Workbook # 51 Epilepsy and Seizure Management for Home Health ...

Audio Conference designed for
trainers and paraprofessionals.
Workbook # 51
Epilepsy and Seizure
Management for Home
Health Care Providers
2010 Home Care
Community
Forum Series
Community Health Care Services Foundation, Inc.
99 Troy Road, Suite 200, East Greenbush, NY 12061
(Tel.) 518.463.1167 (Fax) 518.463.1606
www.chcfoundation.org

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Forum 51: Epilepsy and Seizure Management for Home Health Care Providers
Presenter: Julie Eisele PhD
Julie Eisele is the Community Educator for the Epilepsy Foundation of Northeastern NY
where her responsibilities include information and referral, community education and
advocacy. She is a Developmental Psychologist whose research has focused on children
with early brain injury. Previously, she was an Assistant Professor of Biopsychology at
Skidmore College and the Director of the NYS Traumatic Brain and Spinal Cord Injury
Surveillance Program funded by the Centers for Disease Control and Prevention.
Community Health Care Services Foundation, Inc.
99 Troy Road, Suite 200 • East Greenbush, NY 12061 • (Tel) 518/463-1167 • (Fax) 518/463-1606
www.chcfoundation.org

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Forum 51: Epilepsy and Seizure Management for Home
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Home Care Community Forum #51
Epilepsy and Seizure Management for Home Health Care Providers
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Home Care Community Forum #51
Epilepsy and Seizure Management for Home Health Care Providers
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Community Health Care Services Foundation, Inc.
99 Troy Road, Suite 200
East Greenbush, NY 12061
Phone: 518/463-1167 Fax: 518/463-1606
Home Care Community Forum
WORKBOOK #51
Epilepsy and Seizure Management for Home Health Care Providers
True or False
1. False 6. True
2. True 7. False
3. True 8. False
4. False 9. True
5. True 10. False
Multiple choice
1. B 6. D
2. D 7. A
3. B 8. C
4. C 9. A
5. A 10. D
QUIZ ANSWERS

Forum 51- Epilepsy and Seizure Management for Home Health Care Providers
Learning Objectives:
At the completion of this program, participants will be able to understand:
1. What epilepsy is, its symptoms and causes
2. Different types of seizures, their signs and symptoms
3. Current treatment options and side-effects
4. How and when to administer Seizure First Aid
5. The need for a Seizure Emergency Plan
Conscious
Consciousness
Electroencephalogram
(EEG)
Epilepsy
Epileptologist
Neurological
Seizure
Status epilepticus
Glossary
Having awareness of one's self, acts, and surroundings.
The state of being conscious.
A device that measures the electrical activity of the brain by recording
from external electrodes.
A chronic neurological disorder characterized by a tendency to have
recurrent, unprovoked seizures.
A neurologist that specializes in the treatment of epilepsy.
Relating to the nervous system.
A brief change in the electrical activity of the brain.
30 minutes of either continuous seizure activity or repetitive seizures
without a return of consciousness.
Vagus nerve A large nerve in the neck that leads directly to the brain.
Prepared by Julie Eisele, Ph.D., Community Educator, Epilepsy Foundation of Northeastern New York.
The Epilepsy Foundation of America, Inc. ® provided much of the material in this workbook.
Reprinted with permission.
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Forum 51- Epilepsy and Seizure Management for Home Health Care Providers
I. An Introduction to Epilepsy
A. What is a Seizure?
A brief change in the electrical activity of the brain that alters one or more of the following:
Movement
Sensation
Behavior
Awareness
Emotions
Seizure symptoms depend on where in the brain the electrical activity occurs and how much of
the brain is affected during the seizure. Most seizures occur spontaneously and unpredictably.
Brain cells use tiny electrical signals to send information to other brain cells. During a seizure,
too many brain cells send these signals at the same time. The result may be a change in
consciousness, movement and/or behavior.
Seizures that affect the entire brain usually result in a loss of consciousness. If only part of the
brain is affected, it may cloud awareness, block normal communication, and produce a variety of
undirected, uncontrolled, unorganized movements.
Most seizures last only a minute or two, and end naturally. After a seizure, the person may feel
sick, tired and disoriented. In these cases, caregivers should follow basic seizure first aid, keep
the individual safe during the seizure and monitor for a return to baseline after the seizure ends.
