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A Study Guide on Children's Health

Unit 4: Epilepsy

How will this unit help me?

This unit will:

• raise your awareness of the main features and symptoms of epilepsy;
• enable you to identify strategies to support young people with epilepsy in schools.

On completion of this unit you will be able to:

• recognise the main signs and symptoms of epilepsy;
• identify the range of treatments available to young people;
• assess ways of responding to an epilepsy related incident;
• evaluate the support and information resources available.

Setting the scene

What is epilepsy?

Epilepsy can affect anyone at any age. It is the most common serious neurological condition in the world. Throughout our lives, millions of messages are sent between a vast network of cells in our brain controlling everything we do, think and feel. The body has its own mechanisms in place to ensure that these messages are received in the normal manner. However, occasionally, without warning, these messages can be scrambled, due to an upset in brain chemistry and this disturbed pattern may result in a seizure.

A seizure is caused by a temporary change in the way brain cells work. There are many different types of seizure and they affect children in different ways. No two children will experience entirely the same symptoms; each child will experience epilepsy in a way that is unique to them. During a seizure a child may experience a number of unusual sensations or movements and/or alterations in the level of consciousness. The seizure usually lasts only a matter of minutes or seconds after which the brain returns to normal. The child may or may not have a warning.

What can be the triggers?

Many children with epilepsy gain complete control of their seizures with regular use of appropriate antiepileptic medication. Triggers can include:

How to recognise a seizure

There are many different types of seizure that a teacher would need to look out for, for example:

Tonic-clonic seizures - the child might cry out, lose consciousness and fall to the ground. The body stiffens (tonic phase) and then convulses (clonic phase). The child's lips might turn blue and her/his mouth mayfill with frothy saliva if the inside of the cheek or tongue has been bitten. The child may have been incontinent and as s/he recovers may be confused, sleepy or have a bad headache.

Absence seizures - the child is seen to stop suddenly and stares into space. Slight movements of the eyelids might be seen. These are brief periods of interrupted consciousness and can happen several times a day. This can affect the child's ability to absorb information and it may therefore, be important for the teacher to regularly repeat information and instructions.

Myoclonic seizures - the child will experience sudden jerks or contractions in her/his muscles, which may be severe enough to throw her/him to the ground. After a brief loss of consciousness, the child should recover quickly and is not normally confused.

Atonic seizures - the child's muscles suddenly relax, causing her/him to drop to the ground. Again, there is a brief loss of consciousness, but recovery is almost immediate.

Tonic seizures - the child's muscles stiffen and s/he may fall down, injuring her/himself. Breathing might also become difficult.

Complex partial seizures - the child can appear awake but may be unable to communicate. Actions may seem inappropriate, for example, plucking at clothes, lip smacking, repeating her/himself, head turning, wandering aimlessly, running or undressing. The child will not usually respond to instructions or questions.

The child does not normally need to be sent home after a seizure.

For more information on seizures, see Guidelines for Teachers - How to manage epilepsy, from Epilepsy Action Scotland.

Teaching a child with epilepsy

Teachers need to be aware when a child in their class has epilepsy. They will require information about epilepsy and about first aid measures when a child is having a seizure. Teachers can also help by being supportive and encouraging (but not over-protective). They can educate other children (and perhaps the parents of other children) about epilepsy and be wary of possible incidents of name-calling or other forms of bullying. Teachers can also observe changes in a child's behaviour, ability or attainment. A wide range of factors may affect how well a child with epilepsy performs at school.

Teachers need to consider the implications for the classroom. For example, medication may affect a child's capacity to concentrate, or having repeated absence seizures may cause a child to miss what the teacher has said. The teacher may, therefore, need to amend his/her teaching methods, e.g. to repeat instructions or write down important information. A helpful leaflet, Guidelines for Teachers: How to Manage Epilepsy is available from Epilepsy Action Scotland.

Developing your understanding

Activity 1 : Test your knowledge

The following quiz is devised to enable you to learn more about epilepsy. There may be more than one correct answer to each question. Tick all answers which you believe to be correct. The answers are given at the end of the unit.

1. The incidence of epilepsy amongst children is:

2. The number of children who may develop epilepsy in a school of 800 pupils is around:

3. Epilepsy is caused by:

4. First aid measures for dealing with seizures in school include:

5. Young people who have epilepsy:

How did you get on?

Now that you have an awareness of epilepsy, you may wish to further your

knowledge by visiting the following informative web sites:

http://www.epilepsyscotland.org.uk - Epilepsy Action Scotland

http://www.epilepsy.org.uk - the British Epilepsy Association

http://www.bbc.co.uk/health/epilepsy - the BBC Health Education site

Activity 2 : The responsibility of the school

This is an activity that you can complete on your own, with a partner or in a small group. It is likely that during your career you will teach several children with epilepsy. The approach taken by the school is vital for positive school / parent partnerships. The aim of this activity is for you to consider information that the school should obtain from parents about their child in order to assist with classroom management and organisation. Try to identify six questions. The first one has been done for you.

