Maja Ilic, M.D. of Westchester Health Pediatrics discusses the management of seizures in school-age children.

1. Management of
Seizures in school-age
Children
Maja Ilic, MD
Pediatric Neurologist and Epileptologist
Westchester Health
March 31, 2016

2. The nurse should have an understanding of seizures as
well as antiepileptic medications (esp rescue
medications), seizures first aid and precautions to
minimize seizures negative impact on child's quality of
life.

3. Clinical Stereotypical, usually unprovoked, disturbance of
consciousness, behavior, emotion, motor function or
sensation as a result of the cortical neuronal discharge
What is seizure?

4. At least 2 unprovoked seizures occurring >24 h apart
“First unprovoked seizure and a probability of further seizures similar to the
general recurrence risk (at least 60%) after 2 unprovoked seizures, occurring
over the next 10 years.”
WHAT IS EPILEPSY
R. Fisher et al: A practical clinical definition of epilepsy; Epilepsia, 55(4):475–482, 2014

5. Possible precipitation factors
Overexertion
Fever, infections
Massive sleep deprivation
Recent head trauma, concussion
Anxiety, stress
Excessive use of stimulants (ADHD)
Electrolyte disturbance (dehydration, low Glc, Na, Ca, Mg)
Flashing lights

6. EPILEPSY CLASSIFICATION:
Generalized Epilepsy
Focal Epilepsy
Secondary Generalized

7. Seizure onset characterized by electrical
abnormality affecting both hemispheres of the brain
Generalized tonic clonic
Tonic
Myoclonic
- Absence
- Atonic
GENERALIZED SEIZURES

8. Most patients (>60%) will have excellent seizure
control with medications
Some patients will continue to have seizures despite good medical therapy
Ketogenic diet
VNS
Epilepsy surgery

9. Impaired quality of life
Poor school performance
Cognitive deficits (esp memory)
Behavior problems
Social isolation
Increased morbidity and mortality
Accidents
Depression, CVA, CVD
Death-SUDEP
Driving restrictions
Loss of independence
Impact of Refractory Epilepsy

10. Seizure Safety

11. Important for to be aware/have available:
What type of seizure (medical alert bracelet)
Rescue medications
2 spare dose of maintenance medication
When is it (and isn’t) necessary to call for emergency help?

12. Documented nursing assessment notes:
What occurred during ictal (active seizure) phase (progression, sequencing, symmetry of
activity, clonic, tonic)
Consult and obtain information from witnesses
Child should be monitored (RR, HR, temperature, color change, injuries,…)
Posticatal condition and activity should be documented
Any actions taken, including an medication given should be documented

13. ACTIVITIES THAT SHOULD BE AVOIDED/ CLOSELY SUPERVISED:
Swimming alone (life vest)
Wear head protection when playing contact sports/risk of falling
When riding a bicycle, wear helmet, knee pads and elbow pads
Avoid high traffic areas
Climbing chars or ladders and highs
Climb only as high as you can fall without injuring yourself
Use of electrical appliances, sharp objects
Limit exposure to flashing lights (certain seizures types)
Stand well back from the road when waiting for the school bus and away from the
platform edge

14. SEIZURE FIRST AID

15. Loosen clothing
DO NOT try to force an airway (injury)
Turn the person into a side-lying position as soon as convulsion has stopped
DO NOT restrain (will not stop the seizure)
PROVIDE AS MUCH PRIVACY AS POSSIBLE during and after the seizure activity
Continue to asses until child returns to baseline
Allow child to sleep, reorient upon awakening

16. When to call 911:
Lasting > 5min or has 2 or more seizures
If first seizure
If seizure occurred in water
If has patient with DM
Breathing affected or not returning to baseline after seizure stopped

17. HELPFUL LINKS:
www.epilepsyfoundation.org
www.epilepsyadvocate.com
www.epilepsy.com
www.paceusa.org

18. Nursing Assessment and Treatment of
Headaches in School-age Children

19. •It is essential that school nurse is familiar with the
various types and causes of headaches, and is able to
recognize and respond to the warning sings of
potentially serious headaches
• Appropriate assessment is imperative for accurate interpretation of the cause
so that effective intervention can be implemented

