Are we failing to provide adequate rescue medication to children at risk of prolonged convulsive seizures in schools?

Abstract

ObjectiveThis paper explores the issues that arise from the discussion of administering rescue medication to children who experience prolonged convulsive seizures in mainstream schools in the UK.Situation analysisCurrent guidelines recommend immediate treatment of children with such seizures (defined as seizures lasting more than 5 min) to prevent progression to status epilepticus and neurological morbidity. As children are unconscious during prolonged convulsive seizures, whether or not they receive their treatment in time depends on the presence of a teacher or other member of staff trained and able to administer rescue medication. However, it is thought that the situation varies between schools and depends mainly on the goodwill and resources available locally.RecommendationsA more systematic response is needed to ensure that children receive rescue medication regardless of where their seizure occurs. Possible ways forward include: greater use of training resources for schools available from epilepsy voluntary sector organisations; consistent, practical information to schools; transparent guidance outlining a clear care pathway from the hospital to the school; and implementation and adherence to each child's individual healthcare plan.ImplicationsChildren requiring emergency treatment for prolonged convulsive seizures during school hours test the goals of integrated, person-centred care as well as joined-up working to which the National Health Service (NHS) aspires. As changes to the NHS come into play and local services become reconfigured, every effort should be made to take account of the particular needs of this vulnerable group of children within broader efforts to improve the quality of paediatric epilepsy services overall.

An educational campaign toward epilepsy among Italian primary school teachers

“…As children are unconscious during prolonged convulsive seizures, the administration of rescue medication depends on the presence of a teacher or other members of staff trained and able to administer such treatment. However, the situation is highly variable across schools and depends mainly on the goodwill and the local resources [28]. In addition, several teachers may have concerns about the legal implications of the administration of rescue medication.…”

Knowledge and attitudes of school teachers, preschool teachers and students in teacher training about epilepsy and emergency management of seizures

“…The Practices in Emergency and Rescue Medication for Epilepsy Managed with Community Administered Therapy investigated the management of prolonged convulsive seizures in children outside the hospital in six European countries as judged by healthcare professionals and parents. In the view of healthcare professionals, emergency treatment is insufficient especially in schools 33 34. Yet, the teachers’ perspective remains insufficiently explored.…”

“…In our study, two third of participants would either not take a child on an excursion or only under conditions not all of which are realistic. Training sessions and an adjustment of general conditions, for example, availability of a sufficient number of staff, should ensure participation of all children in class activities as far as possible 33 36 37. Existing special examination regulations taking into account the special needs of students with epilepsy can also improve participation rates but were only familiar to a minority of school teachers and students in teacher training.…”

Rescue Medicine for Epilepsy in Education Settings

“…A recent report from the United Kingdom recommended better integration between schools, providers, and families of students. 5 Similar issues have been discussed regarding school-based management of asthma, diabetes, and food allergies. [6][7][8] …”