In Australia, it is estimated that almost 60,000 people under the age of 20 years have epilepsy.
People can develop epilepsy at any stage of their lives but a large number have their first seizure(s) during childhood or adolescence. Therefore, from time to time teachers will have students with existing epilepsy or newly diagnosed epilepsy.
Seizures can be controlled in greater than 70 percent of people with antiepileptic medication, and a large number of children grow out of their epilepsy by adolescence.
Students with epilepsy may face challenges unknown to other students. These may be major obstacles or minor inconveniences depending on factors such as:
- How often seizures occur
- The type and severity of seizures
- Medications – type and dose
- Associated issues with cognition or behaviour
- Social and psychological adjustment
- The level of understanding of epilepsy by school staff
- The attitudes and level of knowledge of other students and peers
Negative reactions from peers, other students and school staff can negatively influence the person with epilepsy.
Epilepsy is not a condition to be feared. It is important for teachers to have a general understanding of the disease, its various forms, physical, psychological and treatment effects.
It is important to understand that seizures are often fully controlled with medication and even if they aren’t, a seizure is only a temporary interruption. People with epilepsy can carry on as normal in between seizures. Under certain circumstances, a seizure is likely to occur – often caused by ‘triggers’. There are some common triggers, and some individual triggers.
Likely seizure triggers
The most common seizure triggers reported by people with epilepsy include:
- Missing medications
- Stress – physical or emotional
- Lack of sleep, overtiredness
- Hormonal changes (females)
- A very small percentage of people with epilepsy are sensitive to strobe lights and patterns – these can be caused by television, videos, computer screens, and flashing lights
- Growth spurts in children or youth
- Becoming overheated
- Alcohol and drugs
Be aware of seizure triggers. Parents or the child should inform the school about their individual triggers.
Memory and concentration
Memory and concentration are crucial for learning, and sometimes people with epilepsy complain of difficulties in this area. There are a number of reasons why someone with epilepsy has difficulties with memory and concentration and some possible causes include:
- Side effects of medications
Sometimes medications may affect the student’s ability to learn. This is often related to the dose of the medication. Some common side effects of antiepileptic medications include:
- Concentration, short term memory loss
- Hyperactivity, drowsiness, fatigue
- Hand, eye, balance, speech problems, unsteadiness, dizziness
- Nausea, vomiting, weight gain/loss
- Depression, aggressiveness, anti-social behaviours
If the student seems excessively sleepy or lacking in energy during the day, parents should be informed.
Seizures are brief, but the effects can be lasting. The after effects of seizures include tiredness, drowsiness, headaches, nausea, and mood changes. After a seizure, the person is unlikely to be able to concentrate well, and will most likely need a rest or short sleep. It will depend on the child if they need to go home or not.
Many people with epilepsy also have “subclinical” epileptiform activity in the brain in-between seizures. This is abnormal electrical activity, but not enough to generate a seizure, but this abnormal activity can also attribute to learning difficulties.
If seizures are causes by some underlying condition of the brain – even minor – this may involve the area of the brain associated with memory, or may change the way the brain handles information.
- Psychosocial issues
Epilepsy is a chronic disorder and may have similar effects on children as would other chronic diseases.
Seizures are unpredictable. Many people report that the most frightening thing about seizures is their unpredictability. Therefore, it may be even more difficult to adapt to epilepsy than to other more predictable chronic conditions.
Even a child whose epilepsy is controlled with medication may still be anxious about having another seizure, especially in the presence of peers.
Fear and anxiety can be quite common and can also lead to depression. It is important to observe the child for changes in behaviour and loss of interest in activities.
Overprotection and restrictions on activities can also affect a person’s self-esteem and make them feel ‘different’.
Independence and social acceptance are important – so it is important to let the student lead as normal life as possible – balancing safety and common sense vs risk.
Teacher attitudes may influence the extent to which students with epilepsy participate in sport and extra-curricular activities. A student with epilepsy must never swim alone and sports such as highboard, scuba diving and rock climbing are best avoided. The student who is denied the opportunity to participate may well have feelings of social isolation and rejection reinforced. Restrictions should be discussed with the student and family.
