SEIZURE DISORDERS

1. SEIZURE DISORDERS

2. WHO CAN HAVE SEIZURES ? • Approximately 2 million Americans have seizure disorders. • Anyone can have a seizure disorder and the majority of people who do have seizure disorders lead normal lives. • The Americans with Disabilities Act (ADA) forbids discrimination in employment and services against students who have seizure disorders. • Approximately one third of people with developmental disabilities may have a seizure disorder.

3. WHAT CAUSES SOMEONE TO DEVELOP A SEIZURE DISORDER ? • Some students have primary epilepsy in which there is no apparent identifiable cause. • Examples of other causes of seizures are: • infections of the brain • injuries to the brain • stroke • brain tumors • birth injuries • congenital defects • reduced oxygen to the brain • chemical poisoning • very low calcium • very low blood sugar • drug toxicity or withdrawal • alcoholism or withdrawal • Alzheimer’s Disease

4. Types of Seizure Disorders • Generalized Seizures • Tonic-Clonic (also called Grand Mal or Major Motor Seizures) • Absence (also called Petit Mal) • Atonic (also called Drop Seizures) • Myoclonic • Partial Seizures • Simple Partial • Complex Partial (also called Temporal Lobe or Psychomotor Seizures)

5. Generalized Seizures • During a generalized seizure there are abnormal and excessive discharges of nerve cell throughout the brain and there is loss of consciousness.

6. Tonic – Clonic (Grand Mal) Seizures • Involves motor activity of the whole body • There is stiffening or rigidity (tonic action) & jerking (clonic action) of the muscles of the body, particularly of the arms & legs, caused by a sudden bursts of abnormal generalized electrical discharges involving the whole brain without warning • A contraction of the diaphragm & chest muscles may cause the characteristic "epileptic cry“ and brief period of not breathing • Other common features are falls, incontinence, high risk for injury • May last up to several minutes • Usually are followed by a period of drowsiness & disorientation (post‑ictal phase) which may last from minutes to several hours. • This type of seizure disorder is usually well controlled in only about 50 % of people

7. Absence (Petit Mal) Seizures • May consist of a brief loss of consciousness • May present as small amounts of tremors or twitching, staring, blinking, eye movements or movements of the mouth such as lip smacking • Usually last only a few seconds, may be frequent and may be hard to recognize • There is immediate and full recovery afterwards • Absence seizures are always associated with a specific EEG pattern • In some people resolves around age 20

8. Other Generalized Seizures • Atonic Seizures: Consists of a very sudden loss of body tone resulting in a fall or head drop which lasts only a few seconds. There is rapid recovery afterwards. • Myoclonic Seizures: Consists of rapid muscular contractions, usually bilateral, and may involve the entire body, the head, trunk or upper extremities, but can be limited to one extremity or muscle group. The jerks may be rapidly repetitive or be just single jerks.

9. Partial Seizures • During a partial seizure nerve cells discharge abnormal amounts of electrical activity in only part of the brain. There may or may not be loss of consciousness. • It may spread to other parts of the brain and then become a generalized seizure.

10. Simple Partial Seizures • Usually does not involve loss of consciousness, the person is aware • Affects only a part of the body or extremity, but it can spread to the rest of the body, in which case it then becomes a generalized seizure, this called a Jacksonian March • May consist of a sensory experience such as a sound, smell, visual disturbance or strange feeling, abdominal pain or discomfort • Partial seizures may be difficult to recognize if they appear as a blank expression or sensory experience, unless the person is a good reporter

11. Complex Partial (Temporal Lobe, Psychomotor) Seizures • Consciousness is impaired, the person is unaware of the seizure & will has no have memory of it • Often preceded by an aura which can be a sensory experience or feeling a strange sensation such as a strange feeling in the stomach, an unpleasant odor, flashing lights, ringing sound, dreamy sense of unreality, or a sense of deja vu. • Sometimes people can become irritable or have behavior changes for hours or even days before the actual seizure activity • During the seizure the person may engage in random behaviors that look purposeful, called automatisms. • Usually there is a similar pattern of behaviors or actions with each seizure. Examples of behavioral patterns are: lip smacking, lint picking, hand rubbing, chewing motions, violent rages, fear, walking about, or inappropriate laughter. • The person will be unaware of his/her surroundings, unresponsive to others • The seizure may be followed by a period of confusion.

12. Status Epilepticus • Prolonged seizure activity or rapid succession of seizures without regaining consciousness between seizures. • This requires emergency care.

