Workbook # 51 Epilepsy and Seizure Management for Home Health ...
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Audio Conference designed <strong>for</strong><br />
trainers <strong>and</strong> paraprofessionals.<br />
<strong>Workbook</strong> # <strong>51</strong><br />
<strong>Epilepsy</strong> <strong>and</strong> <strong>Seizure</strong><br />
<strong>Management</strong> <strong>for</strong> <strong>Home</strong><br />
<strong>Health</strong> Care Providers<br />
2010 <strong>Home</strong> Care<br />
Community<br />
Forum Series<br />
Community <strong>Health</strong> Care Services Foundation, Inc.<br />
99 Troy Road, Suite 200, East Greenbush, NY 12061<br />
(Tel.) <strong>51</strong>8.463.1167 (Fax) <strong>51</strong>8.463.1606<br />
www.chcfoundation.org
Welcome!<br />
<strong>Home</strong> Care Community Forums are free educational programs specifically designed <strong>for</strong><br />
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presentations <strong>for</strong> past Forums can be found at www.chcfoundation.org.<br />
Forum <strong>51</strong>: <strong>Epilepsy</strong> <strong>and</strong> <strong>Seizure</strong> <strong>Management</strong> <strong>for</strong> <strong>Home</strong> <strong>Health</strong> Care Providers<br />
Presenter: Julie Eisele PhD<br />
Julie Eisele is the Community Educator <strong>for</strong> the <strong>Epilepsy</strong> Foundation of Northeastern NY<br />
where her responsibilities include in<strong>for</strong>mation <strong>and</strong> referral, community education <strong>and</strong><br />
advocacy. She is a Developmental Psychologist whose research has focused on children<br />
with early brain injury. Previously, she was an Assistant Professor of Biopsychology at<br />
Skidmore College <strong>and</strong> the Director of the NYS Traumatic Brain <strong>and</strong> Spinal Cord Injury<br />
Surveillance Program funded by the Centers <strong>for</strong> Disease Control <strong>and</strong> Prevention.<br />
Community <strong>Health</strong> Care Services Foundation, Inc.<br />
99 Troy Road, Suite 200 • East Greenbush, NY 12061 • (Tel) <strong>51</strong>8/463-1167 • (Fax) <strong>51</strong>8/463-1606<br />
www.chcfoundation.org
<strong>Home</strong> Care Community Forum<br />
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Awarded to<br />
_______________<br />
For Participating in<br />
Forum <strong>51</strong>: <strong>Epilepsy</strong> <strong>and</strong> <strong>Seizure</strong> <strong>Management</strong> <strong>for</strong> <strong>Home</strong><br />
<strong>Health</strong> Care Providers<br />
A training program provided by<br />
Community <strong>Health</strong> Care Services Foundation, Inc.<br />
Date_______________________________________ Signed_______________________________________
<strong>Home</strong> Care Community Forum #<strong>51</strong><br />
<strong>Epilepsy</strong> <strong>and</strong> <strong>Seizure</strong> <strong>Management</strong> <strong>for</strong> <strong>Home</strong> <strong>Health</strong> Care Providers<br />
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www.chcfoundation.org
<strong>Home</strong> Care Community Forum #<strong>51</strong><br />
<strong>Epilepsy</strong> <strong>and</strong> <strong>Seizure</strong> <strong>Management</strong> <strong>for</strong> <strong>Home</strong> <strong>Health</strong> Care Providers<br />
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Community <strong>Health</strong> Care Services Foundation, Inc.<br />
99 Troy Road, Suite 200 East Greenbush, NY 12061<br />
Phone: <strong>51</strong>8-463-1167 Fax: <strong>51</strong>8-463-1606<br />
www.chcfoundation.org<br />
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99 Troy Road, Suite 200<br />
East Greenbush, NY 12061<br />
Phone: <strong>51</strong>8/463-1167 Fax: <strong>51</strong>8/463-1606<br />
<strong>Home</strong> Care Community Forum<br />
WORKBOOK #<strong>51</strong><br />
<strong>Epilepsy</strong> <strong>and</strong> <strong>Seizure</strong> <strong>Management</strong> <strong>for</strong> <strong>Home</strong> <strong>Health</strong> Care Providers<br />
True or False<br />
1. False 6. True<br />
2. True 7. False<br />
3. True 8. False<br />
4. False 9. True<br />
5. True 10. False<br />
Multiple choice<br />
1. B 6. D<br />
2. D 7. A<br />
3. B 8. C<br />
4. C 9. A<br />
5. A 10. D<br />
QUIZ ANSWERS
Forum <strong>51</strong>- <strong>Epilepsy</strong> <strong>and</strong> <strong>Seizure</strong> <strong>Management</strong> <strong>for</strong> <strong>Home</strong> <strong>Health</strong> Care Providers<br />
Learning Objectives:<br />
At the completion of this program, participants will be able to underst<strong>and</strong>:<br />
1. What epilepsy is, its symptoms <strong>and</strong> causes<br />
2. Different types of seizures, their signs <strong>and</strong> symptoms<br />
3. Current treatment options <strong>and</strong> side-effects<br />
4. How <strong>and</strong> when to administer <strong>Seizure</strong> First Aid<br />
5. The need <strong>for</strong> a <strong>Seizure</strong> Emergency Plan<br />
Conscious<br />
Consciousness<br />
Electroencephalogram<br />
(EEG)<br />
<strong>Epilepsy</strong><br />
Epileptologist<br />
Neurological<br />
<strong>Seizure</strong><br />
Status epilepticus<br />
Glossary<br />
Having awareness of one's self, acts, <strong>and</strong> surroundings.<br />
The state of being conscious.<br />
A device that measures the electrical activity of the brain by recording<br />
