895 Central Ave., Suite 550 Cincinnati, OH 45202

1. 895 Central Ave., Suite 550Cincinnati, OH 45202 Phone: (513) 721-2905 Toll Free: (877) 804-2241 Email: tom.koprowski@cincinnatiepilepsy.org Website: www.cincinnatiepilepsy.org

2. In-Service Goals • Improve Recognition of Seizures • Review Appropriate Response to Seizures • Review Administration of Rescue Medications

3. Definition of a Seizure • A seizure is a brief interruption in the normal functioning of the brain that takes the form of a massive release of electrical energy (like an electrical storm). • This release of electrical energy and its outward manifestation is what is called a seizure.

4. Definition of epilepsy • Epilepsy is defined as a neurological disorder that is characterized by recurrent seizures that occur on an unpredictable basis. • The onset of these seizures can occur without warning at any time in a person’s life.

5. Prevalence & Incidence rate • 3 million Americans are diagnosed with epilepsy. • 200,000 new cases of seizures and epilepsy occur each year. • Epilepsy strikes most often in the young (under age 2) and the old (over 65 years), although it can develop at any age. • 326,000 school age children (15 and under) are affected by epilepsy; 90,000 of these children have severe seizures. • 570,000 adults over 65 years develop epilepsy.

6. Causes of symptomatic seizures Symptomatic seizures can be linked to a direct cause, including: • Head trauma • Lack of oxygen during birth • Abnormal brain tissue (ex: tumors or tubers) • Genetic conditions (such as tuberous sclerosis) • Lead poisoning • Brain malformations • Brain infections (ex: meningitis or encephalitis) • Stroke • High Fever

7. Causes of epilepsy • In 70% of the cases of epilepsy, the cause cannot be determined. • The remaining 30% have identifiable causes.

8. Seizure Classifications • Generalized Seizures involve the whole brain. They include: • Tonic-Clonic • Absence • Atonic • Myoclonic • Partial Seizures involve a specific area of the brain. They include: • Simple • Complex

9. Tonic-clonic seizures • Symptoms of a tonic-clonic seizure include: • Loss of consciousness • Falling • Rigidity • Convulsions • Shallow breathing • Drooling • Occasionally, skin may turn blue • Possible loss of bladder of bowel control • Usually followed by confusion, tiredness and emotional upset • Usually lasts 1-3 minutes

10. Absence seizures • Symptoms of an absence seizure include: • Pause in activity with a blank stare • Brief lapse of awareness • Usually lasts 1-10 seconds • May be confused with behavioral issues

11. Complex Seizures • Symptoms of complex seizures include: • Altered awareness • Blank stare or dazed look • Automatisms: • Picking at clothes • Lip smacking • Chewing • Garbled speech • Clumsy or disoriented movements • Aimless walking

12. Complex Partial Seizures continued • Picking things up • Often lasts 1 to 3 minutes • Often followed by: • Tiredness • Headache • Emotional upset • May be confused with other behaviors

13. Seizure Action Planning • Assess individual’s needs and gather information • Customize a seizure action plan • Teach family, friends and co-workers interventions and tailor interventions as needed

14. Status Epilepticus • Medically defined as 30 minutes of uninterrupted seizure activity and may include: • One prolonged seizure • Multiple seizures without recovery to baseline • Is a “MEDICAL EMERGENCY” and requires immediate action to stop the seizure activity • Every person’s seizure action plan should clearly define what constitutes a seizure emergency and have a detailed emergency plan response • Discrete Status Epilepticus

15. Seizure First Aid

16. When is a Seizure an Emergency? • First time seizure • Convulsive seizure lasting more than 5 minutes • Repeated seizures without regaining consciousness • Individual has diabetes or is pregnant • Seizure occurs in water or injury is suspected • Parents/Guardians request an emergency evaluation • If individual is not breathing after a convulsive seizure • Non-convulsive seizure lasting more than 5 minutes beyond the normal duration for that individual Follow seizure emergency definition and protocol as defined by healthcare provider in seizure action plan

17. PRN Medications for Seizures • Sometimes AEDs are prescribed for patients who tend to have seizure clusters or status epilepticus • Several of these include: • Ativan ® (generic: lorazepam) • Versed ® (generic: midazolam); now available in a nasal spray • Diastat ® (generic: diazepam); dispensed as a rectal gel

18. INTRANASAL MIDAZOLAM INSTRUCTIONS • Remove plastic cap from vial • Twist the blunted needle into syringe • Holding vial upside down insert the needle into stopper and withdraw prescribed amount of medication • Remove needle and replace with MAD® atomizer. • The child’s head may be in any position • Place the tip of the atomizer into the nostril and press the plunger until ½ of the midazolam has been atomized, and then atomize the remainder into the other nostril.

19. 895 Central Ave., Suite 550Cincinnati, OH 45202 Phone: (513) 721-2905 Toll Free: (877) 804-2241 Fax: (513) 721-0799 Email: tom.koprowski@cincinnatiepilepsy.org Website: www.cincinnatiepilepsy.org