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Seizures

Limestone Learning Foundation
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Health Issues Handbook - Templates and Guidelines

This handbook is an official guideline issued under AP-140, Safe Environments of the Limestone District School Board

Table of Contents

Awareness

Seizures are periods of sustained hyperactivity in the brain. During a seizure, the nerve cells leave their normal activities, in synchronized bursts. Seizures may include muscle spasms, mental confusion, distortion of the senses, dizziness, loss of consciousness, uncontrolled or aimless body movement (e.g. walking, mumbling), incontinence, and vomiting. Generally behaviours experienced during a seizure cannot be recalled afterwards.

Causes
  • Brain injury (caused by tumour, stroke or trauma)
  • Birth trauma
  • Poisoning from substance abuse or environmental contaminants, e.g. lead poisoning
  • Aftermath of infection, e.g. meningitis
  • Alteration in blood sugar, e.g. hypoglycemia
Epilepsy is a disorder of the central nervous system, characterized by spontaneous, repeated seizures, caused by sudden, brief malfunctions of the brain.

Management and Prevention

Seizure Recognition
  • Staring spells and does not respond
  • Periods of confusion about where they are, what class is doing
  • Head dropping
  • Sudden loss of muscle tone
  • Episodes of rapid blinking of the eyes or rolling upwards
  • Unusual movements of the mouth or face accompanied by a blank expression
  • Not focused or dazed behaviour
  • Walking aimlessly, mumbling or repetitive movements that seem unusual for the time and environment.
  • Involuntary jerking of an arm or leg
  • Convulsions may occur in which the body stiffens, the child may cry out, fall unconscious and then undergo massive jerking movements. Bladder and bowel control may be lost and the child may vomit.
Responsibilities

Parents should inform the school about their child’s seizure disorder, explaining about types of seizures, description, first aid required, current medication and any side effects including post-seizure symptoms or behaviours.
  • Students, if possible, can make the teacher aware of “auras” or other indicators that a seizure might occur.
  • The school should educate teachers and other school personnel, i.e. yard supervision people and bus drivers as well as classroom students on seizures, identification and first aid. Accommodations following a seizure should be made available.
  • If a child is on medication (the school needs to be aware of what medication and if taken at school) the Board’s Policy and Procedures need to be followed, including the completion of all forms related to Policy E-10, Administration of Medication. The above documentation will assist the school in developing the Emergency Medical Alert Form included at the end of this section.
Tips for Teachers
  • Treat child as you would treat any other student
  • Have The Epilepsy and Seizure Disorder Resource Centre of Eastern Ontario located in Kingston do presentations for students and/or teachers
  • For absence seizures, write instructions on board
  • Assign a class buddy to help if they missed instructions or place during reading. It is also important to give every student a buddy so that they don’t feel that this child is receiving special treatment.
  • Learn the aura’s (something that takes place before seizures) so you can be prepared
  • Make a chart of the first aid procedure visible in the classroom
  • If child is prone to Tonic Clonic seizures (see below) have their desk placed so that if they fall, there is room for the seizure to run its course
  • At the beginning of the year have a discussion with the class about respecting each others differences

Emergency Treatment

Types of Seizures - The following describes types of seizure and staff responses. The Medical Safety Plan outlines specific symptoms, staff responses and the emergency plan for individual students.

1. Generalized Tonic Clonic:
Previously called Grand Mals seizures are convulsions in which the body stiffens, the child may cry out, fall unconscious and then undergo massive jerking movements. Bladder and bowel control may be lost and the child may vomit. Seizures usually last one to two minutes. Breathing may be shallow or even stops briefly and renews as jerking movements end. The child may be confused, or belligerent as consciousness returns.

Treatment - First Aid:
Keep calm. Reassure the other children that the child will be fine in a minute. Keep track of how long the seizure lasts. Follow the child's individual Medical Safety Plan to determine when a call to 911 should be made. Generally a call would be made if the seiaure lasts more than 5 minutes or if it repeats without full recovery. Ease the child gently to the floor and clear the area around him/her of anything that could hurt him. Put something flat and soft (like a jacket) under the head so the child will not be injured during the seizure activity. Loosen any tight neckwear. Turn the child gently on his side in the Recovery Position after seizure subsides. This keeps the airway clear and allows any fluid or vomit in the mouth to drain harmlessly away.
  • Don't put anything in the mouth.
  • Don't try to force the mouth open.
  • Don't try to hold their tongue.
  • Don't try to restrain the movements.
When the jerking movements stop, let the child rest until full consciousness returns. Breathing may have been shallow during the seizure and may even have stopped briefly. This can give child's lips and skin a bluish tinge, which corrects naturally as the seizure ends. In the unlikely event that breathing does not begin again, check the child's airway for any obstructions and give artificial respiration. Call 911 (Call parents)

2. Status Epilepticus
Continuous seizure activity, is a life-threatening medical emergency. Seizures occur one after another, lasting 5 minutes or more without recovery of consciousness between seizures. Immediate medical care is required.

