TrainingThe Center for Life Enrichment

Resource: MTTP Student Manual & Epilepsy.com

Seizures

What is a Seizure?A seizure is a sudden disruption of the brain’s

normal electrical activityIn some cases, a seizure can cause a loss of

consciousness and make the body twitch and jerk

People who have a repetitive pattern of seizure activity have a condition called epilepsy

A large percentage of individuals with developmental disabilities have epilepsy

There are more than 40 different seizure disorders

What to look for? The symptoms of a seizure depend upon the area of the

brain affectedFor example, if the abnormal electrical discharge affects

only a very small area of the brain, the individual might simply experience the symptom of an odd smell or taste

When large areas of the brain are involved, signs are more noticeable. The person may jerk and have muscle spasms, known as convulsions

Seizures may also cause a loss of consciousness or altered consciousness, a loss of bladder control and confusion

Most seizures last from 2-5 minutes and leave the person feeling tired and confused

The individual may complain of a headache and sore muscles

Most people cannot recall what happened during the seizure

Types of SeizuresThere are over 40 different types of seizures. Some of

the more common types of seizures include:Febrile Seizures: associated with high fevers and occur

in about 4% of children up to 5 years of ageSimple Partial Seizures: isolated to a small area of the

brain and is not associated with an impairment in consciousness

Jacksonian Seizures: begin in an isolated part of the body and then progressively spread or “march” to other parts of the body on the same side. A Jacksonian seizure may become generalized

Complex Partial Seizures (Psychomotor Seizures): impairment in consciousness and usually lasts 2-4 minutes. The individual appears to lose touch with his/her surroundings and becomes confused. He/she may demonstrate repetitive or meaningless behaviors (e.g. aimless arm or leg movements, utterances of meaningless sounds, etc.). Mild confusion will remain immediately following the seizure

Types of Seizures Continued… Generalized Tonic-Clonic Seizures (Grand Mal

Seizures): the electrical malfunctions in the brain quickly spread to adjoining parts of the brain and the entire brain malfunctions. It is characterized by the sudden onset of muscle tensing and is often associated with an audible cry or moan. The individual loses consciousness and may fall. The muscle tensing changes to muscle contractions which cause jerking movements or convulsions. The individual often turns his/her head to one side, clenches his/her teeth, and loses bladder control. The seizure usually lasts less than 3 minutes. If it lasts 5 full minutes or longer, 911 should be called. An exception would be if the neurologist writes an order/protocol for the individual with different parameters for calling 911. When the seizure is over, the person may initially be confused and extremely tired

Three or more Tonic-Clonic Seizures in a row without full recovery in between is a 911 medical emergency because the person’s breathing is affected. Emergency treatment is needed to stop the seizure activity and prevent permanent damage or death

Types of Seizures Continued…Absence Seizures (Petit Mal Seizures): absence

seizures are generalized with sudden loss and regaining of consciousness and no aura or warning. It is characterized by impairment of the level of consciousness which may cause confusion, diminished awareness of the environment, inability to respond to stimuli, and amnesia. They are not associated with convulsive movements. The presentation may include staring, fluttering of the eyelids, or facial muscle twitching. Absence seizures rarely last longer than 30 seconds and are usually 1-10 seconds in duration. Though brief, these seizures may occur as frequently as 100+ times per day. The seizure ends as suddenly as it began and the individual resumes his/her activity, completely unaware of what has happened

Individual/Caregiver Responsibilities The individual/caregiver should know:

A person with a seizure disorder should wear a medical bracelet or necklace that identifies the disorder and any medications taken

Seizure control can be enhanced by following a healthy diet, getting plenty of sleep and keeping stress levels to a minimum. Since fever can trigger seizures, take medication to lower fever at the first sign of illness

If the individual’s seizures begin with an aura (a sensation that precedes the onset of a seizure), he/she should get to a safe place and lie down until the seizure passes

