A GUIDE FOR TEACHERS Epilepsy
A GUIDE FOR TEACHERSEpilepsyE P I L E P S Y E D U C AT I O N S E R I E S
This publication was produced by theThe Epilepsy Association of Northern AlbertaPhone: 780-488-9600 Toll Free: 1-866-374-5377 Fax: 780-447-5486Email: info@edmontonepilepsy.orgWebsite: www.edmontonepilepsy.orgThis booklet is designed to provide general information about Epilepsy tothe public. It does not include specific medical advice, and people withEpilepsy should not make changes based on this information to previouslyprescribed treatment or activities without first consulting their physician.Special thanks to our Consulting Team, which was comprised of EpilepsySpecialist Neurologists & Neuroscience Nurses, Hospital Epilepsy ClinicStaff, Educators, Individuals with Epilepsy, and Family Members ofIndividuals with Epilepsy.Free Canada-wide distribution of this publicationwas made possible by a sponsorship fromUCB Canada Inc. Edmonton Epilepsy Association, 2018
IndexHow to Recognize Seizures 1Why Seizures Happen 2What Having Epilepsy Means 2Who Epilepsy Affects 3How to Tell the Difference Between One Type of Seizureand Another 4How to Respond to Seizures 7First Aid for Seizures 8How Seizures Are Controlled 10Why Epilepsy Affects Learning 11How Teachers Can Help 13
Epilepsy: A Guide for TeachersTeachers play a vital role in the physical, emotional, andacademic well-being of students with epilepsy. Teachers whoknow how to respond to seizures both improve safetystandards in the school and influence the reactions of fellowstudents and school staff. A teacher who reacts to seizurescalmly and supportively will help others learn to do thesame. In some cases, teachers are the first to notice andrecognize the symptoms of seizures in a student. Teacherswho understand, encourage, and inspire students withepilepsy facilitate learning, independence, and self-esteem.
HHow To Recognize SeizuresSeizures take many different forms. A seizure may last for a fewseconds and involve a blank stare or a sudden fall. It may last for afew minutes and involve a convulsion or random, purposelessmovements such as chewing motions or pulling at clothing.Sometimes it is difficult to distinguish between a seizure and unusualbehavior. What is important to watch for is a pattern of behavior thathappens too often to be by chance.Signs that may indicate that a student is having a seizure include: a sudden loss of awareness that may appear like daydreaming a brief lack of response memory gaps rhythmic head nodding rapid eye blinking repeated movements that appear unnatural repeated jerking movements of the body, arms, or legs sudden falls without an apparent reason sudden stomach pain followed by sleepiness and confusion frequent complaints that things taste, sound, smell, look, orfeel strange sudden fear, panic, or anger without an apparent reason.If you notice these symptoms, record your observations, discuss theobservations with the school nurse and/or principal, and comply withthe school policy regarding reporting to parents.Epilepsy: A Guide for Teachers - 1
WWhy Seizures HappenThe brain is made up of billions of nerve cells or neurons thatcommunicate through electrical and chemical signals. When there isa sudden excessive electrical discharge that disrupts the normalactivity of the nerve cells, a change in the person’s behavior orfunction may result. This abnormal activity in the brain that resultsin a change in the person’s behavior or function is a seizure.A number of causes can result in a disruption of the normal activityof the nerve cells and result in seizures. The causes vary according tothe age of onset of epilepsy. The causes of seizures include genetics,birth injury, developmental disorder such as brain damage to thefetus, brain trauma from car accidents, sports injuries, etc., drug andalcohol abuse, infections such as meningitis, encephalitis, and AIDS,and brain tumor.In many cases, however, the cause of the seizures is unknown.WWhat Having Epilepsy MeansEpilepsy is a condition of the brain that is characterized by recurrentseizures. Approximately one in ten Canadians will experience atleast one seizure during a lifetime. In those children who have asingle seizure, only a small percentage have a second one. Epilepsyis a condition that is defined by multiple seizures.Epilepsy is a seizure disorder, not a psychological disorder or adisease and it is not contagious.Epilepsy: A Guide for Teachers - 2
WWho Epilepsy AffectsEpilepsy is a condition that is more common than most peoplerealize. In the general population, approximately one person in ahundred has epilepsy meaning that approximately one in every onehundred students has epilepsy. In Canada, there are over 330,000people with epilepsy.People of all ageshave epilepsy. TheEpilepsy is a condition that iscondition can begin atany age although itsmore common than mostonset is most often inpeople realize. In the generalchildhood or in thepopulation, approximatelylater years of life.The frequency ofone person in a hundredseizures in childhoodhas epilepsy meaning thatmay be partly due toapproximately one in everythe low seizurethreshold of someone hundred studentschildren. A seizurehas epilepsy.threshold is the levelat which the brainwill have a seizureand the seizure threshold generally rises as the brain matures. Thismay partly explain why children with epilepsy often outgrowthe condition.Epilepsy: A Guide for Teachers - 3
