As you and your family go about your usual lives or face new situations, you may question if the activity or situation will impact your seizures or vice versa. You are not alone. Below are just some of the questions posed by parents, answered by Epilepsy Nurse Educators at Epilepsy Action Australia.
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Learning & Attention
Epilepsy & Seizures
Different children will have very different experiences of how epilepsy affects them, and the impact it has on their learning.
Some children have no major issues with their learning whilst other children are more affected by their condition, and may have significant problems with learning, language or behaviour.
These learning difficulties don’t necessarily mean the child is not smart or capable, but they may require additional support to learn.
Neurological damage, frequent seizures, school absences, or unwanted side effects of antiseizure medications can all affect school performance. Most of the time it is a combination of these factors. The important thing is to recognise there may be a problem and have your child assessed so they can get the right support.
Firstly, keep a diary. You can trace things back and look at when things (such as more seizures, medication changes) happened that might affect learning, concentration, and memory. Usually, you can identify patterns and a reason this way if it’s related to the epilepsy.
If you are not sure about your child’s learning it is best to speak with the teacher and to arrange an assessment with a professional such as a neuropsychologist. Clinical neuropsychologists assess and treat people with brain disorders that affect memory, learning, attention, language, reading, problem-solving and decision-making. They can determine your child’s strengths and weaknesses, and exactly what areas your child will have difficulties with. They also recommend appropriate treatment or strategies to help.
Medications can be part of the problem. Epilepsy medications are important to help control seizures, but sometimes they can have side-effects that impact attention, thinking speed and mood. Obviously this will affect learning.
When epilepsy medication is first started, the side effects are usually worse or until the body gets used to them. Certainly, a high dose can have an effect on learning and thinking. Some signs that learning difficulties are related to medication include:
It is important to discuss this with your neurologist to see if it is possible to review the dose without high risk of seizures happening or even consider changing medications. The ideal situation is to be on one medication, the lowest dose possible without seizures. This is not always possible, but unacceptable side effects should be addressed.
It’s a good idea to speak to your child’s school as well to discuss what to do and have some type of Education Plan. They need to recognise your child’s difficulties and put strategies in place to help.
Impaired attention leads to learning problems. Think about it. If you aren’t paying attention, then you don’t remember much. Attention and memory are closely linked.
Children with epilepsy often have more problems with attention, particularly sustained attention (attention that is needed over a long period). Attention-deficit hyperactivity disorder (ADHD) is most commonly associated with attention impairment. ADHD is more prevalent among children with epilepsy than in the general population.
Antiseizure medication can also affect attention.
This resource includes ideas about helping your child with attention.
ADHD is the most common co-existing disorder in children with epilepsy. Among people with epilepsy, as many as half of children and 20 percent of adults have been diagnosed with ADHD.
Treating someone with both epilepsy and ADHD can be challenging. Some epilepsy medications can exacerbate ADHD symptoms.
The stimulant medications that effectively treat symptoms of ADHD may be less effective in children with epilepsy. The risk of this medication increasing seizure frequency appears to be low, and a recent (2019) study revealed that taking ADHD medications such as Ritalin, was associated with a 27 percent reduction in seizures, compared with not taking the medications. But you should always be diligent and closely monitor your child for seizures or side effects when any new medication is started.
Behavioural and learning strategies that are used for children with ADHD may be useful for a child with epilepsy and ADHD type symptoms.
The two key symptoms of ADHD are inattention and hyperactivity. Many of the symptoms of ADHD are shared by other conditions and it frequently overlaps with other conditions.
The diagnosis is usually made by a specialist paediatrician or child psychiatrist after referral from a doctor and it is also common for psychologists to be involved. Psychologists focus mainly on how the disorder affects behaviour and learning, and what can be done to improve this.
If you are concerned that your child may have attention deficit hyperactivity disorder (ADHD), the first step is to see a doctor. The diagnosis can only be made after a detailed assessment of the child’s behaviour, including interviews with parents or carers and the school.
