Legal Rights of Children with Epilepsy in School & Child Care

CHAPTER SEVEN
Administration of Emergency Antiepileptic Medication in Schools
7.1Q: When should emergency antiepileptic medications be administered and
which ones are appropriate?
A: Some children with epilepsy are susceptible to prolonged seizures; these seizures
can cause serious brain injury and even death. An example of extremely serious
seizure activity is status epilepticus. Status epilepticus is a period of prolonged
seizure activity, occurring either when one seizure does not stop or when a series
or cluster of seizures continues without the person returning to baseline. Current
medical definitions consider 10 minutes as the amount of time after which
uninterrupted seizure activity would be considered status epilepticus. The overall
mortality rate of patients experiencing status is estimated to be 20 percent. Such
seizures can also cause intellectual dysfunction, neurological deficits and
chronic epilepsy. See Chapter 1 for additional information about status
epilepticus.
The standard out-of-hospital medication for treatment of prolonged or cluster
seizures is Diastat AcuDial. This is the trade name of a gel preparation of
diazepam for rectal administration. Diazepam is in a class of drugs called
benzodiazepines, which are central nervous system depressants (a common
brand name of the oral form of this medication is Valium). 46 Caregivers are
directed to administer diazepam—typically three to five minutes after a seizure
begins—in order to abort the seizure and prevent status epilepticus.
Diazepam was specifically developed to be administered by people without
medical training, such as parents, teachers and other caregivers. It is the only
FDA-approved medication for treatment of cluster seizures by non-medically
trained caregivers.
Following standard procedures, as prescribed by the treating physician, lay
people can easily and safely administer diazepam when a prolonged seizure or
cluster of seizures occurs, provided they are familiar with the manufacturer’s
instructions. The medication is contained in pre-packaged syringes that are
46 As noted in Chapter 1, Ativan (lorezapam) and Versed (midazolam) are benzodiazepines that are often
used to control seizures in emergency rooms and other hospital settings. Many doctors suggest using these
medications for seizure clusters or to break a prolonged seizure prior to the development of status
epilepticus before taking a patient to the hospital. These medications have undergone some testing in which
the drug is placed or sprayed inside the cheek or under the tongue of a person who is seizing. However,
since these medications have not completed the clinical trials required for FDA-approval for treatment of
seizures, they are not widely available for this purpose, and their use has been limited to physicians who
feel comfortable providing this option. References to “emergency medication” in this chapter are intended
to include all appropriate medications, unless otherwise specified.
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