If a seizure occurs, what to doAn individual can be protected from injuries that can cause

seizures by wearing a helmet when riding a bicycle, skateboard, or motorcycle, or when playing certain sports, and wearing a seat belt when riding in a motor vehicle

First Aid for Seizures1. Stay calm, most seizures only last a few minutes

2. Prevent injury by moving any nearby objects out of the way

3. Pay attention to the length of the seizure

4. Make the person as comfortable as possible

5. Keep onlookers away

6. Do not hold the person down

7. Do not put anything in the person’s mouth

8. Do not give the person water, pills, or food until the person is fully alert

9. If the seizure continues for longer than five minutes, call 911. An exception would be if the neurologist writes an order/protocol for the individual with different parameters for calling 911

10. Be sensitive and supportive, and ask others to do the same

Epilepsy Foundation’s Recommendations: If there is no specific protocol from the HCP, follow

the Epilepsy’s Foundations recommendation for “when to call for an ambulance”No need to call an ambulance if…

Medical I.D. jewelry or card says “epilepsy”

AndThe seizure ends in under five minutes

AndConsciousness returns without further incident

AndThere are no signs of injury, physical distress, or

pregnancy

Epilepsy Foundation’s Recommendations Continued: An ambulance should be called if…

The seizure has happened in waterThere’s no medical I.D. and no way of knowing whether the

seizure is caused by epilepsyThe person is pregnant, injured, or diabeticThe seizure continues for more than five minutes. An exception

would be if the neurologist writes an order/protocol for the individual with different parameters for calling 911

A second seizure starts shortly after the first has endedConsciousness does not start to return after the shaking has

stopped If the ambulance arrives after consciousness has returned,

the person should be asked whether the seizure was associated with epilepsy and whether emergency room care is wanted

Documentation of Seizures Observe all seizure activity carefully and record the information

accurately This record should be shared with the supervisor, delegating nurse,

residential provider/family, and the individual’s neurologist/HCP Staff’s accuracy in reporting seizure activity is critical in providing

the HCP with information necessary to prescribe an appropriate treatment plan

Be alert to any changes the individual may show from his/her “usual pattern” of seizure activity. Report these changes to your supervisor and delegating nurse immediately

A seizure record must be maintained on all developmentally disabled individuals who receive anticonvulsant medication(s) for the treatment of seizures

Discontinuation of a Seizure Record for a DD individual who is “seizure free” but continues to receive anticonvulsant medication(s) should be reviewed by the team for appropriateness and parameters for reinstituting documentation should be outlined

Anticonvulsant Medications Anticonvulsant medications are used to control recurrent

seizures known as epilepsy/seizure disorder Anticonvulsants do not cure epilepsy Individuals on anticonvulsant medication must see their

doctor regularly for blood tests to monitor drug level in the bloodstream and to monitor for any side effects. Side effects that should be reported to the RN CM/DN and doctor include: Sluggishness Dizziness Hyperactivity Uncontrolled eye movements Speech or vision problems Nausea or vomiting Problems sleeping

Most Commonly Used Anticonvulsant Medications Carbamazepine (Tegretol, Carbatrol) Phenobarbital (Phenobarbital, Luminal) Phenytoin (Dilantin) Primidone (Mysoline) Valproic Acid (Depakene) Divalproex Sodium (Depakote) Tiagabine (Gabitril) Levetiracetam (Keppra) Clonzepam (Klonopin) Lamotrigine (Lamictal) Gabapentin (Neurontin) Topiramate (Topamax) Oxcarbazepine (Trileptal) Zonisamide (Zonegran)

Seizure ChartingOn the front of the Seizure Observation

Record, observe all seizure activity carefully and record the information accurately

On the back of the Seizure Observation Record, write a comment in the spaces provided if any of the check marks on the front of the Record need further explanation. If you have reported the observed seizure activity to your supervisor, RN CM/DN, or HCP, document this in the note/comment section of the Record

Questions?