Sometimes, seizures can last longer than expected. Seizures lasting longer than five minutes
require emergency action. For this reason, all caregivers must have access to a seizure
emergency plan.
B. What is Epilepsy?
Epilepsy is a chronic neurological disorder characterized by a tendency to have recurrent,
unprovoked seizures. Epilepsy is diagnosed when a person has two or more unprovoked
seizures. By unprovoked we mean a seizure that isn’t caused by a fever, low blood sugar, drug
or alcohol intoxication, etc.
Epilepsy is also known as a “seizure disorder.”
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Forum 51- Epilepsy and Seizure Management for Home Health Care Providers
C. Who Gets Epilepsy?
1. Epilepsy affects roughly one percent of the population, with an estimated 3 million
Americans living with epilepsy. It occurs more often in young children, the elderly and
developmentally disabled populations. Children and adults with autism, mental
retardation, cerebral palsy and other developmental disorders are at increased risk for
developing epilepsy.
2. Epilepsy is the leading neurological disorder in childhood and the third leading
neurological disorder in adults.
3. One in ten people will have a seizure in their lifetime.
D. Causes of Epilepsy
II. Diagnoses
The cause is unknown in 70% of cases
Brain Trauma (ex. injury, stroke)
Brain Lesions (ex. tumors)
Poisoning (ex. lead)
Infections of the brain (ex. meningitis, encephalitis, measles)
Brain injury at birth
Genetic causes
Abnormal brain development
Chronic alcohol/ drug abuse
A. How is Epilepsy Diagnosed?
1. A physician can diagnosis epilepsy based on a medical history, physical examination,
blood work, description of seizure activity, electroencephalogram (EEG), brain imaging such as
a magnetic resonance imaging (MRI) or computed tomography (CT scan), and possibly genetic
testing.
An EEG measures the electrical activity of the brain by recording from electrodes
placed on the head.
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Forum 51- Epilepsy and Seizure Management for Home Health Care Providers
2. People with epilepsy are treated by neurologists, family doctors or pediatricians.
B. Types of Seizures
Epileptologists are neurologists with specialized training in epilepsy.
There are over 20 different types of seizures
A person may experience just one type or more than one.
The kind of seizure a person has depends on which part of the brain is affected
and the amount of seizure activity.
Seizures present in a variety of ways but often they present in the same way
each time in an individual.
Seizures can and do vary based on a number of factors.
Seizures can be categorized based on whether they involve the whole brain or
part of the brain.
1. Generalized Seizures
In generalized seizures, abnormal electrical activity involves large areas of both sides of the
brain and causes a loss of consciousness. Symptoms include convulsions, starring, muscle
spasms and falls. Examples of generalized seizures include tonic-clonic, absence, atonic and
myoclonic.
i. Tonic-Clonic Seizures
Previously referred to as Grand Mal.
Generalized Tonic-Clonic seizures are the most common and best known type of
generalized seizure.
They have a sudden onset and render the person unconscious.
They begin with stiffening of the arms and legs (tonic phase), followed by whole
body convulsing (clonic phase).
The person may fall to the ground and emit an involuntary cry.
The person may lose bowel and/or bladder function.
During the tonic phase, breathing may decrease or cease altogether, producing
cyanosis (blueing) of the lips, nail beds, and face.
Breathing typically returns during the clonic (jerking) phase, but it may be
irregular. This clonic phase usually lasts less than a minute.
Some people experience only the tonic, or stiffening phase of the seizure; others
exhibit only the clonic or jerking movements; still others may have a tonic-clonictonic
pattern.
Most tonic-clonic seizures last one to three minutes.
Following the seizure, the person will be lethargic, sore, possibly confused, and
want to sleep. Headaches are common. Full recovery can takes minutes to hours.
ii. Absence Seizure
Previously referred to as Petit Mal.
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Forum 51- Epilepsy and Seizure Management for Home Health Care Providers
Most common in children with an onset between 3 and 10 years of age.
The person stares vacantly and experiences a very brief loss of consciousness,
typically just a few seconds.
May involve small involuntary movements of the face (twitching, blinking, etc.)
and/or arm movements.
The person does not talk and does not hear what is being said.
Consciousness returns quickly and the person resumes previous activity.
Absence seizures can occur in clusters, with up to 100 seizures in a single day.
Up to 40% of patients can outgrow this type of seizure.
Most children with typical absence seizures are otherwise normal.
iii. Atonic seizures
Atonic seizures cause a sudden loss of muscle tone.
