Procedures for Students with Seizures

PROCEDURES FOR STUDENTS WITH SEIZURES

Definition

A seizure is a change in sensation, awareness, or behavior brought about by an electrical disturbance in the brain. Seizures are symptoms of epilepsy. There are several different types of seizures.

Background

Seizures may be caused by birth trauma, head injury, infections, strokes, and brain tumors or from causes that are unknown. In 50% of cases the cause is unknown. Seizures occur when there is uncontrolled electrical activity in the brain. These uncontrolled electrical signals cause a change in awareness, movement or sensation.

Febrile seizures, relatively common in children younger than 5 years old, can occur when a child develops a high fever, usually with the temperature rising to 102˚ F or more. These seizures are usually brief and rarely cause problems. A child who has a febrile seizure is not more likely to develop epilepsy.

Signs and symptoms

Symptoms may vary depending on the part of the brain that is involved.

Staring spells
Confusion
Partial or total loss of consciousness
Muscle spasms
Other involuntary movements

Types of Seizures

Generalized Tonic Clonic (Grand Mal) – convulsions, muscle rigidity, jerking
Absence (Petit Mal) – blank dazed stare, sometimes accompanied by blinking or chewing motions
Complex Partial (Psychomotor, Temporal Lobe) – student is out of touch with surroundings, random and purposeless activities which may include picking at clothing and aimless walking
Simple Partial – fully conscious, jerking of one part of the body, sensory experiences including sounds, smells, feelings and visual distortions
Atonic (Drop Attacks) – complete loss of muscle control resulting in collapse

MANAGEMENT

Meeting of Principal's Team

The principal/designee arranges a joint meeting with the student’s teacher(s), the assigned school nurse, (if applicable) and the student’s parent/guardian at the beginning of each school year.

The purpose of the meeting is to discuss the student’s health status, current medications, and their side effects, health history, triggers, emergency care needed, any health related information necessary to assist the student, how school staff will handle emergencies and in-service education.

The DPC/registrar should ensure that seizure/epilepsy is noted on the student’s health information and on the A06 health screen. Obtain several different phone numbers to call for emergencies, e.g. mother, father, doctor, aunt, uncle, grandparents, etc.

Factors that may increase/trigger seizure activity:

Failure to take medication as prescribed
Stress
Lack of sleep
Hormonal changes
Alcohol use
Drug interactions
Flickering light patterns

Standard Seizure First Aid:

Note time seizure starts
Direct students away from hazards or remove objects that may present danger
During a convulsive seizure, turn students on one side if possible and cushion head
Do not restrain movements
Do not put anything in the mouth
Stay with student until he or she is fully alert and oriented
Record the duration and describe the seizure on the Seizure Log
Report the seizure to the appropriate people: parents, school nurse, and/or administrator

Emergency First Aid:

Most seizures are not medical emergencies, but 911 should be called if:

There is no known history of seizures
Seizure lasts more than 3 minutes
Repeated seizures, especially without regaining consciousness
The student does not resume normal breathing after the seizure ends
There is an obvious injury
The student is pregnant or has diabetes
The seizure occurs in water

When to call 911:

Most seizures are not medical emergencies, but 911 should be called if:

There is no known history of seizures
Seizure lasts more than 3 minutes
Another seizure starts soon after the first seizure
Breathing stops
Loss of consciousness
Bluish color to lips and student does not have oxygen prescribed by a physician
The student does not resume normal breathing after the seizure ends
There is an obvious injury
The student is pregnant or has diabetes
The seizure occurs in water

Use of Rectal Diastat:

Diastat is NOT a routine medication; it is used for prolonged seizure activity
Not all students who have seizures will have an order for Diastat
Diastat is given rectally to students during a seizure
Privacy needs to be maintained during Diastat administration
Staff training by an RN is required for assigned staff to administer Diastat
In general education settings, 911 and the parent/guardian are to be called when the decision to administer Diastat has been made. 911 will assess the student and determine the disposition of the student (hospital or home with parent)
In ESE Centers, with Registered Nurses on-site, the student will be monitored by the nurse and the parent will be notified of the seizure activity and disposition of the student will be based on the child’s condition (e.g., remain at school, go home with parent/guardian, or be transported to the hospital)

Hospital Homebound/Dual Enrollment

If a student has a history of frequent absences, then the school should have the parent consider filling out an application for dual enrollment in the hospital homebound program. Most parents will know their child’s condition as to when to return to school without frequent absences. By planning for dual enrollment at the beginning of the year, a parent can be reassured that the student will be assisted in keeping up with the student’s core courses.

In-Service

At the initial meeting with the parent, the school nurse (if applicable) and the classroom teacher, a plan of action should be discussed about in-service on seizure precautions for the appropriate school staff and the specific information needed to assist the specific student. The assigned school nurse (if applicable) should plan to provide scheduled in-service education to school personnel including teachers, clerical and bus drivers. If the school does not have an assigned nurse, contact the Broward County Health Department on-call nurse for assistance.