- Different types of epilepsy
- Risks and side effects
- Epilepsy management in the classroom
Epilepsy is defined as recurrent seizures that are triggered by abnormal electrical brain activity. Extremely variable in nature, seizures last from a few seconds to a few minutes, and can affect many physical and mental functions. For many people, the term epilepsy is synonymous with generalized tonic-clonic seizures (dramatic convulsions associated with loss of consciousness), but these seizures occur only in a minority of students with epilepsy. Epilepsy is a chronic condition, with expression and prognosis varying greatly from student to student. It is important for teachers to know that with the help of anti-epileptic drugs (AED), approximately 70% of students are essentially seizure free.
The vocabulary surrounding epilepsy can be confusing, but some terms enable communication with parents and health care providers. For example, “seizure” refers to a spell or fit itself, but “epilepsy” refers to a condition (i.e., recurrent seizures). Another important distinction is between seizures caused by a known, underlying neurological condition, such as a traumatic brain injury or Down syndrome (called “symptomatic epilepsy”) and recurrent seizures without a known cause (called “idiopathic epilepsy”). Students with symptomatic epilepsy generally experience greater school problems than their counterparts with idiopathic epilepsy (see Cognitive and Academic Impairments section).
There are other distinctions, such as the nature and location of seizure onset:
- Partial seizures begin in only one region of the brain.
- Generalized seizures begin in both hemispheres of the brain.
- Secondary generalized seizures begin in one hemisphere but spread to both.
Another distinction of importance at school is seizures’ effect on consciousness:
- Simple partial seizures involve no loss of consciousness.
- Complex partial seizures involve a loss of consciousness.
The International League Against Epilepsy uses an even more detailed system.
One type of seizure with subtle symptoms is important for teachers—this is an absence seizure (formerly called petit mal). Some student who present with inattention (simply spacing out) may actually being experiencing absence seizures. Thus, whenever the following are encountered, teachers should alert a parents (so that they consult medical professional): abrupt cessation of an ongoing task, a brief (10-30 second ) trance-like state, eyelid fluttering, lip smacking, or chewing motions during the seizure.
The description of seizure types is not a distinctive as it might seems, and it is possible for a person to display more than one type of seizure.
EdMedKids also provides a diagram summarizing common types of epilepsy.
Epilepsy is the most common childhood neurological disorder, and the third most common neurological disorder among the entire U.S. population. The Epilepsy Foundation estimates that 300,000 children younger than age 15 years have epilepsy. In the Unites States, the childhood prevalence rate is approximately 4 to 9 cases per 1,000. This means that an elementary school campus with 500 students might have two to five students with epilepsy; a larger high school with 2,000 students might have 8 to 18 students with epilepsy.
Epileptic seizures involve an abrupt behavioral change due to abnormal and intense electrical brain activity. Seizures can manifest in many forms depending on the area of the brain involved. Some common symptoms of seizures include, sudden stiffening of the body, jerking or convulsing, loss of posture resulting in a sudden fall, starring, fumbling, or sudden cessation of activity. Seizures usually last from a few seconds to a few minutes and may or may not involve loss of consciousness (see description of Different Types of Epilepsy above). If loss of consciousness occurs, the student’s lips and face may appear to turn blue from inefficient breathing.
Teachers should also know that after a seizure many children experience a postictal (time immediately after the seizure) period of confusion before they are able to regain full awareness. The postical period varies in length depending on the child and can affect academic work (see the Classroom Problems and Solutions section).
Epilepsy is diagnosed after a person has had at least two seizures. Doctors diagnose epilepsy by performing a thorough evaluation of the person who has experienced the seizures. Information is collected about the person’s medical history along with a description of the seizure and with descriptions of what happened before and after the seizure.
An electroencephalogram (EEG) is also commonly used to record abnormal brain activity. The EEG is a machine that records electrical signals from the brain and brain wave patterns from wires connected to electrodes that are taped to the person’s head. EEG results may indicate widespread abnormalities or may indicate specific patterns indicative of a particular epileptic syndrome.
From the thorough clinical evaluation and the EEG results, a specific seizure type can often be determined. The EEG results are also useful for determining the site of seizure onset, which can be helpful for choosing an antiepileptic drug for treatment.