from external electrodes.<br />
A chronic neurological disorder characterized by a tendency to have<br />
recurrent, unprovoked seizures.<br />
A neurologist that specializes in the treatment of epilepsy.<br />
Relating to the nervous system.<br />
A brief change in the electrical activity of the brain.<br />
30 minutes of either continuous seizure activity or repetitive seizures<br />
without a return of consciousness.<br />
Vagus nerve A large nerve in the neck that leads directly to the brain.<br />
Prepared by Julie Eisele, Ph.D., Community Educator, <strong>Epilepsy</strong> Foundation of Northeastern New York.<br />
The <strong>Epilepsy</strong> Foundation of America, Inc. ® provided much of the material in this workbook.<br />
Reprinted with permission.<br />
Community <strong>Health</strong> Care Services Foundation, Inc. 1
Forum <strong>51</strong>- <strong>Epilepsy</strong> <strong>and</strong> <strong>Seizure</strong> <strong>Management</strong> <strong>for</strong> <strong>Home</strong> <strong>Health</strong> Care Providers<br />
I. An Introduction to <strong>Epilepsy</strong><br />
A. What is a <strong>Seizure</strong>?<br />
A brief change in the electrical activity of the brain that alters one or more of the following:<br />
Movement<br />
Sensation<br />
Behavior<br />
Awareness<br />
Emotions<br />
<strong>Seizure</strong> symptoms depend on where in the brain the electrical activity occurs <strong>and</strong> how much of<br />
the brain is affected during the seizure. Most seizures occur spontaneously <strong>and</strong> unpredictably.<br />
Brain cells use tiny electrical signals to send in<strong>for</strong>mation to other brain cells. During a seizure,<br />
too many brain cells send these signals at the same time. The result may be a change in<br />
consciousness, movement <strong>and</strong>/or behavior.<br />
<strong>Seizure</strong>s that affect the entire brain usually result in a loss of consciousness. If only part of the<br />
brain is affected, it may cloud awareness, block normal communication, <strong>and</strong> produce a variety of<br />
undirected, uncontrolled, unorganized movements.<br />
Most seizures last only a minute or two, <strong>and</strong> end naturally. After a seizure, the person may feel<br />
sick, tired <strong>and</strong> disoriented. In these cases, caregivers should follow basic seizure first aid, keep<br />
the individual safe during the seizure <strong>and</strong> monitor <strong>for</strong> a return to baseline after the seizure ends.<br />
Sometimes, seizures can last longer than expected. <strong>Seizure</strong>s lasting longer than five minutes<br />
require emergency action. For this reason, all caregivers must have access to a seizure<br />
emergency plan.<br />
B. What is <strong>Epilepsy</strong>?<br />
<strong>Epilepsy</strong> is a chronic neurological disorder characterized by a tendency to have recurrent,<br />
unprovoked seizures. <strong>Epilepsy</strong> is diagnosed when a person has two or more unprovoked<br />
seizures. By unprovoked we mean a seizure that isn’t caused by a fever, low blood sugar, drug<br />
or alcohol intoxication, etc.<br />
<strong>Epilepsy</strong> is also known as a “seizure disorder.”<br />
Community <strong>Health</strong> Care Services Foundation, Inc. 2
Forum <strong>51</strong>- <strong>Epilepsy</strong> <strong>and</strong> <strong>Seizure</strong> <strong>Management</strong> <strong>for</strong> <strong>Home</strong> <strong>Health</strong> Care Providers<br />
C. Who Gets <strong>Epilepsy</strong>?<br />
1. <strong>Epilepsy</strong> affects roughly one percent of the population, with an estimated 3 million<br />
Americans living with epilepsy. It occurs more often in young children, the elderly <strong>and</strong><br />
developmentally disabled populations. Children <strong>and</strong> adults with autism, mental<br />
retardation, cerebral palsy <strong>and</strong> other developmental disorders are at increased risk <strong>for</strong><br />
developing epilepsy.<br />
2. <strong>Epilepsy</strong> is the leading neurological disorder in childhood <strong>and</strong> the third leading<br />
neurological disorder in adults.<br />
3. One in ten people will have a seizure in their lifetime.<br />
D. Causes of <strong>Epilepsy</strong><br />
II. Diagnoses<br />
The cause is unknown in 70% of cases<br />
Brain Trauma (ex. injury, stroke)<br />
Brain Lesions (ex. tumors)<br />
Poisoning (ex. lead)<br />
Infections of the brain (ex. meningitis, encephalitis, measles)<br />
Brain injury at birth<br />
Genetic causes<br />
Abnormal brain development<br />
Chronic alcohol/ drug abuse<br />
A. How is <strong>Epilepsy</strong> Diagnosed?<br />
1. A physician can diagnosis epilepsy based on a medical history, physical examination,<br />
blood work, description of seizure activity, electroencephalogram (EEG), brain imaging such as<br />
a magnetic resonance imaging (MRI) or computed tomography (CT scan), <strong>and</strong> possibly genetic<br />
testing.<br />
An EEG measures the electrical activity of the brain by recording from electrodes<br />
placed on the head.<br />
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Forum <strong>51</strong>- <strong>Epilepsy</strong> <strong>and</strong> <strong>Seizure</strong> <strong>Management</strong> <strong>for</strong> <strong>Home</strong> <strong>Health</strong> Care Providers<br />
2. People with epilepsy are treated by neurologists, family doctors or pediatricians.<br />