HHow To Tell The Difference BetweenOne Type of Seizure And AnotherAlthough tonic clonic seizures are the ones most often associatedwith epilepsy, there are many types of seizures. The location in thebrain of the abnormally discharging nerve cells determines the formthe seizure will take. A student can have more than one type ofseizure.The different types of seizures begin in different areas of the brainand they are grouped into two categories: partial and generalized. Ifthe sudden excessive electrical activity occurs in one part of thebrain, it is called a partial seizure.If the excessive electrical activity involves the whole brain, theseizure is called a generalized seizure. Sometimes seizures begin aspartial and then spread and become generalized. These are referredto as partial seizures secondarily generalized.Partial SeizuresThe two most common kinds of partial seizures are simple partialand complex partial. During a simple partial seizure, awarenessremains intact. In a complex partial seizure, awareness is impaired.A simple partial seizure (formerly called focal) usually beginssuddenly and lasts seconds to minutes.It involves symptoms that result in a person experiencing an unusualsensation, feeling, or movement called an aura. An aura can takemany different forms and may involve sensory, motor, psychic, orautonomic symptoms. For example, an aura might be a distortion insight, sound, or smell where a student may see, hear, or smell thingsthat aren’t there, or it may be sudden jerky movements of one area ofthe body such as the arm, leg, or face. For instance, the student maysuddenly smell burning rubber when it is nonexistent or a hand maytwitch uncontrollably.Epilepsy: A Guide for Teachers - 4
An aura could also involve a sudden overwhelming emotion such asjoy, sadness, fear, or anger. Or there may be the experience ofautonomic symptoms such as stomach upset, dizziness, a shiver, atingling or burning sensation, pallor, or flushing. Occasionally therewill be the experience of déjà vu during which the student has thesensation of having experienced something before.An aura is a simple partial seizure that may occur alone or mayprogress to a complex partial seizure or a generalized seizure. Theaura can sometimes be used as a warning signal to allow the personto take the necessary precautions to avoid injury.During a complex partial seizure (formerly called psychomotor ortemporal lobe), a student experiences altered awareness and mayappear dazed and confused. A dreamlike experience may occur. Thestudent may be unable to respond or may do so incompletely orinaccurately. Sometimes, the student will lose contact.The seizure often begins with an unusual sensation, feeling, ormovement referred to as an aura. The aura often occurs just beforeawareness is altered and can be used as a warning.Random purposeless movements over which the individual has nocontrol called automatisms often characterize the seizure. These mayinclude movements such as chewing motions, lip smacking, pullingat clothing, or random walking. Occasionally there are moredramatic behavioral changes such as screaming or undressing. Onetype of rare partial seizure known as a gelastic seizure results in astudent giggling or laughing at inappropriate times.A complex partial seizure generally lasts between one and twominutes and is often followed by a period of disorientation andconfusion.Generalized SeizuresA generalized seizure commonly takes one of two forms: absence(without convulsions) or tonic clonic (with convulsions).An absence seizure (formerly called petit mal) results in a blankstare usually lasting less than 10 seconds. The seizure starts and endsabruptly, and awareness is impaired during the seizure. TheseEpilepsy: A Guide for Teachers - 5
seizures are sometimes misinterpreted as daydreaming orinattentiveness. The brief lapse of consciousness causes attentioninterruptions. As a result, a student may miss short parts of thelesson or may suddenly stop talking, stare blankly for a few seconds,and then continue talking without realizing that anything hasoccurred. Rapid blinking may accompany the seizure and the eyesmay roll upwards. Following the seizure, alertness is quicklyregained.Although an absence seizure lasts for seconds, a student mayexperience as many as several hundred absence seizures in a day. Ifabsence seizures are not treated, they could interfere with learning.Sometimes teachers are the first to notice these seizures.Tonic clonic seizures (formerly called grand mal) usually last fromone to three minutes.The tonic phase of this seizure type typically involves a crying out orgroan, a loss of awareness, and a fall as consciousness is lost andmuscles stiffen. The second phase or clonic phase of the seizuretypically involves a convulsion and there is jerking and twitching ofthe muscles in all four limbs. Usually the movements involve thewhole body. Urinary or bowel control may be lost and there may beshallow breathing, a bluish or gray skin color, and drooling. Thebluish color is partly the result of the change in available oxygencaused by a difficulty in breathing as the chest muscles contract. Theseizure may result in the student biting his or her tongue. Peoplecannot swallow their tongues. Never put anything in the student’smouth during the seizure.Awareness is regained slowly following the seizure and the personoften experiences a period of fatigue, confusion, or a severeheadache after the seizure. The student may want to sleep.Other types of generalized seizures include atonic and myoclonicseizures.An atonic seizure is sometimes called a “drop attack” because it canresult in a student suddenly falling to the ground. The seizureinvolves a sudden loss of muscle tone that may cause the student tofall or almost fall, to drop an object he or she is holding, or to nodthe head involuntarily. Typically, an atonic seizure lasts for a fewseconds.Epilepsy: A Guide for Teachers - 6
