Abstracts

Rationale: Children and adolescents with epilepsy may experience seizure clusters at school. School nurses need to quickly implement personalized seizure action plans (SAPs) that include administering seizure rescue drugs. Intranasal benzodiazepine formulations are an effective alternative to rectal formulations, and are the least restrictive choices, aligned to the National Association of School Nurses Clinical Guideline for Students with Seizures and Epilepsy (2018). Diazepam nasal spray (Valtoco®) was approved in 2020 for acute treatment of seizure clusters in patients with epilepsy aged ≥6 years. The objective of this survey was to understand current practices and challenges among school nurses regarding treatment of seizure clusters.

Methods: A survey was developed based on the insights from a series of focus groups of neurology advanced practice providers and nurses. It was emailed in July 2021 to 49,314 school nurses across the US and included 33 questions related to frequency of in-school seizures, SAPs, rescue medications used, perceptions of ease/comfort of using diazepam nasal spray in a school setting, and changes in school practice during off-campus activities, such as sports.

Results: Surveys were completed by 862 (1.7% response rate) licensed school nurses responsible for a median of 680 students each. These nurses recorded a median of 13 years’ school health experience from preschool to high school ages. The majority (80%) estimated being responsible for < 10 students with epilepsy and responded to < 1 seizure/month (77%). Most schools required SAPs (94%). Few nurses had administered intranasal benzodiazepines (Figure 1); 83% knew about diazepam nasal spray. Among nurses who reported administering diazepam nasal spray, the majority felt it was very/extremely easy to administer and were very/extremely comfortable with use in a school setting (Figure 2). The availability of intranasal diazepam may increase participation in after-school activities as assessed by 48.2% of nurses.

Conclusions: Results from this survey indicate that most nurses who administered diazepam nasal spray thought it was easy to use and were comfortable using it. Although many nurses had not yet had the opportunity to administer diazepam nasal spray, they were familiar with it and believed that it could increase participation in extracurricular activities. A possible study limitation is that the survey was conducted during the COVID-19 pandemic when remote learning was in place. This may account for the low level of in-school use of intranasal midazolam and diazepam, which were not available until late 2019/early 2020. Overall, the data collected from this survey highlight the need to update training programs and educational materials on rescue therapies to ensure students have a less restrictive rescue medication for use at school. Although in-school seizures appear to be rare events, both the threat of such a sentinel event and its disruptive consequences underscore the need for a rational and effective treatment plan.

Funding: Please list any funding that was received in support of this abstract.: Neurelis, Inc.