Rescue Medicine for Epilepsy in Education Settings

Abstract

Children and adolescents with epilepsy may experience prolonged seizures in school-associated settings (eg, during transportation, in the classroom, or during sports activities). Prolonged seizures may evolve into status epilepticus. Administering a seizure rescue medication can abort the seizure and may obviate the need for emergency medical services and subsequent care in an emergency department. In turn, this may save patients from the morbidity of more invasive interventions and the cost of escalated care. There are signifi cant variations in prescribing practices for seizure rescue medications, partly because of inconsistencies between jurisdictions in legislation and professional practice guidelines among potential fi rst responders (including school staff). There also are potential liability issues for prescribers, school districts, and unlicensed assistive personnel who might administer the seizure rescue medications. This clinical report highlights issues that providers may consider when prescribing seizure rescue medications and creating school medical orders and/or action plans for students with epilepsy. Collaboration among prescribing providers, families, and schools may be useful in developing plans for the use of seizure rescue medications.

Optimizing the Diagnosis and Management of Dravet Syndrome: Recommendations From a North American Consensus Panel

“…Rescue medications recommended are similar to what is used in other types of epilepsy (rectal diazepam for very young children or buccal or nasal midazolam at any age). 86 However, given the risk of status epilepticus, panelists strongly endorsed that rescue medication be given at seizure onset, rather than after three to five minutes, in those with a history of convulsive seizures that are typically prolonged.…”

Providing teachers with education on epilepsy increased their willingness to handle acute seizures in children from one to 10 years of age

“…The chance of successfully ending a seizure is 96% if the rescue medication is administered in the first 15 minutes after onset, but then it falls to 57% . As ambulances can take too long to arrive to provide rescue medication, nonhealthcare professionals caring for children, such as preschool teachers, should be prepared to play an active role in responding to a seizure .…”

Role of the School Nurse in Providing School Health Services

“…School nurses play an important role in interpreting medical recommendations within the educational environment and, for example, may participate in the development of action plans for epilepsy management and safe transportation of a child with special health care needs. 11,12 School nurses may also provide insight to a student's pediatrician when attendance concerns, parental noncompliance with medical home goals, or even neglect or abuse is suspected. In addition, with increased awareness recently about such issues as head injuries, the school nurse is poised to offer on-site assessment of the student's postconcussion progress and adaptations required in the educational plan.…”