Epilepsy Awareness

1. Epilepsy Awareness Epilepsy Nurse Specialists

2. Learning Outcomes • Demonstrate an awareness of what Epilepsy is and recognition of different seizure types • Be able to support children/young person experiencing seizures, ensuring their safety and dignity • Demonstrate awareness of the importance in observing and recording seizure activity • Recognise possible trigger factors

3. Learning Outcomes • Demonstrate an understanding of the epilepsy/emergency management plan • Plan of action and emergency call sheet • Raise awareness of the impact of epilepsy on a child/young person’s life • Understand the need for balancing risk and achieving a quality of life • Raise awareness of the possible educational implications of the condition • Evaluation and close

4. What is Epilepsy? • Epilepsy has been defined as a tendency to have recurrent seizures, 'fits’ or ‘convulsions’ • These are caused by the chemical balance in the brain being upset and causing abnormal firing of nerve cells • One seizure does not constitute epilepsy • Common condition Affects 1:242 School Age Children/young person (Epilepsy Action 2005) • More common in children/young people with learning disability with approx. 22% of people with learning disability being diagnosed with epilepsy

5. Important Points Never assume that all seizures are epileptic in nature ! Common serious chronic condition Approximately 40 different types of seizures The type of seizure the child/young person experiences depends on which part of the brain it starts and how far or quickly it spreads Can develop at any age, however it is usually diagnosed before the age of 20 Very individual/specific to the child/young person

6. Prognosis of Epilepsy • 20% - 30% Excellent prognosis - Seizure free after AED withdrawal – cause no longer exists • 20% - 30% Good prognosis – remission with AED treatment but cause remains • 30% - 40% Seizures continue despite treatment, AED’s may only reduce frequency or severity (Kwan & Sander 2004)

7. What causes Epilepsy 60 - 70% of cases the cause is unknown Some known causes include: Birth injury Head injury Stroke Brain haemorrhage Brain Tumour Meningitis/encephalitis Drugs Alcohol

8. Potential Triggers Flickering lights/photosensitivity Lack of sleep/tiredness Stress Excitement Missed meals High Temperature Menstrual Missed or late medication

9. Classification of Seizures Frontal Parietal Temporal Occipital Seizures can be divided into two main groups • Generalised Seizures • Tonic-Clonic • Typical Absence • Atonic • Tonic • Myoclonic • Focal Seizures

10. Generalised Seizures • These occur when powerful centrally positioned nerve cells behave abnormally • The discharge spreads more or less simultaneously to all parts of the brain • There is loss of consciousness – can be brief or longer

11. Tonic -Clonic Seizures • Most common type of generalised seizure • The child/Young person may have an aura leading into the tonic/clonic seizure • May lose consciousness • Duration usually 1-2 minutes • May follow on from a focal seizure

12. Tonic Phase • Muscles contract, body stiffens and child falls to the floor • The child may become pale • Their breathing may be irregular and around their lips may appear blue • Saliva may dribble from mouth and can be blood stained if tongue has been bitten • Incontinence may occur

13. Clonic Phase • Consists of short sharp rhythmic jerks caused by alternate contraction and relaxation of muscles in the trunk and limbs • Periods of relaxation become more frequent and prolonged • Muscles relax and the body goes limp. At this stage the child will still be unconscious • Slowly they will regain consciousness, but may be groggy and confused

14. Management of Tonic-Clonic Seizures DO: • Stay calm • Assess danger to child- move if in danger • Protect their head • Loosen tight clothing, remove glasses • Time seizure/observe and record • Once seizure has finished aid breathing by gently placing them in the recovery position • Stay with the child until recovery is complete • Reassure and re-orientate the child, tell them they have had a seizure • Allow the child a period of rest /sleep afterwards if required

15. Management of Tonic-Clonic Seizures DON’T: • Try to restrain or restrict the child's movements • Put anything into their mouth • Give the child anything to eat or drink until they are fully recovered

16. http://learn.epilepsy.org.uk/first-aid-for-seizures-in-schools/http://learn.epilepsy.org.uk/first-aid-for-seizures-in-schools/

17. Typical Absence Seizures • Generally a childhood disorder • Brief lasting only seconds- begins and ends abruptly • May look blank and stare, lasting a few seconds • Eye lid fluttering/blinking may occur • May have minor facial movements or head drop • Able to continue normal activity almost immediately

18. Management of Absence Seizures Usually no help is needed Record the time of day and frequency Reassure if necessary Repeat information that the child may have missed If walking they may require guidance

20. Atonic Seizures(drop attack) Sudden loss of muscle tone Fall heavily to the ground Lasts only a few seconds Able to continue normal activity almost immediately

21. Tonic Seizures Muscles contract Body stiffens- trunk, facial muscles and limbs Results in falls Quick recovery

22. Management of Atonic and Tonic Seizures Maintain the child/young persons safety and dignity Over very quickly therefore little can be done during seizure Check for injuries which may need medical attention Stay with the child and reassure

23. Myoclonic Seizures • Quick muscle jerks usually of limbs however head and shoulders may jerk forward • May be one or both sided • Usually seen in specific childhood epilepsy syndromes • Frequent soon after waking • Short lived so difficult to tell if consciousnessis impaired