Children with ADHD often have other related problems, such as learning difficulties, sleep problems or anxiety. The health professional will also assess these and recommend how to deal with them.
See your GP for a referral to an appropriate paediatrician to start the ball rolling.
Many class clowns struggle with academic concepts and, in an attempt to hide their inabilities, focus their attention on disrupting the class. By doing so, they can make it appear as if they aren’t working simply because they don’t want to, not because they can’t.
Whatever the reasons for children taking on the role of class clown, their behaviour should not be ignored. Try to generate some alternative strategies. For example if the clowning is a cover for fears of failure, the teacher might be able to provide or arrange for instructional support. It is important to work with the school on this and if necessary, seek out some external support as well, such as a tutor or psychologist.
Recently my son has been complaining that he “can’t focus”. He has grown quite a bit and I am worried his medication will need to increase – which will be VERY upsetting to him because he actually wants to stop it. What should I do?
When children have a growth spurt or go through puberty, their medication may need to be reviewed as often the dose they were taking before the growth spurt is too low for their body needs. For this reason, seizures may occur around the time of growth spurts.
It might also be a good idea to work on your son’s concentration , to see if you can improve his focus. His inability to focus may or may not be related to the dose of his medication. However, it could also quite possibly be related to more seizure-like activity happening in the brain (with no outward signs of seizures) because his dose is too low for his increased body weight.
This resource includes information and ideas about attention and ‘focus’ and also suggestions for professionals who may be able to assist.
Memory difficulties can be frustrating for everyone and there are some simple strategies that may help. This resource includes a section on memory which may be of assistance.
Here working memory is discussed.
Memory difficulties is among the most common complaints of people with epilepsy. Many factors contribute to these memory problems. So it is difficult to blame it completely on the antiseizure medication but certainly some of these medications can affect memory function.
Epilepsy and antiseizure medication can cause or make memory problems worse, particularly if the dose is too high. Lowering the dose or changing to a different antiseizure medication may help.
If you notice that memory problems coincide with medication changes, speak with your child’s doctor about your concerns.
Some people are more sensitive to missing a dose than others. Particularly in children, the medication gets broken down faster because they have a faster metabolism.
It is therefore even more important that kids take their medication regularly. If you realise a dose has been missed, then give it as soon as possible and then take the next dose as normal.
If the dose is completely forgotten, don’t double the dose next time; just take the next dose as normal.
If you notice that seizures are happening when they have been controlled previously, it could mean either the child is regularly forgetting doses or they may have gone through a growth spurt and medication levels may no longer be in the therapeutic range and need to be reviewed.
There is no ‘one-size-fits -all’ answer to this, and there are many different factors involved such as:
Poorly controlled epilepsy and repeated seizures of any type affect quality of life, and also may take a long-term toll on brain function. Prolonged seizures are clearly capable of causing injury to the brain.
Aiming for good seizure control is the best thing you can do to maintain and improve brain function.
The effects of midazolam go away quickly and long term effects are very rare. It has less harmful effects than other benzodiazepines because it is water soluble. However, long term use for the management of epilepsy is not recommended though because of the risk of tolerance (reduced effectiveness) but it is a very effective “rescue” medication for seizure emergencies. You may find as your son gets older, he may need a higher dose. It might be worth reviewing his seizure medications so you don’t need to administer the midazolam as often.
It is important to speak to your doctor about any of your concerns.
This is not a simple question to answer as some medications will be suitable for some people and not others. The most frequently used emergency medication for seizures in Australia is midazolam and sometimes diazepam (Valium) is used.
Midazolam is preferred because it is a shorter acting sedative than diazepam (meaning it clears out of the body faster) and it can be administered in an easy way – either in the nose or mouth. Diazepam unfortunately has to be given rectally, which can be tricky in public places.
