People can develop epilepsy at any age but a large number have their first seizure(s) during childhood or adolescence. Therefore, from time to time teachers may have students 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.
Seizures can be controlled with medication and even if they aren’t, a seizure is only temporary and they come and go. Most people with epilepsy can carry on as normal in between seizures.
For many children, epilepsy is easily controlled with medication and they can do what all the other kids can do, and perform as well at school. For others, it can be more challenging. Although overall intellectual ability in children with epilepsy is comparable to the general childhood population they are at greater risk for learning problems and academic under achievement.
This depends on many factors including:
- How often seizures happen
- The type and severity of seizures
- Medication unwanted side effects
- Difficulties with learning
- Social and psychological adjustment
- The level of understanding of epilepsy by school staff
- The attitudes and epilepsy knowledge of other students and peers
Certain circumstances or situations increase the risk of a seizure occurring. These are often called seizure ‘triggers’. There are some common triggers, and some individual triggers and it’s a good idea to be aware of the seizure triggers for any students with epilepsy.
The most common reported seizure triggers include:
- Missing medication
- Stress – physical or emotional
- Lack of sleep, overtiredness
- Hormonal changes (females)
- Growth spurts in children or youth
- Becoming overheated
- Flashing lights and geometric patterns
If you have any students with epilepsy, ask about their particular seizure triggers.
Parents or the child should also inform the teacher about their individual triggers. The school should be informed if at any time the student is at increased risk of seizures – for instance changes in medication.
Memory, attention 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 learning ability. It is often related to the dose of the medication and side effects may be lessened by reducing the medication dose (unless there is a risk of losing seizure control, then a new medication may need to be considered).
There are many different antiepileptic medications, with a variety of unwanted side effects. Some people experience more side effects than others. Some may have few side effects at all.
Some common reported side effects of antiepileptic medications include:
- Drowsiness, dizziness
- Tiredness and fatigue
- Headaches, blurred or double vision
- Poor concentration, or “fogginess” and attention problems
- Memory difficulties
- Poor balance and coordination
- Nausea, vomiting, weight gain or loss
- Hyperactivity, sleep difficulties
- Mood changes
If the student seems excessively sleepy or lacking in energy during the day, or complaining of any above symptoms, parents should be informed.
Seizures are brief, but the after effects can be lasting. These can 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. Seizures during sleep are going to affect sleep patterns for the rest of the night, and most likely cause daytime sleepiness and difficulty learning.
Many people with epilepsy also have “subclinical” or epileptiform activity in the brain in-between seizures. This is abnormal electrical activity, but not enough to generate a seizure, but it can also have effects that contribute to learning difficulties.
If seizures are caused by some another condition of the brain, or are coming from the area of the brain associated with cognition functions, they may change the way the brain handles information.
Epilepsy is generally a long term condition and may have similar effects on children as would other chronic diseases.
Seizures are unpredictable. Many people with epilepsy report that one of the most frightening thing about seizures is not knowing when they are going to happen. Even a child whose epilepsy is controlled with medication may still be anxious about having a seizure, especially at school. Therefore, it may be even more difficult to adapt to epilepsy than to other more predictable chronic conditions.
A child’s perception of their epilepsy can be affected by others reactions to it.
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’. Concern for the child’s safety may lead to restriction of normal school activities, which most children take for granted. This increases the child’s sense of social isolation.
Independence and social acceptance are important – so it is important to let the student participate in the usual activities at school, as much as possible – balancing safety and common sense versus risk.
Concerns and limitations should be discussed with the student and family and put in the seizure management plan.
Negative reactions from peers, other students and school staff can negatively influence the person with epilepsy.
Suggested teaching strategies
These will depend on the level of difficulties the student is having.
- 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. Even ask the student to contribute if they feel comfortable. This can effectively illustrate that epilepsy is both real and manageable, and not to be feared or judged.
If an unexpected seizure happens in front of the class or friends, then the teacher may need to have a discussion or debrief with the students. Witnessing a seizure can be very upsetting but it is also distressing for the student with epilepsy to know they have had a seizure in front of everyone, so it may need to be handled with care.
If the school are aware the student has epilepsy, then this scenario might need to be discussed with developing a management plan.
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. It is also good to discuss the seizure type(s) the student has and whether they are likely to occur at school. This is important so you can recognise a seizure and know what to do.
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. It doesn’t necessarily have to involve telling the class the student has epilepsy.
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
- Epilepsy medications may impact on concentration, attention and memory function
- How the student’s seizure looks, may have an effect on their feelings about their epilepsy. Some types of seizures may be frightening to observe, others can be quite unusual and not recognised as a seizure
- Appropriate understanding and reactions from class mates and teachers can have a 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 less than 2 minutes although there may be a short period of confusion, usually less than 5 minutes, after the seizure
- Occasionally confusion after a seizure can be quite lengthy, but usually only lasts a few minutes
- 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 with epilepsy usually have little or no memory of their seizure
Seizure Management Plans
A seizure management plan (SMP) is a document providing essential information to anyone who may be in a position to assist someone having a seizure – whether that be family, friends, carers, teachers, colleagues or other involved professionals. They are a practical tool that can be used by all caregivers in all settings to manage seizures and seizure emergencies, treatments and safety. School aged children have seizure management plans in place.
Every child’s experience of epilepsy is different and therefore supporting them at school will require an individualised approach
SMPS, can be developed online at Seizure Management Plans
For further information, to arrange an education session or develop a seizure management plan please call:
1300 37 45 37 or email [email protected]
For more information:
EAA factsheet – Seizure Smart – Epilepsy and Education
Classroom problems and solutions – Epilepsy