Historically epilepsy has been wrongly surrounded by myths and misunderstanding. People with epilepsy still sometimes face common misconceptions of insanity, intellectual disability and an inability to achieve.
Some of the history’s greatest achievers had epilepsy yet the myths still survive. They can be changed through education that encourages openness and an understanding of the disorder.
A child’s perception of their epilepsy largely depends on others reactions to it.
Suggested teaching strategies
- Co-operative Learning
Group work develops listening and talking skills, encourages interaction with peers in problem solving and allows students to ask questions and learn from each other.
- Task Analysis
The breaking down of specific tasks into their most basic steps establishes teaching and learning stages that will need to be achieved if the student is to succeed. Task analysis can be applied to any learning or social situation.
Proves effective especially with listening activities. Tell the student, ahead of time, of the purpose of the activity. Give a quick summary of the passage and ask comprehension questions before reading the passage. Knowing the purpose of the activity will help keep the student on task.
A review of the processes used in solving a complex task can be very helpful for the student.
Leads to the consolidation of skills learnt in mastering a task. Unconsolidated skills are not likely to be generalised to other learning tasks.
Uses verbal, visual and symbolic techniques as memory aids. The acquisition of facts and procedural knowledge is governed by memory and the most effective measures for memory development are rehearsal related.
Unexpected disclosure in the classroom
In open classroom discussion of epilepsy, teachers may be faced with the unexpected disclosure by a student that they have epilepsy.
If this occurs, the teacher should guide the discussion to ensure that it is supportive. This can effectively illustrate that epilepsy is both real and manageable, and should not affect the judgements we make about people. The teacher should be careful not to encourage a level of disclosure that the student may, on reflection, regret.
If the disclosing student agrees, during a later session, they may wish to share with the group the type of epilepsy they have, the effect of medication and what they would like others to do if they see them having a seizure.
An educator may be able to visit the school for an education or question and answer session. There are also free short courses online for primary school students and resources for secondary school students.
Unexpected disclosure in private
In the event of an unexpected disclosure in private the teacher can invite the student to talk about it.
Ask the student if they feel the condition and/or medication is affecting their learning and, if so, ask what you can do to help. Discuss who else might need to know, such as teaching staff, coaches and friends, and explore reasons for and against disclosure.
Ask the student whether they would like the opportunity to talk to the class about epilepsy and what they would like you to do if a seizure occurs. Assess degree of coping and if necessary arrange counselling. Thank the student for the disclosure and offer further assistance at any time.
Things to remember
- Children with epilepsy have the same range of intelligence and ability as other children.
- Some neurological disorders that can cause epilepsy can also result in learning difficulties.
- Seizures can create feelings such as anxiety and depression, poor self-image and social problems – all which can affect school performance.
- Missed schooling can impact on learning and important peer socialising.
- Medications may also impact on the student’s level of concentration, attention and memory function.
- How the students seizure looks may have an effect on their self-perception and consequent behaviour. Some types of seizures may be frightening to the uninformed onlooker, others can be quite bizarre and not recognised as a seizure. Appropriate understanding and reactions from class mates and teachers can have a considerable positive effect on a student with epilepsy.
- The time that teachers spend with students places them in a unique position to observe and provide information about a student’s seizures.
- Seizures are not to be feared.
- Most seizures last approximately 1- 3 minutes although there may be a period of confusion after the seizure.
- Sometimes confusion after a seizure can be quite prolonged, from minutes up to several hours.
- People are often exhausted and need rest or sleep after a seizure, especially a tonic clonic seizure.
- Seizures cannot be stopped or slowed by restraint. The brain almost always stops the seizures naturally. Let the person have the seizure and then apply first aid if necessary.
- It is physically impossible to swallow the tongue. There is no need to insert anything into the mouth. This is dangerous and fingers may be bitten or teeth broken.
- Most people usually have no memory of all or most of the seizure.
- You can make a difference!
EAA factsheet – Seizure Smart – Epilepsy and Education
Classroom problems and solutions – Epilepsy