[ Seizure Prevention | Emergency Management ]

Managing Seizures at School

Epilepsy produces seizures that vary dramatically in appearance, effect on the child and the kind of management they require.

Absence

Absence seizures produce momentary loss of awareness, sometimes accompanied by movements of the face, blinking, or arm movements. These may be frequent. These events differ from daydreaming in that they interrupt ongoing activity. The child immediately returns to full awareness after one of these episodes.

Management: Make sure the child did not miss any key parts of the lesson.

Simple partial seizures

Simple partial seizures are limited to one area of the brain. Consciousness is not lost, though the child may not be able to control body movements. Senses may be distorted during the seizure so that the child sees, hears, smells or experiences feelings that are not real.

Management: If the child seems confused or frightened, comfort and reassure.

Complex partial seizures

Complex partial seizures (sometimes called psychomotor or temporal lobe epilepsy) produce a variety of automatic behavior in which consciousness is clouded. The child may get up and walk around, be unresponsive to spoken direction or respond inappropriately, may fling off restraints, may mutter or tap a desk in an aimless, undirected way. He or she may appear to be sleepwalking or drugged. Some children experience fear as part of the seizure and may try to leave the room. This type of seizure usually lasts only a minute or two, but feelings of confusion afterwards may be prolonged. The child will not remember what happened during the seizure and his or her actions while having it will not have been under conscious control.

Management: If a child has an episode of this type and appears dazed and oblivious to his surroundings, the teacher can take his or her arm gently (if away from a seat), speak calmly, and guide  carefully back to his or her seat. Do not grab hold or speak loudly. If the child resists, just make sure he or she is not in any jeopardy. If the child is seated, ignore the automatic behavior but stay in the classroom until full awareness returns. Help re-orient the child if he or she seems confused afterwards.

Generalized tonic clonic

Generalized tonic-clonic seizures are convulsions in which the body stiffens and/or jerks; the child may cry out, fall unconscious and then continue massive jerking movements. Bladder and bowel control may be lost. Seizures usually last a minute or two. Breathing is shallow or even stops briefly, then renews as jerking movements end. The child may be confused, weary or belligerent as consciousness returns.

Management: First aid for a convulsive seizure protects the child from injury while the seizure runs its course. The seizure itself triggers mechanisms in the brain to bring it safely to an end. There are no other first aid steps that can hasten that process. When this type of seizure happens, the teacher should:

• Keep calm. Reassure the other children that the child will be fine in a minute.
• Ease the child gently to the floor and clear the area around him of anything that could hurt him.
• Put something flat and soft (like a folded jacket) under his head so it will not bang against the floor as his body jerks.
• Turn him gently onto his side. This keeps his airway clear and allows any fluid in his mouth to drain harmlessly away. DON'T try to force his mouth open. DON'T try to hold on to his tongue. DON'T put anything in his mouth. DON'T restrain his movements.
• When the jerking movements stop, let the child rest until full consciousness returns.
• Breathing may have been shallow during the seizure, and may even have stopped briefly. This can give the child's lips or skin a bluish tinge, which corrects naturally as the seizure ends. In the unlikely event that breathing does not begin again, check the child's airway for any obstruction. It is rarely necessary to give artificial respiration.

Some children recover quickly after this type of seizure; others need more time. A short period of rest, depending on the child's alertness following the seizure, is usually advised.
However, if the child is able to remain in the classroom afterwards, he or she should be encouraged to do so. Staying in the classroom (or returning to it as soon as possible) allows for continued participation in classroom activity and is psychologically less difficult for the child. Of course, if he has lost bladder or bowel control, he should be allowed to go to the rest room first. A change of clothes kept in the health room or the principal's office will reduce embarrassment when this happens.

If a child has frequent seizures, handling them can become routine once teacher and classmates learn what to expect. One or two of the children can be assigned to help while the others get on with their work.

Other Generalized Seizures

Other Generalized Seizures (akinetic, atonic, myoclonic) produce sudden changes in muscle tone that may cause the child to fall abruptly, or jerk the whole body. A child with this kind of seizure may have to wear a helmet to protect the head. These seizures are more difficult to control than some of the others and, in some cases, may be accompanied by developmental delay.

Management: The child should be helped up, examined for injury from the force of the fall, reassured and allowed to sit quietly until fully recovered.