20. •Headache is …
a single or repetitive discomfort or pain about
the head or face
• Common problem in adults as well in children
•Over 40% of 7-year-olds and 75% of 15-year-olds are reporting
that they have had a headache

21. •Headaches do not originate from the brain tissue but
arise from stimulation of nerve endings in larger arteries
or veins or from the periosteum, skin of the head, face
or neck, mucosal lining of the airways and sinuses, from
the temporal mandibular joint or from the teeth and
gums

22. Headaches categories:
• Sinus
• Migraine
• Tension
• Depression
• Trauma
• Other (Intracranial masses, BIH, Epilepsy, Aneurysms…)

23. Sinus headaches
• Only 15% of patient with sinus pathology report headache
• Pain in, around, above or behind the eyes, in the maxillary rea and in
face rather that head location
• Dull or throbbing
• Increased by changing to reclining position
• Worse in the morning or during night
• Can be associated with fever, cough, postnasal drip, sore throat

24. Migraine
• 5% of elementary-age children are affected (boys
more) and 17% of adolescents (girls more)
• Many have a positive history of motion sickens or vertigo
• 70% of adolescent suffers have positive family history of migraine

25. MIGRAINE or VASCULAR TYPES:
• CLASSIC (with aura): bilateral, unilateral, not always the same side
• COMMON: MOST COMMON IN CHILDREN/ADOLESCENTS: less well-defined
• COMPLICATED: neurological deficits may persist after the pain resolved
- HEMIPLEGIC/HEMISENSORY-unilateral motor weakness/sensory disturbance (may
last hours after headache gone)
- BASILAR- coming from basilar, posterior cerebral arteries, give rise to occipital
headache often with diplopia, tinnitus, or ataxia (older adolescent girls)
- OPHTHALOPLEGIC- rise to same-side third cranial nerve palsy
• CLUSTER: vascular; nasal discharge, congestion, watery eye, but no nausea or
vomiting

26. TENSION HEADACHES
• Caused by muscular contractions and usually have an onset at 8-12 years of
age
• Most common in overweight females
• Preceded by stress
• No prodrome, no nausea, vomiting
• Often lengthy lasting hours to days
• Generalized or occipital and typically dull pain

27. HEADACHES ASSOCIATED WITH HEAD
TRAUMA, CONCUSSIONS:
• Acute or chronic
• Increasing witching the first hours
• Nausea, vomiting, lethargy or seizures in acute phase
• Dizziness, sleep disturbance, depression, learning difficulies later and
can persist days or weeks

28. IMPORTAINT TO ASK:
• Was student dieting?
• Dehydration?
• Is the child sleeping well?
• DM or suffering from hypoglycemia?
• Any change in appetite and weight?
• What was the student just been doing?
• Is it a post gym/exercise headache?
• Sad, crying, depressed, getting along with peers, teachers, siblings?
• Substances of abuse?
• Vision, sensory, motor changes?

29. Important variables in NURSING ASSESMENT:
• Location
• Quality
• Quantity
• Chronological- how has the pain changes since it started
• Prodrome
• Associated symptoms (nausea, vomiting, deficits)
• Aggravating and/or alleviant factors

30. When to refer to MD ?
• Sudden onset
• Increasing severity
• Severe pain on awakening
• Seizures
• History of head trauma
• Fever
• Nuchal rigidity
• Increasing BP
• Lethargy
• Slurred speech
• Rash, petechiae, ecchymosis
• Vomiting

31. Nursing Intervention:
• Vary with assessment
• Reassurance, rest and carbohydrate snack, hydration, allow to relax
• Acetaminophen, ibuprofen, naproxen (sooner)
• Physician orders may include preventive medications (beta blockers, TCA,
anticonvulsants, calcium channel blockers)
• FOR FREQUENT SUFFERER: keep headache log
• Sending child home is last resort
• REFER CHILD TO THE DOCTOR if headaches requires the child to be sent
home more than once a semester