13. WHAT DO YOU DO WHEN YOU SEE A SEIZURE ? • Stay calm • Call for help if it is needed • Do not leave the person alone • Remove all hazards in the area • Help the person to the floor, but do not try to restrain the person • Turn the person's head or body to the side to keep the airway open and to allow saliva and other fluids to flow out and prevent fluids from going into the lungs • Loosen tight clothing, especially around the neck • Protect the head from injury, place something soft under it • Allow time and a comfortable place for the person to rest with supervision afterwards if the person is sleepy or unsteady • Do not expect the person to respond to verbal instructions during the seizure

14. WHAT SHOULD YOU OBSERVE FOR DURING A SEIZURE ? • Changes in mental status or level of awareness: unresponsive, blank stare • Changes in color of skin: pale, bluish (cyanosis) • Eye movement: to one side, rolling up, blinking, moving back and forth • Mouth: salivation, chewing movements, lip smacking • Muscle stiffening or jerking: entire body, one or more body extremities or body parts • "Purposeful" behaviors (Automatisms) or repetitive behaviors: occurring during the seizure itself • Breathing: difficult, stopped • Incontinence of urine or feces • Behavior after the seizure (post‑ictal): irritable, confused, drowsy, deep sleep, unsteady • Duration of the seizure: count only the seizure itself and not the time the person is post‑ictal • Were there unusual behaviors or behavioral patterns before the seizure ? • Were there any unusual events or physical conditions before the seizure ? • Did any injury occur during the seizure ? • Did the seizure stop on its own or did the person require emergency interventions?

15. SHOULD I CALL ANYONE TO REPORT A SEIZURE ? • It is a good idea to make sure other staff are aware that the student has had a seizure so that they can monitor the student closely. • Report seizure activity to the program nurse and supervisor, this must be done immediately in the following situations: • 1. this was the student's first seizure • 2. the student was injured during the seizure • 3. the student requires treatment for status EPILEPTICUS (seizure not stopping on its own) • 4. the seizure was different from the usual pattern for the student • 5. conditions for implementing a medication protocol have occurred and the medication needs to be administered

16. Medication Protocols • DIASTAT, KLONOPIN OR ATIVAN • Medication protocols are specific to the needs of the individual student • Students with a medication protocol must have the medication readily available at all times • Medication protocols must be initiated immediately once the conditions of the protocol are met. • Staff need to be familiar with seizure protocols for the students for whom they are responsible.

17. WHEN DOES A SEIZURE REQUIRE EMERGENCY ATTENTION ? Refer to the student’s individualized protocol General guidelines for calling 911: • When the seizure lasts over 5 minutes or per specific student protocol • If there are multiple seizures in a short period of time, especially if there has not been complete recovery between the seizures • (These first two situations may often reflect status epilepticus; however, it is important to know the student's typical seizure pattern because these criteria may need to be individualized) • This is a first time seizure • If significant injury, especially of the head, occurs as a result of a seizure • If the student has difficulty breathing or if the face turns blue for over 1 minute • If a seizure has occurred while swimming/bathing and there is a question of water being swallowed and entering the lungs • Anytime Diastat was administered while the student was off campus or off hours for Health Services • The person has diabetes

18. WHAT DO YOU DO IF A SEIZURE HAS OCCURRED WHILE IN THE WATER ? • Support the head & face above the surface of the water • Remove the person from the water as rapidly and safely as possible once the seizure is over • Tip the head back to open the airway • Check the for breathing once the seizure has stopped and begin rescue breathing or CPR as necessary if the person has swallowed water and there is a chance that it has entered the lungs, or if there is difficulty breathing after the seizure has stopped, emergency evaluation is necessary

19. THINGS THAT YOU SHOULD NOT DO: • Do not put anything into the person's mouth (the exception being Ativan or Klonopin prescribed to be put inside the cheek to stop seizure activity) • Do not attempt to force the mouth open during a seizure • Do not try to restrain the person during a seizure • Do not give the person anything to eat or drink until the person is fully awake and alert

20. Depakote/Depakene Neurontin Tegretol Trileptal Topamax Lamictal Phenobarbital Onfi Banzel Dilantin Keppra Klonopin Zonegran For prolonged seizures: Diastat Ativan Klonopin Some Examples of Anticonvulsants

21. Side Effects of Anticonvulsants • Sedation, Drowsiness • Weight gain, or decreased appetite • Ataxia (unsteady walking) • Lightheadedness, dizziness • Gastrointestinal problems, stomach pain, nausea, vomiting, constipation • Tremor • Rash • Osteoporosis

22. Good Seizure Prevention Means a Healthy Lifestyle • Regular sleep of 8 hours per night • Limit caffeine • Avoid alcohol • Avoid artificial sweeteners • Avoid large amounts of sugar • Regular meal times and healthy well balanced diet • Regular exercise, avoid over-fatigue or exercise on very hot days • Relaxation and breathing techniques to control stress • Evaluation and treatment of illnesses • Take medications on time as prescribed

23. Other Treatments • Ketogenic diet • Vagus nerve stimulator (VNS) • Surgery