B. Types of <strong>Seizure</strong>s<br />
Epileptologists are neurologists with specialized training in epilepsy.<br />
There are over 20 different types of seizures<br />
A person may experience just one type or more than one.<br />
The kind of seizure a person has depends on which part of the brain is affected<br />
<strong>and</strong> the amount of seizure activity.<br />
<strong>Seizure</strong>s present in a variety of ways but often they present in the same way<br />
each time in an individual.<br />
<strong>Seizure</strong>s can <strong>and</strong> do vary based on a number of factors.<br />
<strong>Seizure</strong>s can be categorized based on whether they involve the whole brain or<br />
part of the brain.<br />
1. Generalized <strong>Seizure</strong>s<br />
In generalized seizures, abnormal electrical activity involves large areas of both sides of the<br />
brain <strong>and</strong> causes a loss of consciousness. Symptoms include convulsions, starring, muscle<br />
spasms <strong>and</strong> falls. Examples of generalized seizures include tonic-clonic, absence, atonic <strong>and</strong><br />
myoclonic.<br />
i. Tonic-Clonic <strong>Seizure</strong>s<br />
Previously referred to as Gr<strong>and</strong> Mal.<br />
Generalized Tonic-Clonic seizures are the most common <strong>and</strong> best known type of<br />
generalized seizure.<br />
They have a sudden onset <strong>and</strong> render the person unconscious.<br />
They begin with stiffening of the arms <strong>and</strong> legs (tonic phase), followed by whole<br />
body convulsing (clonic phase).<br />
The person may fall to the ground <strong>and</strong> emit an involuntary cry.<br />
The person may lose bowel <strong>and</strong>/or bladder function.<br />
During the tonic phase, breathing may decrease or cease altogether, producing<br />
cyanosis (blueing) of the lips, nail beds, <strong>and</strong> face.<br />
Breathing typically returns during the clonic (jerking) phase, but it may be<br />
irregular. This clonic phase usually lasts less than a minute.<br />
Some people experience only the tonic, or stiffening phase of the seizure; others<br />
exhibit only the clonic or jerking movements; still others may have a tonic-clonictonic<br />
pattern.<br />
Most tonic-clonic seizures last one to three minutes.<br />
Following the seizure, the person will be lethargic, sore, possibly confused, <strong>and</strong><br />
want to sleep. Headaches are common. Full recovery can takes minutes to hours.<br />
ii. Absence <strong>Seizure</strong><br />
Previously referred to as Petit Mal.<br />
Community <strong>Health</strong> Care Services Foundation, Inc. 4
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Most common in children with an onset between 3 <strong>and</strong> 10 years of age.<br />
The person stares vacantly <strong>and</strong> experiences a very brief loss of consciousness,<br />
typically just a few seconds.<br />
May involve small involuntary movements of the face (twitching, blinking, etc.)<br />
<strong>and</strong>/or arm movements.<br />
The person does not talk <strong>and</strong> does not hear what is being said.<br />
Consciousness returns quickly <strong>and</strong> the person resumes previous activity.<br />
Absence seizures can occur in clusters, with up to 100 seizures in a single day.<br />
Up to 40% of patients can outgrow this type of seizure.<br />
Most children with typical absence seizures are otherwise normal.<br />
iii. Atonic seizures<br />
Atonic seizures cause a sudden loss of muscle tone.<br />
Motor symptoms include head drops, loss of posture, or sudden collapse.<br />
Because they occur without warning, atonic seizures can result in injuries to the head<br />
<strong>and</strong> face. Protective headgear is sometimes used by children <strong>and</strong> adults.<br />
Other names include drop attacks, astatic or akinetic seizures.<br />
iv. Myoclonic seizures<br />
2. Partial <strong>Seizure</strong>s<br />
The person experiences sudden jerks or muscle contractions, often both sides of<br />
the body at the same time<br />
Occasionally, they involve one arm or a foot.<br />
A similar but normal experience is the sudden jerk of a foot during sleep.<br />
Partial seizures are the most common type of seizure, also called focal seizures.<br />
The electrical disturbance begins in a specific area of one side of<br />
the brain.<br />
They typically do not involve a loss of consciousness but can result in an altered<br />
awareness.<br />
A person’s symptoms depend on the specific part of the brain affected.<br />
Nearly any movement, sensory, or emotional symptom can occur as<br />
part of a partial seizure, including complex visual or auditory hallucinations.<br />
Partial seizures can spread to involve the whole brain resulting in a<br />
generalized seizure.<br />
i. Simple Partial <strong>Seizure</strong>s<br />
Consciousness is maintained during a simple partial seizure.<br />
The person may be unable to speak or move during the seizure, but will often<br />
remember what happened during the seizure.<br />
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Symptoms can include emotional changes (fear, anxiety), isolated, involuntary<br />
movements, sensory sensations (tingling, weakness, sounds, smells, tastes, visual<br />
distortions) <strong>and</strong> psychic symptoms (déjà vu, hallucinations).<br />
Most partial seizures last less than a minute.<br />
