joy. May have nausea, experience odd smells, and have a generally funny feeling in the stomach. Acting out, bizarre behavior. Hysteria. Mental illness. Psychosomatic illness. Parapsychological or mystical experience. No first aid necessary unless seizure becomes convulsive, then first aid as above. No immediate action needed other than reassurance and emotional support. Medical evaluation should be recommended. Complex Partial (Also called Psychomotor or Temporal Lobe) Usually starts with blank stare, followed by chewing, followed by random activity. Person appears unaware of surroundings, may seem dazed and mumble. Unrespon sive. Actions clumsy, not directed. May pick at clothing, pick up objects, try to take clothes off. May run, appear afraid. May struggle or flail at restraint. Once pattern is established, same set of actions usually occur with each seizure. Lasts a few minutes, but post seizure confusion can last substantially longer. No memory of what happened during seizure period. Drunkenness. Intoxication on drugs. Mental illness. Disorderly conduct. Speak calmly and reassuringly to patient and others. Guide gently away from obvious hazards. Stay with person until completely aware of environment. Offer to help get person home. Clumsiness. Normal childhood stage. In a child, lack of good walking skills. In an adult, drunkenness, acute illness. Atonic Seizures (Also called Drop Attacks) A child or adult suddenly collapses and falls. After 10 seconds to a minute he recovers, regains consciousness, and can stand and walk again. No first aid needed (unless he hurt himself as he fell), but the child should be given a thorough medical evaluation. Myoclonic Seizures Sudden brief, massive muscle jerks that may involve the whole body or parts of the body. May cause person to spill what they were holding or fall off a chair. Clumsiness. Poor coordination. No first aid needed, but should be given a thorough medical evaluation. Infantile Spasms These are clusters of quick, sudden movements that start between three months and two years. If a child is sitting up, the head will fall forward, and the arms will flex forward. If lying down, the knees will be drawn up, with arms and head flexed forward as if the baby is reaching for support. Normal movements of the baby. Colic. No first aid, but doctor should be consulted Epilepsy Foundation of America, Inc. Appendix A

22 Appendi xb

23 Appendi xb

24 Appendi xc

25 Appendi xc

26 Seizure Action Plan Effective Date This student is being treated for a seizure disorder. The information below should assist you if a seizure occurs during school hours. Student s Name Date of Birth Parent/Guardian Phone Cell Other Emergency Contact Phone Cell Treating Physician Phone Significant Medical History Seizure Information Seizure Type Length Frequency Description Seizure triggers or warning signs: Student s response after a seizure: Basic First Aid: Care & Comfort Please describe basic first aid procedures: Does student need to leave the classroom after a seizure? Yes No If YES, describe process for returning student to classroom: Emergency Response A seizure emergency for this student is defined as: Seizure Emergency Protocol (Check all that apply and clarify below) Contact school nurse at Call 911 for transport to Notify parent or emergency contact Administer emergency medications as indicated below Notify doctor Other Treatment Protocol During School Hours (include daily and emergency medications) Basic Seizure First Aid Stay calm & track time Keep child safe Do not restrain Do not put anything in mouth Stay with child until fully conscious Record seizure in log For tonic-clonic seizure: Protect head Keep airway open/watch breathing Turn child on side A seizure is generally considered an emergency when: Convulsive (tonic-clonic) seizure lasts longer than 5 minutes Student has repeated seizures without regaining consciousness Student is injured or has diabetes Student has a first-time seizure Student has breathing difficulties Student has a seizure in water Emerg. Dosage & Med. Medication Time of Day Given Common Side Effects & Special Instructions Does student have a Vagus Nerve Stimulator? Yes No If YES, describe magnet use: Special Considerations and Precautions (regarding school activities, sports, trips, etc.) Describe any special considerations or precautions: Physician Signature Date Parent/Guardian Signature Date DPC772A

27 AppendixE

28 Appendi xe

29 Seizure Observation Record Student Name: Date & Time Seizure Length Pre-Seizure Observation (Briefly list behaviors, triggering events, activities) Conscious (yes/no/altered) Injuries (briefly describe) Mouth Eyes Color Extremity Muscle Tone/Body Movements Movements Rigid/clenching Limp Fell down Rocking Wandering around Whole body jerking (R) arm jerking (L) arm jerking (R) leg jerking (L) leg jerking Random Movement Bluish Pale Flushed Pupils dilated Turned (R or L) Rolled up Staring or blinking (clarify) Closed Salivating Chewing Lip smacking Verbal Sounds (gagging, talking, throat clearing, etc.) Breathing (normal, labored, stopped, noisy, etc.) Incontinent (urine or feces) Confused Post-Seizure Observation Sleepy/tired Headache Speech slurring Other Length to Orientation Parents Notified? (time of call) EMS Called? (call time & arrival time) Observer s Name Please put additional notes on back as necessary. Appendix F