Motor symptoms include head drops, loss of posture, or sudden collapse.
Because they occur without warning, atonic seizures can result in injuries to the head
and face. Protective headgear is sometimes used by children and adults.
Other names include drop attacks, astatic or akinetic seizures.
iv. Myoclonic seizures
2. Partial Seizures
The person experiences sudden jerks or muscle contractions, often both sides of
the body at the same time
Occasionally, they involve one arm or a foot.
A similar but normal experience is the sudden jerk of a foot during sleep.
Partial seizures are the most common type of seizure, also called focal seizures.
The electrical disturbance begins in a specific area of one side of
the brain.
They typically do not involve a loss of consciousness but can result in an altered
awareness.
A person’s symptoms depend on the specific part of the brain affected.
Nearly any movement, sensory, or emotional symptom can occur as
part of a partial seizure, including complex visual or auditory hallucinations.
Partial seizures can spread to involve the whole brain resulting in a
generalized seizure.
i. Simple Partial Seizures
Consciousness is maintained during a simple partial seizure.
The person may be unable to speak or move during the seizure, but will often
remember what happened during the seizure.
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Forum 51- Epilepsy and Seizure Management for Home Health Care Providers
Symptoms can include emotional changes (fear, anxiety), isolated, involuntary
movements, sensory sensations (tingling, weakness, sounds, smells, tastes, visual
distortions) and psychic symptoms (déjà vu, hallucinations).
Most partial seizures last less than a minute.
Can result in a complex-partial seizure or generalized tonic-clonic seizure.
ii. Complex Partial Seizures
3. Intractable Seizures
C. Status Epilepticus
Complex partial seizures result in a state of altered consciousness.
Symptoms are variable, but often start with a blank stare followed by
chewing, lip smacking or other purposeless repetitive movements.
Aimless walking, random movements and incoherent speech are common.
Some report an aura or warning sign, such as an abnormal taste or smell,
sensation or emotion.
Complex partial seizures typically last 30 seconds to 2 minutes. Longer seizures
can occur and seizures can generalize to a tonic-clonic seizure.
Complex partial seizures are the most common type of seizure.
They frequently arise from the temporal lobe of the brain.
Seizures of any kind that do not respond to medications.
Twenty percent of people with epilepsy have seizures that are resistant to
medication, otherwise known as refractory epilepsy.
1. Most seizures end after a few minutes. If seizures are prolonged, or occur in a series,
there is an increased risk of status epilepticus, a true life threatening emergency.
2. Status epilepticus is usually defined as 30 minutes of uninterrupted seizure activity or
repeat seizures without a return to consciousness.
3. The Epilepsy Foundation advises parents and the public to call for emergency assistance
when a convulsive seizure lasts for more than five minutes without signs of stopping, or
when successive seizures last more than five minutes without a return to consciousness.
III. Treatment Options
The goal of all epilepsy treatment is to stop the seizures with as few side effects as possible. The most
common treatment is medication. If medication does not work, other options may include surgery, a
medical device or a highly specialized diet.
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Forum 51- Epilepsy and Seizure Management for Home Health Care Providers
A. Medication
Anti-seizure medication is the first line of treatment for epilepsy and is effective in
approximately 75% of patients. For 25% of patients, current medications are not effective at
controlling their seizures. In these cases, other treatments such as surgery and diet need to be
explored.
Ideally, patients will gain adequate seizure control with one medication, but sometimes, multiple
drugs are needed to control seizures.
1. Common Anti-Seizure Drugs
Carbamazepine (Tegretol, Carbatrol)
Clonazepam (Klonopin)
Ethosuximide (Zarontin)
Felbamate (Felbatol)
Gabapentin (Neurontin)
Lacosemide) Vimpat)
Lamotrigine (Lamictal)
Levetiracetam (Keppra)
Oxcarbazepine (Trileptal)
Phenobarbital
Phenytoin (Dilantin, Phenytek)
Pregabalin (Lyrica)
Primidone (Mysoline)
Rufinamide (Banzel)
Tiagabine (Gabitril)
Topiramate (Topamax)
Valproate
Vigabatrin (Sabril)
Zonisimide (Zonegran)
2. Common Anti-Seizure Drug Side-effects
Drug-related:
Cognitive problems
Fatigue
Weight gain or loss
Cosmetic – acne, excessive hairiness or hair loss
Hyperactivity – excitable
Hypoactivity - reduced activity
Personality changes
Mood changes, depression
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Forum 51- Epilepsy and Seizure Management for Home Health Care Providers
Dose-related/toxicity:
Double vision, blurry vision
Dizziness, lightheadedness
Sedation
Slowed thinking
Feels drunk
Coordination problems
Unsteady walking
3. Drug Reaction Warning Signs
1. Rash
2. Prolonged fever
3. Severe sore throat
4. Mouth ulcers
5. Easy bruising
6. Weakness
7. Excessive fatigue
8. Swollen glands
9. Lack of appetite
10. Increased seizures
4. Emergency Medication
Diazepam rectal gel (Diastat), a form of Valium, is a common emergency medication
prescribed for patients who tend to have poorly controlled seizures, cluster seizures or status
epilepticus.