Can result in a complex-partial seizure or generalized tonic-clonic seizure.<br />
ii. Complex Partial <strong>Seizure</strong>s<br />
3. Intractable <strong>Seizure</strong>s<br />
C. Status Epilepticus<br />
Complex partial seizures result in a state of altered consciousness.<br />
Symptoms are variable, but often start with a blank stare followed by<br />
chewing, lip smacking or other purposeless repetitive movements.<br />
Aimless walking, r<strong>and</strong>om movements <strong>and</strong> incoherent speech are common.<br />
Some report an aura or warning sign, such as an abnormal taste or smell,<br />
sensation or emotion.<br />
Complex partial seizures typically last 30 seconds to 2 minutes. Longer seizures<br />
can occur <strong>and</strong> seizures can generalize to a tonic-clonic seizure.<br />
Complex partial seizures are the most common type of seizure.<br />
They frequently arise from the temporal lobe of the brain.<br />
<strong>Seizure</strong>s of any kind that do not respond to medications.<br />
Twenty percent of people with epilepsy have seizures that are resistant to<br />
medication, otherwise known as refractory epilepsy.<br />
1. Most seizures end after a few minutes. If seizures are prolonged, or occur in a series,<br />
there is an increased risk of status epilepticus, a true life threatening emergency.<br />
2. Status epilepticus is usually defined as 30 minutes of uninterrupted seizure activity or<br />
repeat seizures without a return to consciousness.<br />
3. The <strong>Epilepsy</strong> Foundation advises parents <strong>and</strong> the public to call <strong>for</strong> emergency assistance<br />
when a convulsive seizure lasts <strong>for</strong> more than five minutes without signs of stopping, or<br />
when successive seizures last more than five minutes without a return to consciousness.<br />
III. Treatment Options<br />
The goal of all epilepsy treatment is to stop the seizures with as few side effects as possible. The most<br />
common treatment is medication. If medication does not work, other options may include surgery, a<br />
medical device or a highly specialized diet.<br />
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A. Medication<br />
Anti-seizure medication is the first line of treatment <strong>for</strong> epilepsy <strong>and</strong> is effective in<br />
approximately 75% of patients. For 25% of patients, current medications are not effective at<br />
controlling their seizures. In these cases, other treatments such as surgery <strong>and</strong> diet need to be<br />
explored.<br />
Ideally, patients will gain adequate seizure control with one medication, but sometimes, multiple<br />
drugs are needed to control seizures.<br />
1. Common Anti-<strong>Seizure</strong> Drugs<br />
Carbamazepine (Tegretol, Carbatrol)<br />
Clonazepam (Klonopin)<br />
Ethosuximide (Zarontin)<br />
Felbamate (Felbatol)<br />
Gabapentin (Neurontin)<br />
Lacosemide) Vimpat)<br />
Lamotrigine (Lamictal)<br />
Levetiracetam (Keppra)<br />
Oxcarbazepine (Trileptal)<br />
Phenobarbital<br />
Phenytoin (Dilantin, Phenytek)<br />
Pregabalin (Lyrica)<br />
Primidone (Mysoline)<br />
Rufinamide (Banzel)<br />
Tiagabine (Gabitril)<br />
Topiramate (Topamax)<br />
Valproate<br />
Vigabatrin (Sabril)<br />
Zonisimide (Zonegran)<br />
2. Common Anti-<strong>Seizure</strong> Drug Side-effects<br />
Drug-related:<br />
Cognitive problems<br />
Fatigue<br />
Weight gain or loss<br />
Cosmetic – acne, excessive hairiness or hair loss<br />
Hyperactivity – excitable<br />
Hypoactivity - reduced activity<br />
Personality changes<br />
Mood changes, depression<br />
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Dose-related/toxicity:<br />
Double vision, blurry vision<br />
Dizziness, lightheadedness<br />
Sedation<br />
Slowed thinking<br />
Feels drunk<br />
Coordination problems<br />
Unsteady walking<br />
3. Drug Reaction Warning Signs<br />
1. Rash<br />
2. Prolonged fever<br />
3. Severe sore throat<br />
4. Mouth ulcers<br />
5. Easy bruising<br />
6. Weakness<br />
7. Excessive fatigue<br />
8. Swollen gl<strong>and</strong>s<br />
9. Lack of appetite<br />
10. Increased seizures<br />
4. Emergency Medication<br />
Diazepam rectal gel (Diastat), a <strong>for</strong>m of Valium, is a common emergency medication<br />
prescribed <strong>for</strong> patients who tend to have poorly controlled seizures, cluster seizures or status<br />
epilepticus.<br />
Diastat has been approved by the FDA <strong>for</strong> use by family members <strong>and</strong> other<br />
non-medical caregivers.<br />
Training is required <strong>for</strong> proper administration <strong>and</strong> safety. For more<br />
in<strong>for</strong>mation <strong>and</strong> a free video on administration, visit www.diastat.com.<br />
B. Vagus Nerve Stimulator (VNS)<br />
1. A small battery powered device is implanted under the skin in the chest wall. The device<br />
sends small, regular bursts of electrical energy to the vagus nerve, a large nerve in the neck that<br />
leads directly to the brain.<br />
A programmable pulse generator implanted under the skin in left chest<br />
Electrode is surgically wrapped around the left vagus nerve<br />
Sends bursts of electrical energy to the brain via the vagus nerve<br />
Exact mechanism of action not known<br />
Can be activated or turned off with an external magnet<br />
Side effects may include hoarseness, coughing <strong>and</strong> shortness of breath <strong>and</strong><br />
