Seizures in School: Factors Clinicians Should Consider When Creating an Action Plan
Epilepsy is a neurologic condition that affects both children and adults and accounts for approximately 1 million emergency department (ED) visits per year.1,2 The prevalence of epilepsy among children from birth to 17 years old is 6.3 per 1000 children, making it one of the most common neurologic disorders. While some patient's seizures are adequately controlled with pharmacological treatment, many patients fail to achieve complete seizure control.1 Delaying treatment for epilepsy can lead to hospitalization and ED visits, therefore it is important that adequate rescue measures are taken to control a seizure and minimize its effects.2 Because epilepsy is the third most common emergency seen in the school setting, it is important for school personnel to be aware of appropriate seizure intervention measures to provide adequate care for these patients.1,2
Advanced planning prior to attending school is an important step in the management of a child's epilepsy.1 Seizures are typically managed by school nurses, who rely on prescribing professionals for medical orders regarding seizure treatment. These medical orders can then be transcribed into an action plan that uses simple language and dictates what should be done if a child should have a seizure. In situations where a school nurse is unavailable, unlicensed assistive personnel, such as school workers who volunteer to assist a child in the case of a seizure, may use the action plan to care for a patient. In schools that do not have a nurse, prescribing professionals often provide an action plan and training directly to unlicensed assistive personnel.
When writing an action plan, there are several factors that clinicians should take into consideration.1 Generally, to prevent progression to status epilepticus, rescue medications are administered after a seizure has lasted 5 minutes. However, medication administration timing may be modified based on a patient's seizure history or other specific needs. Other important factors to consider when creating an action plan include concomitant medications, history of medication use, when to seek further medical care, and methods of communication with other school personnel and family regarding seizure frequency and medication use. Any question that may arise when a clinician is creating an action plan should be directed to the school principal or heads of school.
There are several different rescue medications available for the treatment of seizures, which are summarized in Table 1.1 In addition to providing instructions regarding medication administration for children with epilepsy, it is also recommended that clinicians provide guidance on the management of potential adverse effects (AEs) from these medications. Common AEs seen with all seizure rescue medications include decreased respiration, oversedation, and cardiopulmonary instability. The severity of these effects varies greatly depending on the length of the seizure, the dose of the medication, and potential interactions with other medications. It is recommended that personnel trained in cardiopulmonary resuscitation be available due to the potential for seizures to be severe and require emergency therapy.