Epilepsy and Vagus Nerve Stimulation System

1. Epilepsy and Vagus Nerve Stimulation System Lincoln High School 2009-2010 In-service Rebecca Lam, School District Nurse

2. Objectives • Discuss general information related to seizures and epilepsy • Identify symptoms of a seizure and immediate action • Identify common treatment options • Discuss purpose and action of VNS system • Discuss step-by-step instruction of VNS and magnet utilization during seizure • Discuss safety considerations during and after seizure

3. What is epilepsy? Epilepsy- brain disorder in which clusters of nerve cells, or neurons, in the brain sometimes signal abnormally. In epilepsy, the normal pattern of neuronal activity becomes disturbed, causing strange sensations, emotions, and behavior or sometimes convulsions, muscle spasms, and loss of consciousness (http://www.ninds.nih.gov/disorders/epilepsy/epilepsy.htm, 2009)

4. Types of Seizures • Generalized Tonic-Clonic (Grand Mal)- sudden rigidity followed by muscle jerks, shallow breathing, bluish skin, loss of bladder/bowel control • Absence- blank stare, rapid blinking, repetitive chewing, lost of awareness during seizures • Simple Partial- uncontrollable jerking of one area of the body while remaining fully cognizant • Complex partial- combination of absence and simple partial • Atonic Seizure- sudden collapse but regains consciousness within seconds to a minute • Myoclonic- sudden brief massive muscle jerks (Epilepsy Foundation of America, 1995)

5. Common Treatment Options • Medications • Surgery • Devices

6. Vagus Nerve Stimulator 101 • Battery-operated implant that gets placed along the vagus nerve to control seizures for patients who have not been responsive to medications • Device is set by the neurologist to send electrical impulses on a regular schedule • Holding a separate magnet at the implant activates the device outside of its regular scheduled intervals (http://www.epilepsy.com/epilepsy/vns, 2006)

7. Magnet Instructions and Safety Considerations Magnet is used if: * Student has a sense that a seizure is coming (aura) * During or at the start of a seizure Instructions: * Swipe magnet across the generator starting at the middle of the chest across the left of the chest counting “one, one-thousand” * Wait 1-2 minutes, if the seizure continues, swipe across again * Do not continue use of magnet for over 4 hours because it can damage the left vagus nerve DO NOT hold magnet on the generator for more than 6 seconds because it will cause the stimulator device to turn off

8. VNS Images

9. Other Necessary First Aid for Seizures • Maintain safe environment • Cushion head • Loosen tight neck wear • Turn patient on side (avoid aspiration) DO NOT: • Place any object in student’s mouth during or immediately after seizure • Hold student down

10. After Seizure Care • Assess student to make sure he/she is breathing • As he/she gains consciousness, orient him/her to place, time, and situation • Allow student to rest until he/she feels ready to return to regular class participation

11. Sources • http://www.epilepsy.com/epilepsy/vns • http://www.ninds.nih.gov/disorders/epilepsy/detail_epilepsy.htm • http://www.musc.edu/mainpages/features/images/vns.jpg