occur during stimulation only<br />
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C. Surgery<br />
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2. VNS Magnet Use<br />
Typically worn on wrist or belt<br />
If the person has a seizure warning sign (aura) s/he or a trained observer may<br />
swipe the magnet over the VNS device to activate it <strong>and</strong> help abort a seizure<br />
Magnet may be swiped during an actual seizure to shorten seizure length<br />
Magnet may be used as often as needed with at least a minute between swipes<br />
Magnet held in place over VNS can turn it off if unit malfunctions<br />
For a free video <strong>and</strong> more in<strong>for</strong>mation visit www.vnstherapy.com<br />
D. Ketogenic Diet<br />
IV. <strong>Seizure</strong> Triggers<br />
A. Breakthrough <strong>Seizure</strong>s<br />
Surgery is a treatment option when the area of the brain causing the seizures is<br />
small <strong>and</strong> focal <strong>and</strong> when the area can be safely removed without a loss of<br />
function.<br />
In certain cases, surgery can significantly reduce or eliminate seizure activity.<br />
A medically supervised diet comprised of a high proportion of fat <strong>and</strong> very<br />
little protein <strong>and</strong> carbohydrates.<br />
By <strong>for</strong>cing the body to burn fat, the body enters a state of ketosis which<br />
somehow works to reduce seizures in some people with epilepsy. Strict<br />
adherence to the diet is necessary as deviation from the diet can cause<br />
breakthrough seizures.<br />
Modified Atkins diet as alternative.<br />
Even when an individual’s seizures are well controlled, breakthrough seizures can <strong>and</strong> do<br />
occur. Below is a list of the leading causes of breakthrough seizures. <strong>Seizure</strong> triggers are<br />
highly individual <strong>and</strong> most individuals might not have any recognizable triggers.<br />
B. Possible <strong>Seizure</strong> Triggers<br />
1. Missed or late medication (#1 reason)<br />
2. Change in medication<br />
3. Change from br<strong>and</strong> name medication to generic <strong>and</strong> vice versa<br />
4. Lack of sleep/fatigue<br />
5. Illness/fever<br />
6. Poor diet/missed meals<br />
7. Low blood sugar / high blood sugar<br />
8. Hunger / Dehydration<br />
9. Flashing lights (rare)<br />
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10. Overheating/overexertion<br />
11. Stress/anxiety<br />
12. Hormonal changes<br />
13. Alcohol / Recreational drug use<br />
14. Drug interactions<br />
V. <strong>Seizure</strong> First Aid<br />
A. Good Communication is Key<br />
1. Communication between the caregiver <strong>and</strong> parent/guardian is necessary to reduce seizure<br />
frequency <strong>and</strong> risk of injury<br />
2. Communicate at the beginning <strong>and</strong> end of each shift<br />
3. Use daily log <strong>and</strong> observation record to document seizure type <strong>and</strong> frequency<br />
4. Discuss physical health as well as behavioral & emotional health<br />
5. Be aware of potential side effects to medication<br />
6. Discuss medication changes, including changes in medication <strong>for</strong>mulation (e.g. br<strong>and</strong> name<br />
versus generic)<br />
7. Discuss changes to seizure action plan, first aid <strong>and</strong> safety precautions<br />
B. <strong>Seizure</strong> First Aid<br />
1. Most seizures are not medical emergencies. Basic first aid varies by seizure type <strong>and</strong> whether<br />
there is a change in consciousness (See Appendix A). Every individual with epilepsy should<br />
have a <strong>Seizure</strong> Action Plan <strong>for</strong> seizure emergencies.<br />
2. Dangerous First Aid <strong>for</strong> All <strong>Seizure</strong> Types<br />
Don’t put anything in the person’s mouth<br />
Don’t try to hold down or restrain the person<br />
Don’t attempt to give oral anti-seizure medications<br />
3. First Aid <strong>for</strong> Generalized Tonic-Clonic <strong>Seizure</strong>s: (See Appendix B)<br />
Stay calm, note time seizure began <strong>and</strong> duration of event<br />
Lay person down <strong>and</strong> turn on side<br />
Place something soft under head<br />
Clear objects away from jerking extremities<br />
Loosen tight clothing<br />
Protect head <strong>and</strong> remove glasses<br />
Do not restrain<br />
Provide privacy if possible<br />
Stay with the person until the seizure ends <strong>and</strong> a full return to consciousness is<br />
observed<br />
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After the seizure ends, re-orient the person to their surroundings<br />
Activate Emergency Protocol after five minutes of continuous seizure activity,<br />
or if another seizure begins be<strong>for</strong>e a full return to consciousness.<br />
4. First Aid <strong>for</strong> Complex Partial <strong>Seizure</strong>s: (See Appendix C)<br />
Note time seizure began <strong>and</strong> duration of event<br />
Speak softly <strong>and</strong> calmly, reassure others<br />
Do not restrain or grab (may result in combativeness)<br />
Gently guide away from hazards<br />
Verbal instructions may not be obeyed<br />
Stay with the person until the seizure ends <strong>and</strong> a full return to consciousness is<br />
observed<br />
After the seizure ends, re-orient the person to their surroundings<br />
Activate Emergency Protocol if:<br />