As an atonic seizure happens suddenly and often with no warning, itcan result in injury. Sometimes a student will have to wear a helmetfor protection. These seizures usually begin in childhood and oftenoccur in students with other seizure types.A myoclonic seizure results in a sudden jerk of part of the body suchas the arm or leg. The abrupt jerk of a muscle group may result in afoot suddenly kicking or in a student being thrown to the ground.Each seizure is very brief although myoclonic seizures may occursingly or in clusters.Status EpilepticusA continuous seizure state, or status epilepticus, is a lifethreatening condition. Seizures are prolonged or occur oneafter another without full recovery between seizures. Theseizures may be convulsive or non-convulsive. Immediatemedical care is necessary.Sudden Unexplained Death inEpilepsy (SUDEP)The cause of SUDEP, where death occurs suddenly for nodiscernible reason, is unknown. This is rare.HHow to Respond to SeizuresYou cannot stop a seizure from occurring. Most seizures last forseconds or several minutes and will end naturally. Once a seizure isover, the student will typically return to normal. As a teacher, it isimportant to assure that the student is not in jeopardy during andfollowing the seizure and to be aware of how to differentiatebetween a typical seizure and what is considered a medicalemergency.Epilepsy: A Guide for Teachers - 7
FFirst AidWhat To Do If Someone Has A Non-Convulsive Seizure(staring blankly, confused, not responding, movements are purposeless)12.2 Move dangerous objects out of the way.3.3 DO NOT restrain the person.4. Gently guide the person away from danger or block4 access to hazards.5. After the seizure, talk reassuringly to the person.5 Stay with the person until complete awareness returns.1. Stay with the person. Let the seizure take its course.Speak calmly and explain to others what is happening.What To Do If Someone Has A Convulsive Seizure(characterized by stiffening, falling, jerking)1. Stay calm. Let the seizure take its course.123. Protect from injury. If necessary, ease the person to the3 floor. Move hard or sharp objects out of the way. Place2. Time the seizure.something soft under the head.4. Loosen anything tight around the neck.Check for medical identification.45.5 DO NOT restrain the person.6. DO NOT put anything in the mouth. The person6 will not swallow his or her tongue.7. Gently roll the person onto his or her side as the7 convulsive seizure subsides to allow saliva or otherfluids to drain away and keep the airway clear.8. After the seizure, talk to the person reassuringly.Do not leave until the person is re-oriented. The personmay need to rest or sleep.8Epilepsy: A Guide for Teachers - 8
Calling An AmbulanceIn assessing the need to call an ambulance, acombination of factors has to be considered. Forexample, if cyanosis (blue or gray color) or laboredbreathing accompanies the seizure, then an ambulancemay be called earlier. If a person is known to haveepilepsy and the seizure pattern is uncomplicated andpredictable, then ambulance help may not be necessary.CALL AN AMBULANCE: If a convulsive seizure lasts longer than 5 minutes. If consciousness or regular breathing does not return after theseizure has ended. If seizure repeats without full recovery between seizures. If confusion after a seizure persists for more than one hour. If a seizure occurs in water and there is any chance that theperson has inhaled water. Inhaling water can cause heart orlung damage. If it is a first-time seizure, or the person is injured, pregnant, orhas diabetes. A person with diabetes may experience a seizureas a result of extremely high or low blood sugar levels.After first aid procedures have been followed, teachersor school staff should: reassure and comfort thestudent if confusion followsthe seizure. provide a change of clothing ifrequired (a change of clothingshould be kept at school). allow the student to remainin the classroom until fullawareness returns. inform the student of whatinstruction was missed. help to re-orient the student. help others to understandwhat happened. allow rest if required. allow time for discussion. allow for the student to go tothe restroom if the studentlost bowel or bladder controlduring the seizure. encourage a positive reactionamongst classmates. proceed with regular class work.Epilepsy: A Guide for Teachers - 9