Diastat has been approved by the FDA for use by family members and other
non-medical caregivers.
Training is required for proper administration and safety. For more
information and a free video on administration, visit www.diastat.com.
B. Vagus Nerve Stimulator (VNS)
1. A small battery powered device is implanted under the skin in the chest wall. The device
sends small, regular bursts of electrical energy to the vagus nerve, a large nerve in the neck that
leads directly to the brain.
A programmable pulse generator implanted under the skin in left chest
Electrode is surgically wrapped around the left vagus nerve
Sends bursts of electrical energy to the brain via the vagus nerve
Exact mechanism of action not known
Can be activated or turned off with an external magnet
Side effects may include hoarseness, coughing and shortness of breath and
occur during stimulation only
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C. Surgery
Forum 51- Epilepsy and Seizure Management for Home Health Care Providers
2. VNS Magnet Use
Typically worn on wrist or belt
If the person has a seizure warning sign (aura) s/he or a trained observer may
swipe the magnet over the VNS device to activate it and help abort a seizure
Magnet may be swiped during an actual seizure to shorten seizure length
Magnet may be used as often as needed with at least a minute between swipes
Magnet held in place over VNS can turn it off if unit malfunctions
For a free video and more information visit www.vnstherapy.com
D. Ketogenic Diet
IV. Seizure Triggers
A. Breakthrough Seizures
Surgery is a treatment option when the area of the brain causing the seizures is
small and focal and when the area can be safely removed without a loss of
function.
In certain cases, surgery can significantly reduce or eliminate seizure activity.
A medically supervised diet comprised of a high proportion of fat and very
little protein and carbohydrates.
By forcing the body to burn fat, the body enters a state of ketosis which
somehow works to reduce seizures in some people with epilepsy. Strict
adherence to the diet is necessary as deviation from the diet can cause
breakthrough seizures.
Modified Atkins diet as alternative.
Even when an individual’s seizures are well controlled, breakthrough seizures can and do
occur. Below is a list of the leading causes of breakthrough seizures. Seizure triggers are
highly individual and most individuals might not have any recognizable triggers.
B. Possible Seizure Triggers
1. Missed or late medication (#1 reason)
2. Change in medication
3. Change from brand name medication to generic and vice versa
4. Lack of sleep/fatigue
5. Illness/fever
6. Poor diet/missed meals
7. Low blood sugar / high blood sugar
8. Hunger / Dehydration
9. Flashing lights (rare)
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Forum 51- Epilepsy and Seizure Management for Home Health Care Providers
10. Overheating/overexertion
11. Stress/anxiety
12. Hormonal changes
13. Alcohol / Recreational drug use
14. Drug interactions
V. Seizure First Aid
A. Good Communication is Key
1. Communication between the caregiver and parent/guardian is necessary to reduce seizure
frequency and risk of injury
2. Communicate at the beginning and end of each shift
3. Use daily log and observation record to document seizure type and frequency
4. Discuss physical health as well as behavioral & emotional health
5. Be aware of potential side effects to medication
6. Discuss medication changes, including changes in medication formulation (e.g. brand name
versus generic)
7. Discuss changes to seizure action plan, first aid and safety precautions
B. Seizure First Aid
1. Most seizures are not medical emergencies. Basic first aid varies by seizure type and whether
there is a change in consciousness (See Appendix A). Every individual with epilepsy should
have a Seizure Action Plan for seizure emergencies.