<strong>Seizure</strong> lasts <strong>for</strong> five minutes beyond what is routine <strong>for</strong> that individual.<br />
If a second seizure begins be<strong>for</strong>e a full return to consciousness.<br />
If confusion or disorientation lasts <strong>for</strong> more than 30 minutes after the seizure<br />
ends.<br />
5. Absence, Simple Partial, Myoclonic <strong>and</strong> Atonic <strong>Seizure</strong>s:<br />
First aid is generally not needed <strong>for</strong> these types of seizures unless:<br />
<strong>Seizure</strong> progresses to a generalized tonic-clonic seizure<br />
Repeated seizures occur without a return to consciousness<br />
Confusion or altered state lasting 30 minutes or more after seizure ends<br />
Person is injured during the seizure<br />
6. When is a <strong>Seizure</strong> an Emergency?<br />
First time seizure<br />
Convulsive seizure lasting more than 5 minutes<br />
Repeated seizures without a return to consciousness<br />
More seizures than usual or change in type<br />
Person is injured<br />
Person has trouble breathing after seizure<br />
Person has diabetes or is pregnant<br />
<strong>Seizure</strong> occurs in water<br />
7. Use of Emergency Medications (Diastat)<br />
Prescribed <strong>for</strong> seizure clusters <strong>and</strong> prolonged seizures<br />
Must be fully trained in administration<br />
Emergency protocol should include:<br />
Medication name<br />
Details about exactly when it should be given<br />
Specific administration instructions<br />
Monitor responses <strong>and</strong> side effects<br />
Follow <strong>Seizure</strong> Action Plan emergency response protocol<br />
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8. Tonic-Clonic <strong>Seizure</strong> in a Wheelchair<br />
Do not remove from wheelchair unless absolutely necessary<br />
Secure wheelchair to prevent movement<br />
Fasten seatbelt (loosely) to prevent person from falling out of wheelchair<br />
Protect <strong>and</strong> support head<br />
Ensure breathing is unobstructed <strong>and</strong> allow secretions to flow from mouth<br />
Pad wheelchair to prevent injuries to limbs<br />
Follow relevant seizure first aid protocol<br />
VI. <strong>Seizure</strong> <strong>Management</strong> Tools<br />
A. <strong>Seizure</strong> Action Plan (See Appendix D)<br />
A medical care plan to be used in cases of seizure emergencies. Should be approved by<br />
the treating physician <strong>and</strong> all caregivers should have access to the plan.<br />
B. <strong>Seizure</strong> Questionnaire (See Appendix E)<br />
In<strong>for</strong>mation on seizure history <strong>and</strong> treatment that is used to help design the <strong>Seizure</strong><br />
Action Plan.<br />
C. Observation Record (See Appendix F)<br />
A log to record physical <strong>and</strong> behavioral changes related to seizure activity.<br />
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RESOURCES<br />
<strong>Epilepsy</strong> Foundation: www.epilepsyfoundation.org<br />
Centers <strong>for</strong> Disease Control: www.cdc.gov/epilepsy<br />
<strong>Epilepsy</strong>.com: www.epilepsy.com<br />
National Library of Medicine:<br />
www.nlm.nih.gov/medlineplus/epilepsy/html<br />
Project Access: www.access<strong>for</strong>epilepsy.com<br />
<strong>Seizure</strong> Tracker: www.seizuretracker.com<br />
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True of False<br />
Forum <strong>51</strong>- <strong>Epilepsy</strong> <strong>and</strong> <strong>Seizure</strong> <strong>Management</strong> <strong>for</strong> <strong>Home</strong> <strong>Health</strong> Care Providers<br />
1. ________ Most seizures are medical<br />
emergencies.<br />
2. ________ <strong>Seizure</strong>s result from changes in the<br />
electrical activity of the brain.<br />
3. ________ On average, one in ten people will<br />
have a seizure in their lifetime.<br />
4. ________ Brain injury is not a cause of<br />
epilepsy.<br />
5. ________ A person can be conscious during a<br />
seizure.<br />
6. ________ <strong>Seizure</strong>s that last longer than five<br />
minutes can be considered a seizure emergency.<br />
7. ________ Anti-seizure medication is<br />
effective <strong>for</strong> 95% of people with epilepsy.<br />
8. ________ The Ketogenic Diet is comprised of<br />
a very low proportion of fat.<br />
9. ________ Placing any type of object in a<br />
person’s mouth during a seizure is dangerous.<br />
10. ________ Restraining someone during a<br />
complex partial seizure is necessary <strong>for</strong> safety.<br />
Multiple Choice<br />
1. Generalized seizures that affect the entire brain<br />
usually<br />
(a) result in no loss of consciousness<br />
(b) result in a loss of consciousness<br />
(c) result in a partial loss of consciousness<br />
(d) result in hallucinations<br />
2. A seizure can affect which of the following?<br />
(a) Movement<br />
(b) Sensation<br />
(c) Emotions<br />
(d) All of the above<br />
3. <strong>Epilepsy</strong> is defined by<br />
(a) predictable seizures<br />
(b) recurrent, unprovoked seizures<br />
(c) mental retardation<br />
(d) depression<br />
QUIZ<br />
4. Which of the following is not a cause of<br />
epilepsy?<br />
(a) genetics<br />
(b) brain trauma<br />
(c) mental illness<br />
(d) poisoning<br />
5. An EEG:<br />
(a) records brain activity<br />
(b) takes a picture of the brain<br />
(c) measures heart rate<br />
(d) measures pulse rate<br />