1. Tell me about your child's condition?

2.

3.

4.

5.

6.

If possible, discuss your list of questions with others. Compare your questions with the list at the end of the unit.

What would you do?

Consider the following situations and the related questions. You can also discuss them with a partner or in a small group. Once you have considered your own ideas, read the commentary at the end of the unit.

Situation 1

Soon after the start of the new school session a pupil, whom you know to have epilepsy, becomes unwell in class. Although she does not become unconscious, she is disorientated and this behaviour is frightening for the other children who are not aware of her epilepsy.

What is your immediate response? How might you provide support for the pupil with epilepsy and reassure the other pupils?

Situation 2

During the lunch break, you hear a child calling out in an inappropriate manner to another child in your class. You can see that this pupil is upset. He suffers from epilepsy and the teasing and name-calling is related to a seizure experienced during assembly last week.

What is your immediate response? What further action should you take? A commentary is provided at the end of the unit.

Want to know more?

The following are considered useful background reading and references for students involved in initial teacher education. They are not intended as recommendations for classroom use.

www.epilepsy.scotland.org.uk

Epilepsy Action Scotland
48 Govan Road
Glasgow, G51 1JL

Tel: 0141 427 4911
Helpline: 0141 427 522

Guidelines for Teachers: How to Manage Epilepsy - A helpful leaflet available from: Epilepsy Action Scotland.

Epilepsy Action
New Anstey House
Gate Way Drive
Leeds
LS10 7NW

Freephone Helpline: 0808 800 5050
Office phone: 0113 210 8800

British Epilepsy Association (1995) Epilepsy & Children. Leeds: BEA.

Irvine, S. (1997) A Guide to Child Health in the Primary School. Edinburgh: Health Education Board for Scotland.

Answers

Activity 2: The responsibility of the school.

Teachers should find out as much as possible about a child's epilepsy from their parents. Positive attitudes towards epilepsy and confidence in dealing with symptoms not only benefit the child but also ensure that all pupils adopt a healthy understanding of the condition. Parent-teacher partnerships prevent the child from becoming withdrawn and can help to ascertain any learning difficulties.

Possible questions you may wish to ask:

• What type of seizure does your child have?
• How long do they last?
• What do the seizures look like?
• How might the seizures or medication affect the child's ability to learn?
• What first aid is recommended?
• Are there any particular triggers?
• What type of medication is your child taking?
• Are there any side effects?
• Does the child experience any prior warning of a seizure? (This is known as an aura.)
• Are there any other factors of which teachers should be aware?

It is also beneficial to you if the child has an understanding of their condition and how to cope with it in a positive manner.

Epilepsy Action Scotland and the British Epilepsy Association have useful resources to help you understand epilepsy within a school context. See references at the end of this unit.

Commentary

Situation 1

This incident has taken place in your classroom. Your first priority is to safeguard the child and at the same time provide reassurance. You must remain calm and be in control of the situation. Calmly reassure the other children. Send a child to the school office to inform the head teacher (and/or to the next classroom to summon adult help).

• Note the time and how long the seizure lasts.
• Clear a space around the child away from sharp edges and equipment.
• Cushion the head (e.g. with a rolled-up jacket).
• Loosen tight clothing.
• Carefully remove glasses if worn.
• If there has been incontinence, cover the child to prevent embarrassment.
• As soon as possible after the seizure has finished, turn the child into the recovery position.
• Be supportive during the confused episode. The child may need to rest or sleep for a short time, preferably in private.

It is not necessary to send a child home after a seizure, but each child is different. It is important to follow appropriate school-parent decisions at this point, i.e. a decision will have been taken in consultation with the parents when the child's condition was initially discussed.

After, discuss with parents/carers (and the child) the issue of informing class-mates. If agreed, conduct lessons with the class about epilepsy to ensure they are informed and knowledgeable, and that the child with epilepsy is not vulnerable to bullying.

Do not:

• move the child during the seizure unless they are in danger; e.g. beside water, on the road, near a fire, at the top of the stairs;
• try to stop their movements;
• put anything into their mouths or between their teeth;
• give them something to drink.

Note

You do not have to call a doctor or ambulance when you know the child has epilepsy and the seizure is following the normal pattern of behaviour.

Situation 2

Children with epilepsy can be targets for bullying and teasing in schools. In particular, there is the possibility of mockery after a seizure. Sometimes children can be excluded from activities that would help them gain skills and self-confidence. As a result they don't feel able to assert themselves. The school environment can allow children with epilepsy to break free from over protection and isolation and they should be actively encouraged to participate in all aspects of school life in order to prevent them from being singled out as different. The class teacher should give the child support and encouragement to stand up for him/herself.

When a seizure takes place in a classroom or at an assembly, all children are affected. They may be genuinely afraid for the well being of the child. They will be upset at seeing a classmate who appeared to be fit and healthy ten minutes ago, now looking unwell or strange in behaviour and speech. When this occurs, children need factual information appropriate to their age. Children also need to be told that what has happened poses no danger to them or the child who has had the seizure and also how they can help.

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