24. Management of Myoclonic Seizures • Usually so short lived little can be done other than reassure when over. • May become unsteady so if they fall assist and check for injuries • Stay with the child until they recover • Reassure

26. Focal Seizures • Focal seizures have a starting point in a particular area of the brain. • The type of seizure activity seen is dependant on where the focus point is. • Focal seizures can spread to the rest of the brain resulting in a secondary generalised seizure

27. Focal Seizures Symptoms can last from seconds to 1 – 3 minutes can present as: Either mumbling or uncontrolled laughter Sucking, chewing or swallowing movements Plucking at or removing clothing May wander around as if confused

28. Management of Focal Seizures DO: Stay calm Guide the child from danger Stay with the child until recovery is complete Reassure and explain anything they have missed

29. Management of Focal Seizures DON’T: Restrain the child Act in a way that could frighten them, such as making abrupt movements or shouting at them Give the child anything to eat or drink until they are fully recovered

32. Call an Ambulance if …… You think the child needs urgent medical assistance The child has any breathing difficulties following a seizure It is a first seizure The seizure continues for longer than normal One seizure follows another without the child regaining consciousness

33. Following a Seizure After a seizure the child may be….. Confused Have no memory of what has occurred Subdued Tired & sleepy Have a headache Concentration impaired Hyperactivity

34. Care following a Seizure Clear understanding of what has occurred Observe: Breathing & colour Any injuries Be aware of post-ictal state Offer support and counselling as appropriate

35. SUDEP (sudden unexpected death in epilepsy) • Sudden death with no obvious cause • Can occur with/without evidence of a seizure • It is estimated that approx 1 per 1000 people with epilepsy in the UK die as a result.

36. Role of School Staff/Carer • Be aware of children with epilepsy • Have as much information as possible about specific seizures from parent/carer • Observe any unusual behaviour & liaise with parent/carer • School staff may be first to pick up on the seizures like Absences/day dreaming • Positive attitude to epilepsy • Try to avoid treating epilepsy as an illness

37. Role of School Staff/Carer contd. • Recognise/record changes in mood/behaviour/academic achievement/social interaction • Risk assess for particular activities • Promote communication with parents • Minimize embarrassment • Observe and record details of seizures

38. Description of Seizure Why? • Informs care staff of what is normal for child/young person • Assists with establishing a diagnosis • Observe changes in frequency and type of seizures • Helps monitor effects of treatment • Important to review recordings otherwise changes may go unnoticed.

39. Observation of Seizures –Before - During - After • How did the child/young person feel before the event? • In what environment/activity? • Time of day or night? • Anything ‘trigger’ the event? • Was there a warning? • What was the event like? • Standing / Sitting / Lying? • Was there a fall? • Parts of body effected/movements? • Eyes open/closed?

40. Observation of Seizures –Before - During – After contd. • Were they unconscious -fully or just had a vagueness • If unconscious ? How long • Behaviour after seizure • Incontinence /tongue bite /excessive salvia • Any injury or bruising • Length of time in the seizure • How were they after the event ? • Recovery time • Howe did the staff cope with the event • ?Anxiety /debriefing

41. Seizure Management Plan Seizure Management Plan should be in place & available agreed by: Parent/carer Children’s Epilepsy Nurse Specialist Updated yearly or more often if required Be aware of who is responsible for first aid Parent/carer should be informed of seizure ASAP Record seizure

42. Seizure Management Plan WILL PROVIDE: • Description of seizure • Triggers • Management of the seizures • What to do in an emergency • Any other relevant information applicable to the individual child

43. Emergency Seizure Management Plan This is only provided for children who are prescribed emergency medication WILL PROVIDE: Description of seizure/duration Indications for use of emergency medication Initial dose of emergency medication The child’s/young person’s response to emergency medication (if known) Who is trained to administer the medication Consent from the parents for this to be administered

44. Educational Implications A change in behaviour can be observed : May be caused by • Seizure activity • Side effects of medication BUTBehaviour can be independent of seizures/medication? Memory: Can experience some loss or difficulty retaining Information, depending on each individual child/young person.

45. Care of other Pupils • Reassure other pupils present • The type of seizure they witness will have a direct impact on how they cope so give them an opportunity to express their worries and fears. • Do not keep epilepsy a secret

46. Sport Most children with epilepsy should be able to fully participate in most activities ensuring adequate supervision is provided Each activity & each child should be considered individually Special considerations & precautions should be discussed with the parent

47. Social Life The following can increase the risk of seizures: Excess alcohol Lack of sleep Disturbed sleep patterns Missing meals Forgetting to take medication Recreational drugs

48. Points to remember • Do I know about the child’s/young person’s epilepsy? • Is there a Seizure Management Plan in place? • Is the child/young person prescribed emergency medication? if so are relevant staff trained to administer? • Has the person’s epilepsy been reviewed recently? • Lifestyle and impact on Epilepsy • Are any Risk assessment required?

49. Points to Remember contd. Are all relevant staff aware? Normally seizures run their course and the child recovers without need for medical intervention. Children should be given the opportunity to participate in the same activities as their peers promoting independence, confidence and self-esteem.

50. Further Information WEBSITES: • WWW.Young Epilepsy.org.uk • Epilepsy Action Northern Ireland