6. Which of the following is not a symptom of a<br />
complex partial seizure?<br />
(a) w<strong>and</strong>ering<br />
(b) altered consciousness<br />
(c) repetitive movements<br />
(d) coherent speech<br />
7. Which of the following is not associated with a<br />
tonic-clonic seizure?<br />
(a) w<strong>and</strong>ering<br />
(b) loss of consciousness<br />
(c ) whole body convulsions<br />
(d) abnormal breathing<br />
8. Which of the following is not a common sideeffect<br />
of anti-seizure medication?<br />
(a) fatigue<br />
(b) cognitive problems<br />
(c) diabetes<br />
(d) depression<br />
9. Why is it important to time seizures?<br />
(a) because seizures that continue <strong>for</strong> more than<br />
five minutes can be considered an emergency.<br />
(b) because seizures always end after five<br />
minutes.<br />
(c) because it’s important to know what time of<br />
day the seizure occurred.<br />
(d) all of the above<br />
10. Possible seizure triggers in someone that has<br />
epilepsy include:<br />
(a) illness<br />
(b) change of medication<br />
(c) hormonal changes<br />
(d) all of the above<br />
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<strong>Seizure</strong> Recognition <strong>and</strong> First Aid<br />
<strong>Seizure</strong> Type What it Looks Like What it is Not What to Do<br />
Generalized<br />
Tonic Clonic<br />
(Also called Gr<strong>and</strong><br />
Mal)<br />
Absence<br />
(Also called Petit Mal)<br />
Simple Partial<br />
Complex Partial<br />
(Also called<br />
Psychomotor or<br />
Temporal Lobe)<br />
Atonic <strong>Seizure</strong>s<br />
(Also called Drop<br />
Attacks)<br />
Myoclonic<br />
<strong>Seizure</strong>s<br />
Infantile Spasms<br />
Sudden cry, fall, rigidity, followed by muscle<br />
jerks, shallow breathing or temporarily sus‑<br />
pended breathing, bluish skin, possible loss<br />
of bladder or bowel control, usually lasts a<br />
couple of minutes. Normal breathing then<br />
starts again. There may be some confusion<br />
<strong>and</strong>/or fatigue, followed by return to full con‑<br />
sciousness.<br />
A blank stare, beginning <strong>and</strong> ending abruptly,<br />
lasting only a few seconds, most common in<br />
children. May be accom panied by rapid blinking,<br />
some chewing movements of the mouth. Child<br />
or adult is unaware of what’s going on during<br />
the seizure, but quickly returns to full aware‑<br />
ness once it has stopped. May result in learning<br />
difficulties if not recognized <strong>and</strong> treated.<br />
Jerking may begin in one area of body, arm,<br />
leg, or face. Can’t be stopped, but patient<br />
stays awake <strong>and</strong> aware. Jerking may proceed<br />
from one area of the body to another, <strong>and</strong><br />
sometimes spreads to become a convulsive<br />
seizure.<br />
Partial sensory seizures may not be obvious<br />
to an onlooker. Patient experiences a dis‑<br />
torted environment. May see or hear things<br />
that aren’t there, may feel unexplained fear,<br />
sadness, anger, or joy. May have nausea,<br />
experience odd smells, <strong>and</strong> have a generally<br />
“funny” feeling in the stomach.<br />
Usually starts with blank stare, followed by<br />
chewing, followed by r<strong>and</strong>om activity. Person<br />
appears unaware of surroundings, may seem<br />
dazed <strong>and</strong> mumble. Unrespon sive. Actions<br />
clumsy, not directed. May pick at clothing,<br />
pick up objects, try to take clothes off. May<br />
run, appear afraid. May struggle or flail at<br />
restraint. Once pattern is established, same<br />
set of actions usually occur with each seizure.<br />
Lasts a few minutes, but post‑seizure confu‑<br />
sion can last substantially longer. No memory<br />
of what happened during seizure period.<br />
A child or adult suddenly collapses <strong>and</strong> falls.<br />
After 10 seconds to a minute he recovers,<br />
regains consciousness, <strong>and</strong> can st<strong>and</strong> <strong>and</strong><br />
walk again.<br />
Sudden brief, massive muscle jerks that may<br />
involve the whole body or parts of the body.<br />
May cause person to spill what they were<br />
holding or fall off a chair.<br />
These are clusters of quick, sudden move‑<br />
ments that start between three months <strong>and</strong><br />
two years. If a child is sitting up, the head will<br />
fall <strong>for</strong>ward, <strong>and</strong> the arms will flex <strong>for</strong>ward. If<br />
lying down, the knees will be drawn up, with<br />
arms <strong>and</strong> head flexed <strong>for</strong>ward as if the baby is<br />
reaching <strong>for</strong> support.<br />
Heart attack.<br />
Stroke.<br />
Daydreaming.<br />
Lack of attention.<br />
Deliberate ignoring of<br />
adult instructions.<br />
Acting out, bizarre<br />
behavior.<br />
Hysteria.<br />
Mental illness.<br />
Psychosomatic illness.<br />
Parapsychological or<br />
mystical experience.<br />
Drunkenness.<br />
Intoxication on drugs.<br />
Mental illness.<br />
Disorderly conduct.<br />
Clumsiness.<br />
Normal childhood<br />
“stage.”<br />
In a child, lack of good<br />
walking skills.<br />
In an adult,<br />
drunkenness, acute<br />
illness.<br />
Clumsiness.<br />
Poor coordination.<br />
Normal movements of<br />
the baby.<br />
Colic.<br />
Look <strong>for</strong> medical identification.<br />
Protect from nearby hazards.<br />
Loosen shirt collars.<br />
Protect head from injury.<br />