It is best to discuss this with your doctor as it’s an individual thing.
I have heard there is a ‘laughing seizure’. I have a child who is on the autism spectrum and has Tourette’s. He has episodes of inappropriate laughing and we are not sure if it’s behaviour or a possible seizure.
A laughing seizure is called Gelastic seizure. It is rare and involves sudden crying or laughing. It is not the usual sound of happy laughter and it is usually out of context. It is usually followed by signs of focal seizures, such as changes in awareness and lip smacking (chewing).
Gelastic epilepsy can go on for very long periods of time without a diagnosis, because it is often mistaken as a normal laughing or crying, especially in your son’s case where there are other factors involved. It is difficult to say if it is behavioural unless you keep a diary and it would be a good idea to record it on camera to show the doctor.
It is important to speak to the doctor about these though because they are often caused by a lesion in the brain.
My seizures are becoming more frequent and lasting longer. This has dramatically affected my learning – memory, word finding, processing – I feel like I have become “slow”. Are there any exercises I can do to help? It’s really affecting me, not only academically, but personally too.
Firstly it is important to address the change in your seizure patterns. There may be a reason for it, and you shouldn’t just accept it. It can be hard to know what’s going on when a seizure pattern changes. Sometimes it is stress or major life changes – physical, physiological or emotional. It could be a sickness, hormonal, fever, or an infection. Whatever the cause, it sounds like your medications aren’t working like they should be. You will need to see your doctor to check levels and review your medications.
Certainly you can put in place strategies to help with your learning as well, but it sounds like your epilepsy needs a review as a priority first because this is probably the reason your memory is affected. If you reduce the seizures, it will definitely show an improvement on your learning.
If your child has been diagnosed with epilepsy, you may be worried that it will be a life-long condition. There are many age-related epilepsies and about 7 in 10 children diagnosed with epilepsy, not just absence epilepsy, will “grow out of it” by the time they are 20.
A recent study shows that the majority of children with epilepsy will have seizure remission, with or without treatment. If a child has been free of seizures for some years, it may be worth seeing your doctor to review reducing or weaning off antiseizure medication, to see if it’s still really needed. The remission rate for childhood absence epilepsy is 80-90%.
Just like commencing a medication, weaning off a medication can cause side effects, or withdrawal effects too. If anything out of the ordinary happens get in touch with the doctor for advice. Coming off medication is like starting; it needs to be done slowly and over time, and sometimes needs to be adjusted according to how the person is tolerating the change.
The effects of an epilepsy diagnosis are not limited to just your family. A child with epilepsy should be supported in leading as normal a life as possible, given his or her particular situation. This view should be shared with extended family members, teachers, coaches, and friends. It is important for you to recognise how the diagnosis might affect others and communicate with them accordingly.
This resource includes a section about talking to others about your child’s epilepsy which may be of interest.
When seizures happen during sleep, they cause awakenings and disrupt sleep which causes daytime drowsiness.
A seizure during sleep, even at the beginning of the evening, affects sleep patterns for the rest of the night. People with epilepsy are not often aware of seizures that happen during sleep and may suffer for years from daytime sleepiness and concentration problems without knowing why. So if someone has regular seizures, particularly during sleep, this can significantly affect their functioning during the day.
It sounds like your child may need a sleep EEG to see what is going on.
Depression will affect mood, physical health and psychological health, including learning ability.
Symptoms of depression occur in 25-30% of adolescents with epilepsy. Trouble with concentration and learning are major symptoms. Anxiety is seen in 23% of children with epilepsy. Symptoms include distractibility and restlessness.
Depression can definitely impair learning. It interferes with thought process, the ability to make decisions and concentration. Depression changes the brain, which can slow the brain’s functioning. It usually causes memory problems and your child may have trouble remembering events or details. It can even cause confusion, or the child being overwhelmed or becoming frustrated easily. Even everyday tasks can be difficult for someone with depression.