Treatment - Call 911 (Call parents)

3. Post-ictal Psychoses
Refers to short-lived events, behavioural manifestations following seizures. It may include, but is not limited to the following in various degrees: clouding of consciousness, disorientation or delirium, delusions and hallucinations.

4. Simple Partial Seizures
Are limited to one area of the brain. Consciousness is not lost, though the child may not be able to control body movements. Senses may be distorted during the seizures so that the child sees, hears, and smells, or experiences feelings that are not real or heightened senses of perception. Examples: such as smells of burnt toast or eggs. They may see flashing lights.

Treatment - First Aid is usually not required although the child may require comforting and reassurance and re-orientation to present activities (Inform parents).*See Post-ictal psychosis.

5. Absence
Previously called petit mal seizures produce momentary loss of awareness, sometimes accompanied by movements of the face, blinking or arm movements. These may be frequent. The child immediately returns to full awareness after one of these episodes. These seizures are at times difficult to see. Children appear confused or "lost" in current discussions or activities. Providing opportunities for "review" of material or "written" instructions may help the children in class.

Treatment - No first aid is required (Inform parents). * See Post-ictal psychosis.

6. Complex Partial Seizures
Also called temporal lobe or psychomotor epilepsy, produce a sequence of automatic behaviour in which consciousness is lost or clouded. The child may get up and walk around, may pick at clothes, may fling off restraints, may mutter, or tap a desk in aimless undirected way. He may appear to be sleepwalking or drugged. Some children experience fear or paranoia as part of the seizure and may try to leave the room. This type of seizure lasts only a minute or two, but feeling of confusion afterwards may prolong. The child will not remember what he did during the seizure. His actions while having it will not have been under control.

Treatment - First Aid: take arm gently to guide the child to their seat, speak to them calmly. Do not grab hold or speak loudly. If child resists just make sure he/she is not in jeopardy. If child is in seat, ignore automatic behaviour but have him/her stay in the classroom until full awareness returns. Help re-orient the child if he feels confused afterwards (Inform parents).

7. Other Generalized Seizures
Akinetic, Atonic, Myoclonic, produce sudden changes in muscle tone that may cause the child to fall abruptly or jerk the whole body. A child with this kind of seizures may have to wear a helmet to protect the head. The seizures are more difficult to control than some of the others and in some cases may be accompanied by some degree of developmental delay.

Treatment - First Aid: The child should be helped up and examined for injury from the force of the fall, reassured and allowed to sit quietly until fully recovered (Inform parents).

Questions and Answers

Q: How will epilepsy affect a student's school performance?

A: A teachers survey indicated that children with epilepsy may have twice as many problems such as lack of concentration, restlessness, and fidgeting difficulties. Some children with left temporal lobe foci have trouble remembering things, which makes it hard to remember spelling rules. Math problems usually are apparent by the time the child is in grade three. Learning disabilities occur in an estimated 5-50% of children with epilepsy. Seizure type is an important risk factor with most effects on cognitive functions coming from tonic clonic
and complex partial seizures.
Things that may affect the child's learning are:
  • medications that prevent seizures
  • unrecognized seizure activity in the brain may be interfering with attention
  • underlying conditions in the brain that are interfering with learning, memory or the way the brain handles information. This may only happen in some young people with epilepsy. Many students with epilepsy do well in school without any of these difficulties.
Students with epilepsy exhibit the same range of intelligence and ability as other students. If the student has absence seizures quite often during class time, they may be missing out on important information. This may cause difficulties for the student, and it is important that someone takes the time with them to catch up on what they have missed. Learning disabilities may be more common in children who have epilepsy, for three reasons: 1) frequent seizures; 2) anti-epileptic drugs (AED's); 3) underlying brain damage.

