Epilepsy

Epilepsy is a relatively common disorder that takes the form of recurring seizures. A seizure occurs when there is a sudden uncontrolled surge in the normal electrical activity in all or part of the brain.

Epilepsy affects people of all levels of intelligence and from all age groups. Probably about two people in every hundred have some form of epilepsy. However in a majority of cases, seizures can be well controlled by continuing treatment with a range of effective drugs.

Most people with epilepsy can lead an essentially normal life. About 60% of people will have excellent control of their epilepsy if they take their medication regularly. A further 20% will have the frequency and severity of their seizures greatly reduced, while the remaining 20% will have intractable (uncontrolled) epilepsy.

While the cause of a person's epilepsy is not known in many cases, we do know that seizures can result from such things as severe head injuries, birth damage and brain infections.

Tonic-clonic seizures (Previously called Grand Mal)

In this type of seizure the person suddenly falls rigid and unconscious to the ground (tonic phase), and may then begin to shake, or to convulse, with vigorous and regular muscle contractions (clonic phase). Saliva may bubble from the mouth, and if the tongue or lips have been bitten there may be a little blood as well. Sometimes the intense muscular contraction at the beginning of the seizure causes a cry as the air is forced from the lungs, and the bladder may empty.

Seizures of this kind usually stop on their own within four or five minutes, but most people will then sleep for half and hour or more afterwards and may be drowsy and confused on awakening.

Complex Partial Seizures (Temporal Lobe Epilepsy):

Complex Partial seizures are often accompanied by strange sensations, sweating, upset stomach, nausea, illusions and feeling of déjà vu. Consciousness is impaired, therefore reassurance and comforting the person is important. The person may wander around aimlessly and continue to stare. They may perform familiar actions but in an unusual and repetitive way. These repetitive actions are called "automatisms". Do NOT restrain the person in any way (this may provoke an unconscious reaction), but rather guide them gently from danger.

Childhood Absence Epilepsy (Previously called Petit Mal):

Absence seizures are relatively common in childhood usually between the ages of 3-12 years, with peaks around 6-7 years. It is more common in girls than boys. Absence seizures are characterised by brief episodes of staring with impairment of awareness and responsiveness. The seizure usually lasts 10 seconds, but may last as long as 20 seconds. Absence seizures start and end suddenly. Sometimes their eyes may blink rapid or roll upwards, or there may be minor twitching of the face. This may happened many times during the day. It may be mistaken for daydreaming or lack of concentration. This may also affect their learning.

First aid:

Tonic Clonic Seizures:

Keep calm.
Move any objects out of the way.
Place something soft under their head.
Roll the person over onto their side as soon as possible with head turned to one side and chin extended (recovery position). This will prevent the tongue falling back and will keep the airway open. In most cases the seizure will come to an end well within a few minutes.
Don't move the person during the seizure unless it is essential for their safety.
Don't try to force anything into the mouth as you may break teeth or have your fingers badly bitten.
Don't try to stop the seizure - you can't stop it.
Call an ambulance if the seizure has not stopped within five minutes, if the person is injured, if another seizure follows quickly or if you are in doubt.
Offer support and reassurance when the person returns to consciousness.
Help the person to a place close by where they can rest or sleep for a while to recover from the seizure, and make certain they are able to look after themselves when they awake.
Consider the implications for other students who may have been present.

Complex Partial Seizures:

Try to guide the person gently to safety.
Do not try and restrain the person during the seizure.
Stay with the person until they have fully recovered.
Tell them that they have had a seizure and reassure them.
Call an ambulance if the person has not begun to recover after 10 minutes

Absence Seizures:

Recognise that the seizure has occurred.
Reassure the person and repeat any information which may have been missed during the seizure.

Treatment for a prolonged, major seizure

For some few students who have severe epilepsy (and some other rare medical conditions) the immediate administration of rectal DiazepamTM may be necessary at various times. The procedure is rectal infusion: the introduction of a fluid into the rectum for the purposes of drug administration. Alternatively, some students may require buccal (oral) or intranasal midazolam administered for a prolonged seizure.

There are some risks associated with administering rectal DiazepamTM:

hygiene risks
the risk of perforation of the rectum
risks related to dosage
diagnosis before administering ValiumTM
observation after administration
social risks
risk of unconsciousness, and even death.

This risk is reduced with rectal tubules now available through hospitals.

Guidelines for the use of rectal ValiumTM

The small number of students who need to have rectal ValiumTM administered at school are usually identified early and are well known to health and education services. This knowledge should make it possible to make decisions about medical management on a child-by-child basis. There is therefore no need for generally applicable rules.
If there is a need for possible administration of rectal ValiumTM, a management group should be formed for each child involving the paediatrician, child's parents, teacher, and other professionals. A management plan should be written as part of the student's medical action plan.
In some circumstances, the frequency of seizures may create a need for high level support in the school setting.
Where parents, doctor and school staff agree, the administration of rectal diazepam could be carried out by a trained staff member in the specific needs of the one child. (see Form 6).
Staff should only be permitted to undertake such procedures if they have been credentialed, and if they are willing and confident to carry out the procedure. (See Training and Credentialing of Staff).
Because of the risks involved, it is recommended that two people are available during and after the administration of the drug, to observe the child.
Care should be taken in recording all procedures and observations. Strict procedures should be established for accounting for and storage of the drug and recording effects, as detailed in the section on oral medication.
Midazolam is now also used for children who have prolongued seizures and is much easier to administer. It is available in plastic ampoules 5mg per 1ml. This can be given as nasal droplets or buccal (cheek droplets) for seizure management.

The above guidelines for administration of rectal valium still apply for the use of Midazolam.

For information regarding Midazolam training please contact the Epilepsy Association of Tasmania Inc, by phone or email in each area of the state. Yellow folders for medical practitioners to fill in regarding individual epilepsy plans and protocols also provided by the Epilepsy Association of Tasmania:

Hobart
Phone: 62 346967
Email: etas.s@bigpond.net.au

Launceston
Phone: 63 365 148
Email: etas.n@bigpond.net.au

Burnie
Phone: 64 31 7848
Email: etas.nw@bigpond.net.au

Website: www.epilepsytasmania.org