Fact:

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Epilepsy in School

• Fact
• The school nurse plays a significant role in the
  life of a student with epilepsy. An involved
  nurse can positively impact the future of a
  student with epilepsy.

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Today we will talk about

• Seizure types.
• Epilepsy syndromes.
• Treatments.
• Common medications.
• Medication Side Effects.
• Epilepsy and the IEP.
• Accommodations
• Diastat in school.
• Seizure plans.

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Early Detection Why?
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Generalized Tonic-Clonic

• Also known as Grand-Mal.
• Begin w/stiffening of the limbs (tonic phase).
• Followed by jerking of limbs and face (clonic
  phase).
• In some cases will require Diastat.

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Myoclonic Seizures

• Rapid brief jerking movements.
• Typically occur on both sides of the body.
• Often confused as clumsiness.
• Typically do not require first aid.

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Atonic Seizures

• Also known as drop seizures.
• Causes abrupt loss of muscle tone.
• Often causes head and face injuries.
• Wearing of helmet recommended.
• Tough seizures to control.
• First aid needed if injury is caused.

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Absence Seizures

• Also know as petit-mal seizures or staring
  spells
• Lapses of awareness the end abruptly.
• No warning and no after effect.
• More common in children than adults.
• Children can have 50-100 per day.
• Affects school performance.

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Simple Partial Seizures

• No loss of consciousness.
• Involves one side of the brain.
• Sudden jerk.
• Sensory phenomena.
• No first aid required, should be logged and timed.

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Complex Partial Seizure

• Involves one side of the brain.
• May have aura.
• Repeated movements i.e. lip smacking, picking at
  clothes, fumbling.
• Unaware of environment/surroundings.
• May wander.
• Typically no first aid required, should be logged
  and timed.

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Gelastic Epilepsy

• Gelastic is greek for laughter.
• Pediatric seizures can begin at any age, often
  between 2-3 years of age.
• More often boys than girls.
• Laughter described as empty or hollow, not
  pleasant.
• Can be followed by complex partial seizure.
• Often caused by small tumor in hypothalamus.

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Infantile Spasms

• Typically starts at 4-8 months of age.
• Most severe type of pediatric epilepsy.
• Seizures come in clusters/bending forward, arms
  flare out.
• Prognosis poor.
• Stops by age 5, often goes to another seizure
  type.
• Treatment ACTH steroid injections.

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Lennox-Gastaut Syndrome

• Severe form of childhood epilepsy.
• Multiple seizure types, i.e. atonic, myoclonic,
  tonic, atypical absence.
• Most children have impaired intellect.
• Can be caused from malformation of brain, TBI,
  metabolic disorder.
• 30-35 cause unknown.

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Dravet Syndrome

• Also called SMEI (severe myoclonic epilpesy in
  infancy).
• Begins in first year of life with frequent
  febrile seizures.
• Often causes status epilepticus.
• Hard to treat.
• Outcome poor.
• Caused by genetic defect.

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Status Epilepticus

• Life threatening condition where the brain is in
  a constant state of seizures.
• Typically defined as constant state of seizures
  for 30 minutes .
• Any type of seizure disorder can cause status
  epilepticus.
• Immediate medical attention needed!

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Vagal Nerve Stimulator (VNS)

• Used in addition to AEDs.
• 80 of implanted patients experience fewer
  seizures.
• 75 of patients are able to reduce their AEDs.
• Improved seizure control w/o the medication side
  effects.

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Ketogenic Diet

• High fat/low carb diet.
• Helps control seizures in up to 2/3 of children
  with refractory epilepsy.
• Medical Treatment must be started under close
  medical supervision.
• Calories restricted to 75 of daily requirement,
  90 from fat.
• Works well if followed properly.

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Common Seizure Meds

• Lyrica
• Mysoline
• Neurontin
• Phenobarbital
• Phenytek
• Primidone
• Sabril
• Tegretol
• Tegretol XR
• Tiagabine
• Topamax
• Trileptal
• Valproic Acid
• Vimpat
• Zarontin
• Zonegran

• Banzel
• Carbatrol
• Clonazepam
• Depakene
• Depakote
• Depakote ER
• Diastat
• Dilantin
• Felbatol
• Felbamate
• Frisium
• Gabitril
• Keppra
• Keppra XR
• Klonopin
• Lamictal

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Possible Side Effects

• Lethargy
• Hair Loss
• Processing/Word finding issues.
• Dental/Oral
• Anxious/irritable
• Rash
• IQ Decline

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Common Side Effects

• Lethargy
• Hair Loss
• Processing/Word finding issues.
• Dental/Oral
• Anxious/irritable
• IQ Decline
• Rash

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Switch Gears
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OHI Definition
Other health impairment means having limited
strength, vitality, or alertness, including a
heightened alertness to environmental stimuli,
that results in limited alertness with respect to
the educational environment, that (i) Is due to
chronic or acute health problems such as asthma,
attention deficit disorder or attention deficit
hyperactivity disorder, diabetes, epilepsy, a
heart condition, hemophilia, lead poisoning,
leukemia, nephritis, rheumatic fever, sickle cell
anemia, and Tourette syndrome and (ii)
Adversely affects a child's educational
performance.
Source ISBE Regulations IDEA
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Why does a student with epilepsy qualify for an
IEP?

• HR 1350 Sec. 602(3) states as follows
• (i) With mental retardation, hearing impairments
  speech or language impairments, visual
  impairmnts, serious emotional distrubance,
  orthopedic impairments, autism, traumatic brain
  injury, other health impairment, or specific
  learning disabilities and (ii) who, by reason
  thereof needs special education and related
  services.

Source Federal IDEA Law
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Suggested Accommodations

• Extended Time for Tests/Quizzes
• Reduced Homework Assignments
• Reduced Spelling Words
• Tests/Quizzes taken in a quiet area
• Tests/Quizzes read out loud
• Use of a calculator
• Use of a number line
• Graphic organizer
• Outline of classroom Notes
• Extra set of books at home

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Seizure Medication Administration

• No nurse on site (this cannot affect placement)
• ISBE Medication Regulations

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Diastat

• A program for administration of medication to
  students in schools must be developed and managed
  by a certified school nurse or registered nurse
  in accordance with the Recommended Guidelines for
  Medication Administration in Schools. Each
  school district must determine who (e.g.
  superintendent, principal) is responsible for
  administering medication in the absence of a
  certified school nurse or registered nurse.
  Pursuant to section 105 ILCS 5/10-22.21b of the
  School Code, teachers and other
  non-administrative employees cannot be required
  to administer medication, although they may
  volunteer to do so.

Source ISBE Regulations - Medication
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Diastat

• The Illinois Department of Professional
  Regulation (IDPR) issued a legal opinion which
  allows a school employee to stand in the place of
  a parent or guardian in administration of
  medication or supervision of self-medication in
  the school setting. School employees who do not
  hold a valid IDPR license must receive training
  in the correct procedure to be used to administer
  medication and/or provide a specific treatment.
  This does not prohibit any school employee from
  administering emergency assistance to a student.
• A certified school nurse or registered nurse must
  manage this medication administration program
  following the Recommended Guidelines for
  Medication Administration in Schools developed by
  the Illinois Department Human Services (IDHS) and
  the Illinois State Board of Education (ISBE),
  September 2000. A designated administer will be
  responsible for medication administration or
  supervision of self-medication when a nurse is
  not available. Teachers or other employees
  cannot be required to administer medication or
  supervise self-medication although they may
  volunteer to do so.

Source ISBE/IDHS
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All seizures require a plan!
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QUESTIONS