Q: Does epilepsy affect a child's behaviour at school?

A: No, epilepsy itself does not affect a child's behaviour. However, sometimes problem behaviour will result from side effects due to medications, parental overprotection or over indulgence, or difficulties in school. Depression is also very common in people with epilepsy. This may be due to medications, and/or social factors. It is important that the teacher treats and disciplines the student with epilepsy in the same manner as all the other students.

Q: What about physical activities? Are there things that children with epilepsy should/should not do?

A: Children who have epilepsy can participate in the same activities as any other children. Daily physical activity and involvement in team/group sports increase self-esteem, independence and overall quality of life for all children. Care must be taken to protect all children from head injuries (e.g. wearing a helmet for batting, cycling, etc.). Children with epilepsy who are involved in swimming activities should swim only under supervision (just as any other child!). The lifeguard or instructor at the swimming facility should be made aware that the student has epilepsy before they enter the pool. Serious injuries in children with epilepsy are uncommon and rarely occur during participation in sports. Bathroom floors or school hallways can be much more dangerous than ice skating, hockey, or soccer.

Q: Do I need to change my classroom or lessons for a student with epilepsy?

A: No, teachers do not need to make any drastic changes to their lessons or their classrooms. However, there are a number of things a teacher can do to help a student with epilepsy to feel more comfortable and at ease in the classroom.
  • If the student is prone to tonic-clonic seizures, have their desk situated so that if they fall, there is plenty of room for the seizure to run its course.
  • Hang a poster in the room or at a central location in the school that lists the important first aid steps to help someone who is having a seizure.
  • Have a buddy system in place so that students are never alone in the bathrooms or hallways. It is important that everyone in the class has a buddy, so that the child with epilepsy does not feel that they are receiving special treatment or that they are the only ones who can not go anywhere alone.
  • At the beginning of the year, lead a discussion with your class about respecting each other's differences.
  • Have a question and answer period with your students about epilepsy (see Appendix, "Some Questions Kids Ask") . This will help dispel myths and calm some of the fears they may have.
  • Invite the Kids on the Block (puppet show) to visit your class and/or your school.
Q: Does the child require medication at school?

A: The child may require medication depending on his/her individual Medical Safety Plan. Please follow all Board Policies related to the Administration of Medication (AP 314).

Q: How should a child with a seizure disorder be identified by staff.

A: If the child has a tonic clonic seizure disorder (grand mal), or the potential for that condition, they should be identified as part of any school procedure for Emergency Alert Form (AP 314).

Q: What can a parent do to establish adequate communication regarding their child's seizures?

The Parents' Contribution
General Information about Epilepsy - Many teachers and administrators have never seen a seizure and may be uncomfortable about dealing with a child who has them. Parents should make sure that the school gets information about epilepsy, first aid, seizure types, and the possible effects of anticonvulsant medication. If you wish, your local epilepsy organization can contact the school for you and provide this information. If seizures are not well controlled, it may be a good idea to educate the other children in the class. Many epilepsy organizations can provide Kids on the Block, a puppet show designed to educate gradeschoolers about epilepsy.

Specific Information about Your Child - Parents will want to provide the school with specific information about their child. This should include: the type of seizures, a description of the seizures, warning signs (if any), procedures to follow during seizures, medications taken by the child, side effects of the medications and/or seizure's, the name of your doctor, and triggers for your child's seizures (strobe lights). The school will need your permission to share pertinent information with the appropriate personnel.

Some Questions Kids Ask

Q: What is epilepsy?

A: Epilepsy means that sometimes the electrical signals in the brain don't work quite right. When that happens, a person with epilepsy will have something called a seizure. Some kids have a kind of epilepsy that makes them have something called a tonic clonic seizure. These kinds of seizures make the person fall down on the ground and shake all over. It might look a bit scary, but it doesn't last very long, and the person is okay afterwards. There are other kinds of seizures that are not as big, and not as noticeable.

Q: Why do some kids have seizures?

A: Kids have seizures when there is a change in how their brain is working. The brain sends messages to different parts of the body. Your brain might send a message to your feet to tell them to move, or to your eyes to close when you are tired. When someone has a seizure, the messages in the brain get too strong, and start moving too fast. The messages get all mixed up, and then the person has a seizure.

Q: How do you get epilepsy?

A: Doctors don't know how kids get epilepsy. Some people start having seizures because they have been in an accident and have hit their head really badly. Other kids might start having seizures if they've been very, very sick and their brain gets an infection.

