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Transcript of Epilepsy
Meet our Student
Bobby is an 8 year old boy with epilepsy. He has had reoccurring tonic clonic seizures, most recently 3 months ago while at home. He has an ICP but DOESNT like the extra attention from the EA, Ms Helpful. Bobby takes the antiepileptic medication Tegretol to help control his seizures. He finds that this medicine makes him tired, dizzy and nauseous at times. He has to take 1 dose of Tegretol while at school.
Team Players for Bobby
Will provide background of the child's condition for the ICP and required medication. They may assist with training. They will keep the EA, NSS and teacher current of changes.
Nursing Support Services (NSS)
Will help to develop the ICP and train and certify the EA's. Offers ongoing support to the school. Consults neurologist when required.
Is familiar with the ICP, oversees the EA, follows directions of the OT in respect to child safety.
Helps with planning a safe, risk free environment at school and at home. May suggest relaxation techniques like deep breathing, massage and meditation.
Primarily involved with staffing issues. Ensures the child has appropriate services.
Is kept up to date on frequency, severity of seizures. Adjusts medications as required.
Will provide support for anxiety, depression as deemed necessary.
Types of Seizures
seizures occur in
of the brain. There are 2 types:
Simple Partial Seizures
Person experiences unusual sensations (odd tastes, feeling like wanting to throw up, intense emotions) or movements while fully conscious.
Complex Partial Seizures
Person is not fully conscious, or may lose consciousness altogether, and may make repetitive movements (for example: cycling, kicking). They may wander around in a confused manner and will have no memory of having the seizure.
Diagnosis of Epilepsy
What is a seizure?
A seizure is a temporary disruption of the electrical impulses being sent to the brain. Special cells called
help to form an electrical path in the brain . A seizure happens when abnormal activities occur in the electrical signals of these neurons, which results in your body receiving mixed ups signals. There are more than 20 different types of seizures and they can be convulsive or non-convulsive.
What is Epilepsy?
Epilepsy is a common serious neurological disorder characterized by
seizures. Epilepsy is not diagnosed until a person has had more than 1 seizure. Often a person with epilepsy has more than 1 type of seizure.
1 in 12 people will have a seizure in their lifetime, however, having a seizure doesn't mean a person has epilepsy.
Clonic Tonic (convulsive)
Also known as a "grand mal" seizure and is often the type people think about in relation to epilepsy.
Start of seizure
: person becomes unconscious, body goes stiff, will fall backwards if standing, may cry out and bite their tongue or cheek
During the seizure:
person jerks and shakes as their muscles relax and tighten, may become cyanotic, possible loss of bowel or bladder control
After the seizure
: breathing and color return to normal, feel tired, confused, have a headache and/or feel sleepy
Example of a tonic clonic seizure
Diagnosis is done by a neurologist and will include the use of Electroencephalogram (EEG) recordings. This tool is used to measure electrical activity in the brain. CT scans, MRI's, thorough medical historys and blood analysis may also be used as diagnostic tools.
Famous Folks with Epilepsy
Chandra Gunn (Womens US Olympic hockey goalie)
seizures involve the
brain. They can be non-convulsive or convulsive.
Absence Seizures (non-convulsive)
This brief seizure resembles daydreaming. It happens so quickly that it often goes unnoticed. It is more common in children than adults. It can look like a blank stare and the person may not respond to what is happening around them.
Atonic Seizure (non-convulsive)
A quick seizure characterized by sudden relaxation of the muscles. If standing, the person will drop to the ground usually falling forwards. Quick recovery.
Mycolonic Seizure (non-convulsive)
A sudden startle movement that may cause you to drop objects. They are brief but may happen in clusters.
Common Treatments of Epilepsy
50-60% of the cases of epilepsy are of unknown causes. Of the remainder, the following causes are most common:
low oxygen during birth
brain tumor or stroke
infections such as meningitis or encephalitis
abnormalities in brain development
Epilepsy cannot be cured, so the goal of treatment is to control or reduce the frequency and severity of seizures. Treatment options are
Medication is the most common way to treat epilepsy and is almost always the first treatment tried. It will work up to 70% of the time. The Ketogenic diet (high fat, low carb, controlled protein) is an option for children in cases where seizures havent been controlled with medication.
Role of the EA
An important role of the EA will be documentation of seizures. The following should be documented:
what happened before, during and after the seizure
what were the triggers? (consider factors such as heat, intense emotion, illness, missed meals, missed medication, stress)
did the student lose consciousness?
what parts of the body were involved?
how long did the seizure last?
did any injury happen as a result of a fall?
did 911 have to be called?
Issues of growth and Development
Having epilepsy does not necessarily affect
growth and development. However, having seizures, getting accustomed to medication, constant doctors visits (or other specialists) may temporarily set back academic achievement. Issues with memory may occur as frequent or severe seizures can interrupt forming new memories. Also, children may experience difficulties in paying attention before, during and after seizures.
1. There can be feelings of shame with having epilepsy
2. If a parent is anxious or over protective the child may learn this, which erodes their self confidence and feelings of being in control.
3. If a child is encouraged to fully participate in all activities, then they have a higher chance of being a confident, independent adult.
4. Teachers and parents may also underestimate abilities in their attempts to keep a child safe.
Medications: Anti-epileptic drugs can have side effects that impact physical safety, these include:
difficulties in alertness
slowing of fine motor and visual motor speeds
As an EA you must be aware of how the meds affect your student.
seizures are unpredictable and can result in a student "dropping" to the ground. Safety is not always guaranteed but the following are some guidelines to consider in the classroom/school:
pad sharp edges of tables
avoid glass decorations
keep floors clear of clutter
provide a helmet for PE
have adults with First Aide training in close proximity
Causes of Epilepsy
Events that May Trigger a Seizure
illness, fever, allergies
lack of sleep
emotions such as anger, worry and fear
The following steps are outlined in the ICP. If a student has a seizure at school the EA will:
Position the child and stay with them
call for help
Protect the child from harm
do not restrain
do not place anything in the child's mouth
document the event
notify appropriate people
If the seizures lasts for less than 5 minutes, reassure and reorient the child once the seizure has stopped .
For Bobby's ICP, if his seizure lasts longer than 5 minutes, Ativan must be administered. The steps for this are as follows:
check the expiry date of the Ativan bottle to ensure it hasn't expired
review the 8 Rights of medication administration (Universal Precautions)
glove 1 hand
place 1 tablet of Ativan inside Bobby's mouth, between the cheek and gum, with the gloved hand
massage cheek for 20-30 second while Ativan dissolves
be certified by NSS for seizure management
follows Individual Care Plan
keeps up to date on medications for the child
monitors the child at all times
provides a safe environment, considers safety during field trips
works with teachers, parents and child to educate peers of the disorder in order to create a supportive classroom, may also educate peers so they are are not distressed if they witness a seizure
encourage the child to develop awareness of their own needs, including signs of an oncoming seizure or if they are tired and need a break
allows for rest time if needed
has knowledge of the side effects of mediation and makes curriculum modifications if necessary
works with team players
Bobby doesn't like support so what is an EA to do?
use the communication book so parents know how the day went and what homework needs to be done
EA will make best effort not to hover!
use signals (thumbs up or down) periodically to communicate how Bobby is feeling
set a fixed time for medication that will work around breaks, keeping from pulling him out from class in front of peers (EA can wait in the hallway once routine is established)
EA to keep distance but maintain visual contact with student during recess/lunch