How to deal with seizures in school

If you are a student with epilepsy, or the parent of a student with epilepsy, you may be thinking about the upcoming school year and wondering that if a seizure occurs in school how will it be treated. The development of an emergency seizure treatment plan is the best assurance that if you or your child has a seizure in school the staff will treat it appropriately.Almost 3 million people in the United States have epilepsy, a neurological condition characterized by unprovoked seizures.

Children under the age of 15 represent 326,000 of these affected persons. Most of these individuals will have complete seizure control by taking daily antiepileptic medications; about 30 % however, will continue to have seizures despite the use of these medications.Seizure emergencies are usually treated at the site with rescue medication and occasionally, for those persons with a vagus nerve stimulator, with an extra stimulation.

The only FDA approved medication for at home (or school) treatment by lay persons is rectal diazepam gel (Diastat AcuDial). This medication has been proven safe and effective in the treatment of prolonged and repetitive seizures. When developing an individualized seizure emergency plan, the school nurse must be apprised of the student’s seizure type, usual daily medication, usual seizure semiology (or what the seizure looks like), how long it usually lasts and any other effects that the child experiences when having a seizure.

A licensed medical provider must order any medication or other treatment to be given in the case of a seizure emergency. Medications must include name, dose and form, and must specify the situation in which the medication should be administered. For instance, if the child experiences a seizure lasting longer than 5 minutes, administer 5 milligrams of diazepam gel rectally. Individual school systems may have a standardized form that the medical provider must complete in relation to administering medication or other treatments in school.

The parent or guardian must supply the medication to be administered. If the state and school district approves administration of medication by a person other than a school nurse there must be proper training provided to that person. There should be a written protocol for them to review as necessary, as well as documentation of training. This can be completed by the school nurse with input from the treating physician, nurse or local epilepsy affiliate. Administering rectal medication in school presents some advanced planning.

Rectal diazepam gel should be contained in a secure, locked, well-situated storage location. Other items that may be utilized during a seizure emergency should be kept together and brought to the site when needed. These include a small blanket (or other material suitable to provide privacy for the student), under pad, gloves, small plastic garbage bag, medication record form with pen and the seizure emergency treatment plan/information. As in any emergency, staff should know at what point 911 should be called.

For seizures that do not stop with treatment at the scene, the child will require an emergency department visit. If seizures stop, the student may need to be observed or to rest in the nurse’s office for some time.For students with seizure disorders, the role of a school nurse is not only to respond to seizure emergencies, but also to provide an environment that enhances and encourages the student’s educational, social, and personal growth.

Generating an environment that allows for a flow of communication between the student, parent/guardian, physician or health care team, and the school nurse is an important factor for appropriate and effective student health care. The availability of a well-organized seizure emergency treatment plan permits effective management of seizure emergencies at school and decreases the potential for seizure-related complications.

An individualized treatment plan provides confidence to school nurses and other trained personnel while minimizing the adverse effects of seizures and potentially reducing the need for emergency hospital visits. An effective and safe seizure rescue medication is a key component in treating prolonged and repetitive seizures.

Parents and health care providers must advocate for children with epilepsy to receive the care they need in school while assuring that their education and extracurricular activities are not constrained by seizures. Development of detailed protocols and a seizure emergency treatment plan will enable a school nurse to give the best possible treatment to students with seizures within the school environment.