2. Dangerous First Aid for All Seizure Types
Don’t put anything in the person’s mouth
Don’t try to hold down or restrain the person
Don’t attempt to give oral anti-seizure medications
3. First Aid for Generalized Tonic-Clonic Seizures: (See Appendix B)
Stay calm, note time seizure began and duration of event
Lay person down and turn on side
Place something soft under head
Clear objects away from jerking extremities
Loosen tight clothing
Protect head and remove glasses
Do not restrain
Provide privacy if possible
Stay with the person until the seizure ends and a full return to consciousness is
observed
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Forum 51- Epilepsy and Seizure Management for Home Health Care Providers
After the seizure ends, re-orient the person to their surroundings
Activate Emergency Protocol after five minutes of continuous seizure activity,
or if another seizure begins before a full return to consciousness.
4. First Aid for Complex Partial Seizures: (See Appendix C)
Note time seizure began and duration of event
Speak softly and calmly, reassure others
Do not restrain or grab (may result in combativeness)
Gently guide away from hazards
Verbal instructions may not be obeyed
Stay with the person until the seizure ends and a full return to consciousness is
observed
After the seizure ends, re-orient the person to their surroundings
Activate Emergency Protocol if:
Seizure lasts for five minutes beyond what is routine for that individual.
If a second seizure begins before a full return to consciousness.
If confusion or disorientation lasts for more than 30 minutes after the seizure
ends.
5. Absence, Simple Partial, Myoclonic and Atonic Seizures:
First aid is generally not needed for these types of seizures unless:
Seizure progresses to a generalized tonic-clonic seizure
Repeated seizures occur without a return to consciousness
Confusion or altered state lasting 30 minutes or more after seizure ends
Person is injured during the seizure
6. When is a Seizure an Emergency?
First time seizure
Convulsive seizure lasting more than 5 minutes
Repeated seizures without a return to consciousness
More seizures than usual or change in type
Person is injured
Person has trouble breathing after seizure
Person has diabetes or is pregnant
Seizure occurs in water
7. Use of Emergency Medications (Diastat)
Prescribed for seizure clusters and prolonged seizures
Must be fully trained in administration
Emergency protocol should include:
Medication name
Details about exactly when it should be given
Specific administration instructions
Monitor responses and side effects
Follow Seizure Action Plan emergency response protocol
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Forum 51- Epilepsy and Seizure Management for Home Health Care Providers
8. Tonic-Clonic Seizure in a Wheelchair
Do not remove from wheelchair unless absolutely necessary
Secure wheelchair to prevent movement
Fasten seatbelt (loosely) to prevent person from falling out of wheelchair
Protect and support head
Ensure breathing is unobstructed and allow secretions to flow from mouth
Pad wheelchair to prevent injuries to limbs
Follow relevant seizure first aid protocol
VI. Seizure Management Tools
A. Seizure Action Plan (See Appendix D)
A medical care plan to be used in cases of seizure emergencies. Should be approved by
the treating physician and all caregivers should have access to the plan.
B. Seizure Questionnaire (See Appendix E)
Information on seizure history and treatment that is used to help design the Seizure
Action Plan.
C. Observation Record (See Appendix F)
A log to record physical and behavioral changes related to seizure activity.
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Forum 51- Epilepsy and Seizure Management for Home Health Care Providers
RESOURCES
Epilepsy Foundation: www.epilepsyfoundation.org
Centers for Disease Control: www.cdc.gov/epilepsy
Epilepsy.com: www.epilepsy.com
National Library of Medicine:
www.nlm.nih.gov/medlineplus/epilepsy/html
Project Access: www.accessforepilepsy.com
Seizure Tracker: www.seizuretracker.com
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True of False
Forum 51- Epilepsy and Seizure Management for Home Health Care Providers
1. ________ Most seizures are medical
emergencies.
2. ________ Seizures result from changes in the
electrical activity of the brain.
3. ________ On average, one in ten people will
have a seizure in their lifetime.
4. ________ Brain injury is not a cause of
epilepsy.
5. ________ A person can be conscious during a
seizure.
6. ________ Seizures that last longer than five
minutes can be considered a seizure emergency.
7. ________ Anti-seizure medication is
effective for 95% of people with epilepsy.
8. ________ The Ketogenic Diet is comprised of
a very low proportion of fat.
9. ________ Placing any type of object in a
person’s mouth during a seizure is dangerous.
10. ________ Restraining someone during a
complex partial seizure is necessary for safety.