It may assist to speak with your GP about a referral to a professional to assist your child with depression. Also have a look at Depression in kids and teens.
It can be very difficult to differentiate between a daydream and an absence seizure. A general rule of thumb (but not always) is:
Short term memory loss of events before and after a seizure is very common. Some people eventually get some memory recall, while others lose it forever. It’s probably best to study thoroughly, over a period of time rather than cramming, and take notes.
If a seizure occurs very close to exam time, and you do have memory loss, most education institutions should make allowances and have exemptions from the exam on medical grounds, or have special conditions to allow you to take it on another day.
Remember to try to avoid seizure triggers such as sleep deprivation, stress and excessive caffeine or stimulants.
My 11 year old is really sensitive about the seizures she has experienced (she wet her pants at school) and won’t talk with me about them. She gets really upset if anyone broaches the subject, even the doctor. I have tried everything and am at a loss to know how to help.
Your daughter is at a difficult age and is probably too upset and embarrassed to discuss her seizures at this point. A possibility is to seek another person around her age, who also has epilepsy, and is willing to talk about it with your daughter – either on the phone or online. Just knowing that she is not alone and others experience the same difficulties, feelings and issues may help. You may want to contact Epilepsy Action Australia to see if we can put someone in touch with your daughter.
If her school has a counsellor, then see if your daughter is interested in speaking to him/her instead.
All antiseizure medications have some side effects and different people have a different response to many drugs. Some people seem more vulnerable than others to the side effects. Usually after the initial few weeks, side effects should lessen or disappear. Unfortunately there are times when a medication has unacceptable or ongoing side effects for that person, and it usually means it needs to be changed.
If your child’s learning problems are recent, and you feel the medication is affecting your child’s learning and daily life, then you should speak to your neurologist to review it.
Melatonin is a hormone that is produced in the brain. Melatonin levels vary in 24 hour cycles and are controlled by our body clock. Melatonin appears to be important in helping regulate the internal body clock’s cycle of sleep and wakefulness and is used to treat sleep difficulties in children.
Melatonin use in children appears to be safe and works well in the short term. Long term use is only appropriate if there is a specific sleep disorder.
Side effects in children are very rare. When people report them, it is not yet certain if they are caused by melatonin or by something else. You should talk about this with your child’s doctor.
For more information go to the Sleep Health Foundation website.
Your son’s excessive daytime sleepiness could have many causes. His doctor should be able to help you determine if he is experiencing night seizures or if epilepsy medication side-effects are the cause of the sleepiness. If not, there are a number of sleep disorders that can cause excessive daytime sleepiness, but you should investigate seizures or medication first.
Ask your GP for a referral to a sleep specialist.
You could also try to get him to do the following for a better night’s sleep:
If your child has seizures that are set off by flashing lights, then he has what we call photosensitive epilepsy. This type of epilepsy has a genetic link and may be present in several members of one family and is more active early in life.
So it is likely your specialist is thinking there is a chance that one of your other children may also develop photosensitive epilepsy.
There are many paediatric neurologists around Australia, and this would probably be the next step to take. There are also paediatric neurologists that specialise in epilepsy (epileptologists), so if you can see an epileptologist, then this is even better.
Your paediatrician or GP will need to write a referral.
Any school child who receives special education and related services must have an Individualized Education Program (IEP). The IEP creates an opportunity for teachers, parents, school staff and students (when appropriate) to work together to improve educational results for children with disabilities or learning needs.
To create an effective IEP, parents, teachers, other school staff and often the student must come together to look closely at the student’s unique needs. These people pool knowledge, experience and commitment to design an educational program that will help the student be involved in, and progress in, the general curriculum. The IEP guides the delivery of special education supports and services for the student with a disability. The IEP helps the child set, and attain, his or her chosen goals.
NOTE: IEP as of 2018 will become One Plan and be carried through to secondary schools from primary schools.