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December 11, 2006
Creating a preparedness plan can alleviate the stress and uncertainty of a seizure. Confusion, stigma, and avoidance are common terms used by healthcare providers to describe the way people with epilepsy are generally perceived. Although more people suffer from and die as a result of epilepsy each year, those with epilepsy often do not let anyone know they have the disorder out of fear of being shunned. Epilepsy affects approximately 2.5 million Americans, one third of whom are newly diagnosed children. Pediatric neurologists, nurses, and health departments across the country are working together to educate and empower parents, providers, and patients, teaching them that preparedness is key to dealing with a seizure disorder. “Epilepsy can affect anyone. Although it is more common in neonatal and geriatric cases, it can and does occur in people for sometimes no reason at all,” says Steven M. Wolf, director of pediatric epilepsy and codirector of the epilepsy unit at Beth Israel Medical Center and St. Lukes-Roosevelt Medical Center in New York. Types of Seizures A seizure can be the result of any number of factors or it can be unprovoked. Some reasons a seizure may occur include: head trauma, high fever, and overwhelming infections such as a virus or meningitis. Metabolic disorders and a brain tumor can also cause seizures, but other symptoms generally accompany these presentations, Wolf says. Within the diagnosis of epilepsy are two types of seizures that occur depending on what part of the brain the seizure affects, says Wolf. A generalized seizure affects both sides of the brain while a partial seizure originates from one part of the brain. Within each seizure category are several subcategories. “In order to properly train a school nurse or other healthcare provider, it is imperative to know what type of seizures the child has to know how to properly care for them,” says Patricia McGoldrick, NP, MPA, of the pediatric neurology and epilepsy department at Beth Israel Medical Center and the associate director of the Developmental Disability Center at St. Lukes-Roosevelt Medical Center. “In most cases, once a person has been diagnosed with either generalized or partial seizures rarely do they cross over to the other,” says Wolf. Under the generalized category, the subcategories include the following: • Absence seizures: Also known as “petit mal,” “this is the most common type of seizure in school-aged children because it is characterized by staring spells. It is often detected by the teacher,” says Wolf. In most cases, the child has no warning that the seizure is coming and is overwhelmed with feelings of missing something once they recover from it. The seizure tends to last 15 seconds and although it mimics daydreaming, the child will not respond if called or touched, Wolf explains. • Tonic-clonic seizures: Often referred to as “grand mal,” in these seizures the child’s body becomes rigid before he or she falls to the ground with massive jerking movements. These seizures generally last between one and two minutes with the child’s breathing becoming very shallow or stopping entirely while jerking. When the child wakes, he or she is often confused, sleepy, or angry. • Atonic seizures cause victims to lose tone and fall to the ground before they can react. Although the seizure lasts only roughly 15 seconds, victims can harm themselves from the fall. • Myoclonic seizures are similar to the muscle jerks people experience while sleeping. The seizure can cause sudden, brief, and massive muscle jerks that range from mild to severe. • Juvenile myoclonic epilepsy generally starts around puberty and is most common in people who had absence seizures as a child, according to Epilepsy.com. The two types of partial seizures are complex and simple. A complex partial seizure, which often originates in the temporal lobe or frontal lobe of the brain, is characterized by a blank stare or a daydreamlike look. The person may make random movements, stumble around, repeat phrases or words, or pull at their clothes while not being conscious of their behavior, according to Epilepsy.com. The seizure lasts between 30 seconds and two minutes, and the person will have no recollection of his or her behavior. Unlike a complex partial seizure, a person who has simple partial seizures will be conscious of his or her surroundings but cannot control his or her movements. Also, senses may become exaggerated. According to Epilepsy.com, this type of seizure lasts no more than two minutes but can affect the motor or nervous system. Being Prepared With nearly 315,000 students in America having epilepsy, it is natural to assume that the school nurse, teacher, or teacher’s aide knows what to do in the event of a seizure. However, this is most often not the case. “Sixty percent of school nurses are uncomfortable with caring for a student with epilepsy and another large majority have never had to treat a child with a seizure,” explains O’Hara. Whether or not a school nurse has cared for a child with epilepsy, it is important to create a standardized plan of care for how school officials