Multiple Choice
1. Generalized seizures that affect the entire brain
usually
(a) result in no loss of consciousness
(b) result in a loss of consciousness
(c) result in a partial loss of consciousness
(d) result in hallucinations
2. A seizure can affect which of the following?
(a) Movement
(b) Sensation
(c) Emotions
(d) All of the above
3. Epilepsy is defined by
(a) predictable seizures
(b) recurrent, unprovoked seizures
(c) mental retardation
(d) depression
QUIZ
4. Which of the following is not a cause of
epilepsy?
(a) genetics
(b) brain trauma
(c) mental illness
(d) poisoning
5. An EEG:
(a) records brain activity
(b) takes a picture of the brain
(c) measures heart rate
(d) measures pulse rate
6. Which of the following is not a symptom of a
complex partial seizure?
(a) wandering
(b) altered consciousness
(c) repetitive movements
(d) coherent speech
7. Which of the following is not associated with a
tonic-clonic seizure?
(a) wandering
(b) loss of consciousness
(c ) whole body convulsions
(d) abnormal breathing
8. Which of the following is not a common sideeffect
of anti-seizure medication?
(a) fatigue
(b) cognitive problems
(c) diabetes
(d) depression
9. Why is it important to time seizures?
(a) because seizures that continue for more than
five minutes can be considered an emergency.
(b) because seizures always end after five
minutes.
(c) because it’s important to know what time of
day the seizure occurred.
(d) all of the above
10. Possible seizure triggers in someone that has
epilepsy include:
(a) illness
(b) change of medication
(c) hormonal changes
(d) all of the above
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Seizure Recognition and First Aid
Seizure Type What it Looks Like What it is Not What to Do
Generalized
Tonic Clonic
(Also called Grand
Mal)
Absence
(Also called Petit Mal)
Simple Partial
Complex Partial
(Also called
Psychomotor or
Temporal Lobe)
Atonic Seizures
(Also called Drop
Attacks)
Myoclonic
Seizures
Infantile Spasms
Sudden cry, fall, rigidity, followed by muscle
jerks, shallow breathing or temporarily sus‑
pended breathing, bluish skin, possible loss
of bladder or bowel control, usually lasts a
couple of minutes. Normal breathing then
starts again. There may be some confusion
and/or fatigue, followed by return to full con‑
sciousness.
A blank stare, beginning and ending abruptly,
lasting only a few seconds, most common in
children. May be accom panied by rapid blinking,
some chewing movements of the mouth. Child
or adult is unaware of what’s going on during
the seizure, but quickly returns to full aware‑
ness once it has stopped. May result in learning
difficulties if not recognized and treated.
Jerking may begin in one area of body, arm,
leg, or face. Can’t be stopped, but patient
stays awake and aware. Jerking may proceed
from one area of the body to another, and
sometimes spreads to become a convulsive
seizure.
Partial sensory seizures may not be obvious
to an onlooker. Patient experiences a dis‑
torted environment. May see or hear things
that aren’t there, may feel unexplained fear,
sadness, anger, or joy. May have nausea,
experience odd smells, and have a generally
“funny” feeling in the stomach.
Usually starts with blank stare, followed by
chewing, followed by random activity. Person
appears unaware of surroundings, may seem
dazed and mumble. Unrespon sive. Actions
clumsy, not directed. May pick at clothing,
pick up objects, try to take clothes off. May
run, appear afraid. May struggle or flail at
restraint. Once pattern is established, same
set of actions usually occur with each seizure.
Lasts a few minutes, but post‑seizure confu‑
sion can last substantially longer. No memory
of what happened during seizure period.
A child or adult suddenly collapses and falls.
After 10 seconds to a minute he recovers,
regains consciousness, and can stand and
walk again.
Sudden brief, massive muscle jerks that may
involve the whole body or parts of the body.
May cause person to spill what they were
holding or fall off a chair.
These are clusters of quick, sudden move‑
ments that start between three months and
two years. If a child is sitting up, the head will
fall forward, and the arms will flex forward. If
lying down, the knees will be drawn up, with
arms and head flexed forward as if the baby is
reaching for support.
Heart attack.
Stroke.
Daydreaming.
Lack of attention.
Deliberate ignoring of
adult instructions.
Acting out, bizarre
behavior.
Hysteria.
Mental illness.
Psychosomatic illness.
Parapsychological or
mystical experience.
Drunkenness.
Intoxication on drugs.
Mental illness.
Disorderly conduct.
Clumsiness.
Normal childhood
“stage.”
In a child, lack of good
walking skills.