Several other imaging methods including CT scans, MRI scans, and PET scans can also be helpful for diagnosing epilepsy.
Epilepsy is most commonly treated with antiepileptic drugs (AEDs). AEDs are not a cure for epilepsy, but they can bring epilepsy under control for many individuals with the condition. There are many different kinds of AEDs and the medication(s) selected depends on seizure type, age of the child, specific type of epilepsy, and possibility of side effects.
It is especially important for teachers to understand that AEDs have many possible side effects. These include drowsiness, decreased attention, clumsiness, double vision, difficulty producing speech, and irritability. As might be expected, side effect problems are more common and more pronounced when more than one AED (polytherapy) are needed than when one AED is sufficient (monotherapy). However, all children on medication are at risk for side effects so it is important for educators to be aware of possible side effects and to report to parents or health providers changes in alertness, mood, learning rate, or general behavior. EdMedKids provides a link to the Epilepsy Therapy Project, which provides comprehensive information regarding epilepsy medications and their particular side effects. WebMD is another resource that provides information regarding epilepsy medications. These sites list most commonly used medications; by opening specific links on these sites, one can find side effects details for each medication.
Occasionally, AEDs alone are insufficient. In these cases, surgery may be an option for some individuals. Stimulation of the vagus nerve, a large nerve leading into the brain, has also been used to control epilepsy. Recent research has also shown that following a strict ketogenic diet may be effective in helping to control epilepsy for some children. The ketogenic diet is a high fat, low carbohydrate diet. EdMedKids provides a link to the Epilepsy Foundation where teachers can find more information regarding these treatments.
For children with certain seizure types, one of the biggest short-term risks is head injury during a seizure. Any head trauma requires monitoring after the seizure resolves to determine the need for further medical attention. Signs of an action-mandating head injury include failure to return to consciousness after the seizure, difficulty maintaining consciousness, vomiting, vision problems, excessive sleepiness, or weakness in the limbs. If any of these conditions are observed in the child, then immediate medical attention should be sought.
Long-range risks of epilepsy vary depending on the person’s brain structure and the type of epilepsy. For most individuals, epilepsy causes no progressive structural brain changes. For a few individuals, however, epilepsy is associated with changes in brain structures and with impaired memory and impaired ability for new learning. Proper diagnosis and appropriate treatment with AEDs minimize the possibility of progressive brain changes. In addition, there is risk of low self-esteem and depression. A set of classroom risks related to learning, attention, memory, and behavior are also present. See the EdMedKids section titled Classroom Problems and Solutions for more information about mood/self-esteem and about accommodating for learning problems.
Teachers need to be alert for signs that a student is struggling because of seizures or AED side effects. Also, because AEDs are typically administered 1-4 times daily, a plan about trips to the office of school nurse (or nursing assistance) is suggested. Likewise, an individualized plan should also be developed to prescribe the action of school staff in the event that a child has a seizure at school. Furthermore, the child-specific plan should list known seizure triggers. Some students have no precise seizure triggers but other students may be able to recognize events that can trigger a seizure. The most common seizure trigger for many students is failure to take medication as prescribed. Other factors can include ingesting substances, hormone fluctuations, stress, sleep patterns and photosensitivity. Occasionally, plans may also call for students with special risk of head injury to wear a protective helmet. Teachers are encourage to consult with the student’s parents and healthcare team to develop a a child-specific first aid plan that fits the exact nature of the student’s epilepsy.
A seizure at school can affect classmates and the student him/herself. After any type of seizure the student may appear frightened, disoriented, and confused. For convulsive seizures, the Epilepsy Foundation encourages teachers to be as comforting and reassuring as possible. At these times, a student’s individualized plan may call for a period of rest. The child may also require help re-orienting to the environment after a seizure. If a student has a seizure in class, steps may be needed to inform other students about what happened. It is plausible that the social impact of a conspicuous and severe seizure can be reduced by explaining to classmates what happened and by answering their questions. We know of no research to yet address this point, however. The Epilepsy Foundation suggests the student with epilepsy be informed about the class debriefing and be allowed to decide about personally participating.
An explanation of a student’s condition may need to be given to classmates at the beginning of each school year, especially if frequent and severe seizures exist. However, teachers should first collaborate with the child’s parents to determine the best way to present information to the class and to gain their consent to do so.