deal with a seizure. The Fairfax County Health Department and school district have had a collaborative agreement in place since 1957 to standardize the care a child receives based on medical history so there is no confusion as to what the protocol for caring for a particular child may be, says Esther M. Walker, RN, BSN, MSA, nursing research education coordinator with the Fairfax County (Va.) Health Department. In the 2005-2006 school year, within the Fairfax school district, 2,954 children were diagnosed with a seizure disorder. One standard care protocol available within the school district is a seizure preparedness plan. Once a child has been identified as having epilepsy, school officials and the health department work together to create an individualized plan. “The principal of the school will identify three members—generally a teacher, a member of the office, and a teacher’s aide—of his staff in addition to the school nurse to be trained on how to care for the child as well as initiate any rescue medication,” says Walker. “Also on staff at the hospital will be a clinic aide who is an employee of the Fairfax Health Department and he will also be trained to assist in the event of a seizure. “Our standard care plans have been devised with the lay person in mind and each plan is tailored to a specific child. We do not have one set protocol for all children with epilepsy because there are so many different types of seizures to be prepared for,” she continues. During the 2005-2006 school year, Walker says the school district had 50 orders for the Diastat AcuDial rescue medicine available but administered it only 12 times. “In the event that rescue medication must be administered, a call to 9-1-1 is made simultaneously,” she says. A vagus nerve stimulator, which is similar to a pacemaker, was ordered in 12 cases but was not necessarily used all 12 times, according to Walker. Elements of a Preparedness Plan Each seizure preparedness plan should include the following: • the clinical diagnosis of an epileptic disorder along with the type of seizure the patient has (It should be signed by a physician and should include the date of the first seizure as well as the last.); • signs and symptoms of each seizure disorder with proper notation of the type of seizure; • step-by-step instructions of what to do when the patient has a seizure, including first aid; • each plan should be tailored to the individual—for example, if the patient generally has two to three seizures in a row, this should be noted so appropriate steps can be taken; • if rescue medication is ordered, there should be clear, visual instructions of where to locate it and when and how to administer it; and • after the seizure, it should be noted how long the seizure(s) lasted, what signs and symptoms preceded the seizure, and anything considered unusual for that particular patient. The collaborative agreement between the Fairfax Department of Health and the school district is an innovative and well-run program that focuses on each individual student’s health rather than treating all the children the same, says O’Hara. Although most epileptics are wary of wearing a medical identification bracelet, carrying a preparedness plan with them can be helpful to those around them in the event of a seizure, she says. Children with epilepsy generally outgrow it. For teens and adults, the condition can be well-maintained through medication and diet to reduce and possibly eliminate breakthrough seizures. “People with epilepsy can accomplish great things and should not be held back because of it,” says Wolf. — Kim M. Norton is a freelance writer/journalist.
National Institute of Neurological Disorders and Stroke. Accessed September 29, 2006. Lending a Helping Hand • Roll the person on his or her side to prevent choking on any fluids or vomit. Keep the person’s airway open. If necessary, grip the person’s jaw gently and tilt his or her head back. • Cushion the person’s head. Loosen any tight clothing around the neck. • Do not restrict the person from moving unless he or she is in danger. • Do not put anything into the person’s mouth, not even medicine or liquid. These can cause choking or damage to the person’s jaw, tongue, or teeth. • Remove any sharp or solid objects that the person may hit during the seizure. • Note how long the seizure lasts and what symptoms occurred so you can tell a doctor or emergency personnel if necessary. • Stay with the person until the seizure ends. — Source: National Institute of Neurological Disorders and Stroke When to Call 9-1-1 • The seizure happened in water. • The seizure lasts longer than five minutes. • Once the seizure stops, the person does not begin breathing again or does not regain consciousness. • Another seizure starts before the person regains consciousness. • The person injures himself or herself during the seizure. • This is a first seizure or you think it may be. (If in doubt, check to see whether the person has a medical identification card or jewelry stating that he or she has epilepsy or a seizure disorder.) — Source: National Institute of Neurological
Disorders and Stroke
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