Q: Can I catch epilepsy?

A: No, you can't catch epilepsy or pass it around. It's just something that some kids have and some kids don't. You can't get epilepsy from hanging around with someone who has it.

Q: Does it hurt to have a seizure?

A: Having a seizure doesn't hurt. A person having a seizure might get hurt if they hit their head when the seizure starts. That's why it's really important to move things out of the way if you see someone having a seizure. What hurts most though is when someone is having a seizure and people watching say mean things or make fun of the person having the seizure. It's important to remember that kids with epilepsy are no different from you, and that they have feelings just like everyone else.

Q: Can you swallow your tongue when you have a seizure?

A: No, a person with epilepsy can't swallow their tongue when they are having a seizure. Their tongue is attached to their mouth just like yours. When someone is having a seizure, they might bite their tongue a little, or start to choke on their saliva. That's why it's important to turn the person on their side if they are having a seizure, so they don't choke on their saliva. It's also really important to NEVER put anything in the person's mouth.

Q: Can you die from epilepsy?

A: No, epilepsy is not a disease, it's a condition, and no, kids won't die from it. Very rarely, a person with epilepsy might have one seizure after another, after another. This is very serious and the person should be taken to the hospital. But kids usually have medication they take to help control their seizures, so that won't happen to them.

Q: What should I do if I see someone having a seizure?

A: The most important thing is to stay calm! If there's a grown-up nearby, someone could run and get them. Don't leave the person alone when they are having a seizure. Move hard objects out of the way, and put something soft like a jacket, underneath their head. When the person stops shaking, you should roll the person on their side. You don't need to worry or be scared, because the seizure isn't hurting the person, and they will be okay in a few minutes. When someone is having a seizure, they might lose control of their bladders and wet themselves. This is not something to laugh at or make fun of. Just cover them with a jacket or blanket so they don't have to be embarrassed when the seizure is over.

Q: Can epilepsy be cured?

A: There is no cure for epilepsy, but sometimes when kids get older, they stop having seizures. Even if they don't stop having seizures, there are pills they can take to keep the seizures undercontrol.

Q: Can you drive a car or get a job?

A: People with epilepsy can get jobs just like anybody else. There are some jobs that might not be safe for people with epilepsy, like being a lifeguard, or a pilot. Lots of very famous or successful people have epilepsy, and that didn't stop them from doing what they wanted to do. If a person with epilepsy wants to get a driver's license, they might need a doctor's note to say that they have not had a seizure in the past year. People with epilepsy can also get a license if they only have seizures while sleeping, or if their seizures are completely controlled by medication.

Q: How often do seizures happen?

A: This depends on the type of seizures, and whether the person is taking medication for the seizures. Most people who are taking medication for their seizures only have a seizure every few months, but it depends on the person. People who have absence seizures can have them many times in a day.

Q: I've heard that you should put something in a person's mouth if they are having a seizure. Is that true?

A: No, you should never put anything in a person's mouth if they are having a seizure. They won't hurt their teeth or swallow their tongue during a seizure, so putting something in their mouth will only make them more uncomfortable.

Q: Can kids have epilepsy do sports and stuff like regular kids?

A: Absolutely! Kids who have epilepsy can do all the same things you can do. All kids should remember to always swim with a buddy and wear a helmet while cycling, skateboarding, roller blading, or batting in baseball. But having epilepsy shouldn't stop kids from playing sports or doing fun things that they like doing.

Taken from: Hymander, L. Epilepsy in the Classroom: A Resource Guide for Primary Teachers.
Eilepsy Kingston
Permission received from Judi Burrill - Epilepsy Kingston.

Resources

Epilepsy and Seizure Disorder Centre of Eastern Ontario

100 Stuart Street
Kingston Ontario K7L 2V6
Telephone: 613-542-6222
Contact: Kim Neill
Including:
  • Epilepsy in the Classroom: A Resource Guide for Primary Teachers, by: Laina K. Hymander.
  • Epilepsy and Your Child: Parents Information Booklet by the Bloorview Epilepsy Program.
  • All About Epilepsy by Epilepsy Ontario (Teacher's Guide Grade 5-12)
Information all taken and adapted from Epilepsy Kingston. Permission to use received from Judi Burrill.

The Limestone District School Board is situated on traditional territories of the Anishinaabe & Haudenosaunee.