In an adult,
drunkenness, acute
illness.
Clumsiness.
Poor coordination.
Normal movements of
the baby.
Colic.
Look for medical identification.
Protect from nearby hazards.
Loosen shirt collars.
Protect head from injury.
Turn on side to keep airway clear
unless injury exists. Reassure as con‑
sciousness returns.
If single seizure lasted less than 5 min‑
utes, ask if hospital evaluation wanted.
No first aid necessary, but if this is
the first observation of the seizure(s),
medical evaluation should be
recommended.
No first aid necessary unless seizure
becomes convulsive, then first aid
as above.
No immediate action needed other
than reassurance and emotional
support.
Medical evaluation should be
recommended.
Speak calmly and reassuringly to
patient and others.
Guide gently away from obvious
hazards.
Stay with person until completely
aware of environment.
Offer to help get person home.
No first aid needed (unless he hurt
himself as he fell), but the child should
be given a thorough medical evalu‑
ation.
No first aid needed, but should be
given a thorough medical evaluation.
No first aid, but doctor should be
consulted.
© 2010 Epilepsy Foundation of America, Inc.
Appendix A

Appendix B

Appendix B

Appendix C

Appendix C

Emergency Response
A “seizure emergency” for
this student is defined as:
Seizure Action Plan Effective Date
This student is being treated for a seizure disorder. The information below should assist you if a seizure occurs during
school hours.
Student’s Name Date of Birth
Parent/Guardian Phone Cell
Other Emergency Contact Phone Cell
Treating Physician Phone
Significant Medical History
Seizure Information
Seizure Type Length Frequency Description
Seizure triggers or warning signs: Student’s response after a seizure:
Basic First Aid: Care & Comfort
Please describe basic first aid procedures:
Does student need to leave the classroom after a seizure? ❒ Yes ❒ No
If YES, describe process for returning student to classroom:
Seizure Emergency Protocol
(Check all that apply and clarify below)
❒ Contact school nurse at __________________________
❒ Call 911 for transport to __________________________
❒ Notify parent or emergency contact
❒ Administer emergency medications as indicated below
❒ Notify doctor
❒ Other ________________________________________
Treatment Protocol During School Hours (include daily and emergency medications)
Does student have a Vagus Nerve Stimulator? ❒ Yes ❒ No If YES, describe magnet use:
Special Considerations and Precautions (regarding school activities, sports, trips, etc.)
Describe any special considerations or precautions:
•
Basic Seizure First Aid
Stay calm & track time
• Keep child safe
• Do not restrain
• Do not put anything in mouth
• Stay with child until fully conscious
• Record seizure in log
For tonic-clonic seizure:
• Protect head
• Keep airway open/watch breathing
• Turn child on side
A seizure is generally
considered an emergency when:
• Convulsive (tonic-clonic) seizure lasts
longer than 5 minutes
• Student has repeated seizures without
regaining consciousness
• Student is injured or has diabetes
• Student has a first-time seizure
• Student has breathing difficulties
• Student has a seizure in water
Emerg. Dosage &
Med. ✓ Medication Time of Day Given Common Side Effects & Special Instructions
Physician Signature ___________________________________________________ Date _________________________________
Parent/Guardian Signature _____________________________________________ Date _________________________________
DPC772A

Appendix E

Appendix E

Student Name:
Date & Time
Seizure Length
Pre-Seizure Observation (Briefly list behaviors,
triggering events, activities)
Conscious (yes/no/altered)
Injuries (briefly describe)
Muscle Tone/Body
Extremity
Color
Eyes
Mouth
Movements
Movements
Rigid/clenching
Limp
Fell down
Rocking
Wandering around
Whole body jerking
(R) arm jerking
(L) arm jerking
(R) leg jerking
(L) leg jerking
Random Movement
Bluish
Pale
Flushed
Pupils dilated
Turned (R or L)
Rolled up
Staring or blinking (clarify)
Closed
Salivating
Chewing
Lip smacking
Verbal Sounds (gagging, talking, throat clearing, etc.)
Breathing (normal, labored, stopped, noisy, etc.)
Incontinent (urine or feces)
Post-Seizure
Observation
Confused
Sleepy/tired
Headache
Speech slurring
Other
Length to Orientation
Parents Notified? (time of call)
EMS Called? (call time & arrival time)
Observer’s Name
Seizure Observation Record
Please put additional notes on back as necessary. Appendix F