Turn on side to keep airway clear<br />
unless injury exists. Reassure as con‑<br />
sciousness returns.<br />
If single seizure lasted less than 5 min‑<br />
utes, ask if hospital evaluation wanted.<br />
No first aid necessary, but if this is<br />
the first observation of the seizure(s),<br />
medical evaluation should be<br />
recommended.<br />
No first aid necessary unless seizure<br />
becomes convulsive, then first aid<br />
as above.<br />
No immediate action needed other<br />
than reassurance <strong>and</strong> emotional<br />
support.<br />
Medical evaluation should be<br />
recommended.<br />
Speak calmly <strong>and</strong> reassuringly to<br />
patient <strong>and</strong> others.<br />
Guide gently away from obvious<br />
hazards.<br />
Stay with person until completely<br />
aware of environment.<br />
Offer to help get person home.<br />
No first aid needed (unless he hurt<br />
himself as he fell), but the child should<br />
be given a thorough medical evalu‑<br />
ation.<br />
No first aid needed, but should be<br />
given a thorough medical evaluation.<br />
No first aid, but doctor should be<br />
consulted.<br />
© 2010 <strong>Epilepsy</strong> Foundation of America, Inc.<br />
Appendix A
Appendix B
Appendix B
Appendix C
Appendix C
Emergency Response<br />
A “seizure emergency” <strong>for</strong><br />
this student is defined as:<br />
<strong>Seizure</strong> Action Plan Effective Date<br />
This student is being treated <strong>for</strong> a seizure disorder. The in<strong>for</strong>mation below should assist you if a seizure occurs during<br />
school hours.<br />
Student’s Name Date of Birth<br />
Parent/Guardian Phone Cell<br />
Other Emergency Contact Phone Cell<br />
Treating Physician Phone<br />
Significant Medical History<br />
<strong>Seizure</strong> In<strong>for</strong>mation<br />
<strong>Seizure</strong> Type Length Frequency Description<br />
<strong>Seizure</strong> triggers or warning signs: Student’s response after a seizure:<br />
Basic First Aid: Care & Com<strong>for</strong>t<br />
Please describe basic first aid procedures:<br />
Does student need to leave the classroom after a seizure? ❒ Yes ❒ No<br />
If YES, describe process <strong>for</strong> returning student to classroom:<br />
<strong>Seizure</strong> Emergency Protocol<br />
(Check all that apply <strong>and</strong> clarify below)<br />
❒ Contact school nurse at __________________________<br />
❒ Call 911 <strong>for</strong> transport to __________________________<br />
❒ Notify parent or emergency contact<br />
❒ Administer emergency medications as indicated below<br />
❒ Notify doctor<br />
❒ Other ________________________________________<br />
Treatment Protocol During School Hours (include daily <strong>and</strong> emergency medications)<br />
Does student have a Vagus Nerve Stimulator? ❒ Yes ❒ No If YES, describe magnet use:<br />
Special Considerations <strong>and</strong> Precautions (regarding school activities, sports, trips, etc.)<br />
Describe any special considerations or precautions:<br />
•<br />
Basic <strong>Seizure</strong> First Aid<br />
Stay calm & track time<br />
• Keep child safe<br />
• Do not restrain<br />
• Do not put anything in mouth<br />
• Stay with child until fully conscious<br />
• Record seizure in log<br />
For tonic-clonic seizure:<br />
• Protect head<br />
• Keep airway open/watch breathing<br />
• Turn child on side<br />
A seizure is generally<br />
considered an emergency when:<br />
• Convulsive (tonic-clonic) seizure lasts<br />
longer than 5 minutes<br />
• Student has repeated seizures without<br />
regaining consciousness<br />
• Student is injured or has diabetes<br />
• Student has a first-time seizure<br />
• Student has breathing difficulties<br />
• Student has a seizure in water<br />
Emerg. Dosage &<br />
Med. ✓ Medication Time of Day Given Common Side Effects & Special Instructions<br />
Physician Signature ___________________________________________________ Date _________________________________<br />
Parent/Guardian Signature _____________________________________________ Date _________________________________<br />
DPC772A
Appendix E
Appendix E
Student Name:<br />
Date & Time<br />
<strong>Seizure</strong> Length<br />
Pre-<strong>Seizure</strong> Observation (Briefly list behaviors,<br />
triggering events, activities)<br />
Conscious (yes/no/altered)<br />
Injuries (briefly describe)<br />
Muscle Tone/Body<br />
Extremity<br />
Color<br />
Eyes<br />
Mouth<br />
Movements<br />
Movements<br />
Rigid/clenching<br />
Limp<br />
Fell down<br />
Rocking<br />
W<strong>and</strong>ering around<br />
Whole body jerking<br />
(R) arm jerking<br />
(L) arm jerking<br />
(R) leg jerking<br />
(L) leg jerking<br />
R<strong>and</strong>om Movement<br />
Bluish<br />
Pale<br />
Flushed<br />
Pupils dilated<br />
Turned (R or L)<br />
Rolled up<br />
Staring or blinking (clarify)<br />
Closed<br />
Salivating<br />
Chewing<br />
Lip smacking<br />
Verbal Sounds (gagging, talking, throat clearing, etc.)<br />
Breathing (normal, labored, stopped, noisy, etc.)<br />
Incontinent (urine or feces)<br />
Post-<strong>Seizure</strong><br />
Observation<br />
Confused<br />
Sleepy/tired<br />
Headache<br />
Speech slurring<br />
Other<br />
Length to Orientation<br />
Parents Notified? (time of call)<br />
EMS Called? (call time & arrival time)<br />
Observer’s Name<br />
<strong>Seizure</strong> Observation Record<br />
Please put additional notes on back as necessary. Appendix F