HHow Seizures Are ControlledSeizure medication is the primary treatment for epilepsy. Medicinedoes not cure epilepsy, but it often reduces or even stops seizuresfrom occurring by altering the activity of neurons in the brain. Themajority of people achieve seizure control with seizure medication.It may be necessary for students to takemedicine at various times duringthe day. Arrangements should beSeizuremade based on the doctor’smedication is theinstructions and inconjunction with theprimary treatment forparents’ directions. Takingepilepsy. Drugs donʼt cureseizure medication asepilepsy, but they often reduceprescribed is essential.or even stop seizures fromSurgery may also be anoption. Students consideredoccurring by altering thefor surgery usually haveactivity of neurons inseizures that are medicallythe brain.refractory or intractable. Thismeans that they do not respond tomedical treatment such as the use ofseizure medicine. In some cases, the quality of life while onmedication is poor and surgery may be an option.Surgery may involve the removal of the part of the brain where theseizures originate or it may involve a surgical cut to prevent seizuresfrom spreading from one side of the brain to the other byinterrupting the nerve pathways.Other less frequently used methods to treat epilepsy include the useof a device that is similar to a heart pacemaker called a vagus nervestimulator and a special diet known as the ketogenic diet thatinhibits seizures in some individuals.In some cases, seizures remain uncontrolled despite treatment.Epilepsy: A Guide for Teachers - 10
WWhy Epilepsy Affects LearningChildren with epilepsy have the same range of intelligence as otherchildren and often epilepsy itself has no effect on intelligence orability. Children with epilepsy do, however, have a higher rate oflearning problems and difficulty in school and a lower level ofachievement. This may be influenced by many factors including: the side effects of medication the student’s anxiety absenteeism the underlying neurological cause of the epilepsy the seizures themselves the teacher’s attitude.MedicationSeizure medication can affect learning. Some medicationshave side effects that result in hyperactivity or interferewith concentration or memory. Seizure medications canalso result in drowsiness, loss of coordination, fatigue,headache, decreased appetite, behavioral changes, nausea,drooling, tremor, weight gain or loss, double or blurredvision, dizziness, and/or depression. Sometimes side effects arecosmetic and include overgrowth of the gums, hair loss, or excessivehair growth.The side effects tend to be more common when a drug has just beenstarted, when the dosage has been increased, or when more than onedrug has been prescribed.Side effects can interfere with learning and with adaptability in theclassroom.Epilepsy: A Guide for Teachers - 11
Teachers can be of great assistance by being alert to changes inlearning, behavior, and emotional well-being in students withepilepsy and by providing information to the appropriate contacts.AnxietyThe unpredictability of seizures could result in anxiety and insecurityin a student. This may affect initiative and independence in theclassroom.If a teacher is calm and effective in dealing with seizures andreassures the student with epilepsy as well as fellow students, thismay help to alleviate the student’s anxiety.AbsenteeismSeizures and medical tests and treatment may result in a studentmissing more class time than is typical. This could also influenceachievement.Teachers can assist the student by assuring that all missed classwork is available.Neurological CausesIn some cases, the underlying neurologic problemcausing epilepsy may also result in learningproblems. For example, if the condition results inproblems in the association
Epilepsy: A Guide for Teachers - 3 Epilepsy is a condition that is more common than most people realize. In the general population, approximately one person in a hundred has epilepsy meaning that approximately one in every one hundred students has epilepsy. In Canada, there are over 330,000 people with epilepsy. People of all ages have epilepsy .
photosensitive epilepsy only Natural light patterns/sunlight – photosensitive epilepsy only Epilepsy at a glance: what you need to know! Epilepsy is one of the most common serious neurological conditions. People with epilepsy tend to have repeated seizures. Up to 70% of children with epilepsy will either grow out of their epilepsy
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Director, NYU Comprehensive Epilepsy Center New York University Robert Fisher, MD, PhD Maslah Saul MD Professor Director, Stanford Epilepsy Center Stanford University . Dr. Alfonsina Q Davies Endowed Chair in Honor of Paul Crandall for Epilepsy Research Director, Epilepsy Surgery, Pediatric Epilepsy Program .
people with epilepsy are also served by local Epilepsy Foundation affiliates across the country. If you have any questions about epilepsy and seizure disorders, living with epilepsy, or helping a friend or family member who has epilepsy, please visit us on the Web at www.EpilepsyFoundation.org or call 800-332-1000. Our Web site has information .
Epilepsy prioritizes highly innovative, risky, paradigm-shifting projects that address CURE Epilepsy’s mission to cure epilepsy, affirming our core belief that the only acceptable final goal is “no seizures, no side-effects.” CURE Epilepsy: Our mission is to cure epilepsy, by promoting and funding patient-focused research.
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What is epilepsy? 3 Memory 4 Memory problems 5 Memory and epilepsy 6 Improving memory 8 Problem areas 10 Finally 11 This guide explains why people with epilepsy can have memory problems. This leaflet explains why. It also gives some ideas for improving memory.
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