The
presence of any disability in a child may alter the normal dynamics in a family,
and lead to the child being over-protected. Whereas this is an understandable
reaction, particularly if the seizures are accompanied by injury, it is often
harmful in the long run and may lead to inappropriate behaviour and over-dependence
on parents. In addition, parents and teachers may try to protect the child from
stress if this is felt to precipitate seizures. A more productive approach is
to teach the child the skills necessary to cope with stress which is an inevitable
part of everyday life.
Concern about safety may
also lead to a child being barred from workshops, laboratories and
sporting activities. However, blanket restrictions on all children
with epilepsy are unacceptable and the risks to each child must
be assessed individually on the basis of accurate knowledge of that
child's epilepsy. If the seizures are completely controlled or only
occur during sleep, no restrictions are needed. Even if seizures
occur during the day, almost all activities including swimming and
climbing can be undertaken providing there is adequate supervision.
Most children
with epilepsy can watch TV and use VDUs quite safely, but it is sensible to find
out from the doctor if the child is known to be sensitive to flashing lights (photosensitive).
A Factsheet on Photosensitivity is available from the CIEN.
Careers
guidance
Advice on careers for children with epilepsy
should be given early and be based primarily on aptitudes and skills.
Once these are identified, the relevance of the epilepsy should
be considered. The advice of specialist career adviser should be
sought if the epilepsy is still a major problem. A history of epilepsy
can be a bar to jobs in the armed forces, the merchant navy and
those jobs requiring an aircraft pilot's licence. Moreover, any
occupation that is heavily dependent on driving is not normally
recommended as a single seizure while awake will lead to loss of
the licence and perhaps also the job. However, many young people
are very keen to learn to drive and this must be taken into account
if withdrawal of medication is being contemplated as the young person
approaches school leaving age. Entry into some professions such
as nursing, teaching and childcare may prove difficult if there
is a recent history of seizures. Moreover, if these are frequent
or if there are other disabilities, job prospects are currently
poor. However, it must be stressed that skills, personality and
ability to present the epilepsy clearly to a prospective employer
are vital to success in the job market. It is also essential for
the school leaver with epilepsy to have qualifications which are
on par with other job applicants. Young people with epilepsy should
take full advantage of further and higher Employment Service schemes
for young people.
About 6 in every 1000 children of school
age have epilepsy and 80% of these attend ordinary schools. For
the majority, epilepsy does not cause enormous problems particularly
if the child receives early medical attention, accurate information
and appropriate counseling. There are, however, a number of areas
where difficulties may arise and these are summarised in this page.
For more detailed information and explanation, please contact CIEN.
Recognising Epilepsy
A parent or teacher is likely to be the
first adult to witness a seizure in a child. Most people will recognise
a major convulsive tonic clonic seizure previously known as ‘grand
mal’ in which the child loses consciousness and then convulses,
but there are many other types of attack which are due to epilepsy.
A detailed written eyewitness account is invaluable to a doctor
who subsequently sees the child and makes a diagnosis. Other causes
of loss of consciousness will have to be excluded and it should
be remembered that some children who simply faint may also have
mild convulsive movements. Absences, previously known as ‘petit
mal’, are very brief interruptions of consciousness and they may
be difficult to detect. Teachers and parents should be alerted to
this possibility if a child suddenly appears to have vacant spells
or be unusually inattentive. Focal or partial seizures may be difficult
to recognise as they often appear as bizarre behaviour which may
be mistaken for silliness. However such seizures are accompanied
by mental confusion and tend to take the same form each time they
occur. In some children, seizures only occur during sleep, and it
may be some time before the true nature of the attacks is recognised.
Although it is not always possible to identify
a cause for the epilepsy, it is important to try, since the outlook may be related
to the underlying reason for the occurrence of the seizures. Some forms of epilepsy
are benign and will improve spontaneously as the child gets older, but this is
by no means always the case.
Treatment
Epilepsy can be completely controlled
in up to 80% of cases, and all efforts should be made to achieve
this at an early stage. The majority of children with epilepsy will
be treated with medication in tablet, capsule or liquid form. It
is important for everyone involved, including the child, to understand
that treatment is not a cure for the epilepsy but is means of controlling
the seizures and that medication may have to be taken regularly
for several years. Most drug treatment can be given before and after
school hours. Tablets taking should be regarded as essential to
health rather than being a sign of illness. As soon as, possible
the child with epilepsy should take full responsibility for the
medication, otherwise problems may arise over taking tablets reliably,
particularly during adolescence.
Very few children who have focal epilepsy
may be suitable for epilepsy surgery. This can be highly successful
in controlling the seizures without causing additional problems,
but a detailed assessment is required before an operation can be
advised.
Communication
The Disability due to epilepsy can be
substantially reduced if there is good communication between professionals,
parents, the child with epilepsy and school friends. A free interchange
between teachers, parents and carers advisers is essential for all
children with epilepsy and parents should not be reluctant to disclose
and discuss their child’s epilepsy. Also teachers need to know more
than that a particular child “has epilepsy”; this fact alone is
inadequate for correct understanding and supportive care. Detailed
information should be made available by the parents, school doctor
and nurse, general practitioner or pediatrician, and should include
a description of the seizures and their frequency, the speed of
recovery, the most appropriate management for that child, drug treatment
and possible side-effects.
Parents and teachers may find it difficult
to strike the right balance between providing special help when
needed from time to time, and allowing the child to take risks.
Children with epilepsy should experiance all the success and failures
that are needed for normal growing up and an open positive attitude
in parents and teachers is likely to help the child to deal with
the reactions found in school friends. However, it is always difficult
to decide whether other children should be told about the epilepsy.
If seizures are likely to occur during school hours it is better
that information about epilepsy should be included in the ordinary
curriculum, such as in a health education programme, rather than
taught in the agitated aftermath of an unexpected seizure in the
playground or classroom. It is important to discuss with the child
how they would like information about their epilepsy to be communicated
to others.
Classroom management
A major seizure occurring at school can
be very upsetting experience for all concerned. The harmful effects
that may result can be minimized if the teacher acts calmly, deals
with the seizure appropriately, reassures other children and comforts
the child who has had the seizure. The correct management of seizures
is explained in more detail in the CIEN page ‘Seizures’. The vast
majority of seizures are brief and do not require emergency medical
treatment.
So children who have seizures should spend as little time as possible out of the
classroom or away from school, and agreement should be reached between teachers,
the child’s doctor, the parents and the child as to the most appropriate way of
managing a particular child’s epilepsy.
Learning and achievement
Some
teachers may mistakenly have a low expectation of pupils with epilepsy and inadvertently
treat them differently. If the seizures are well controlled and there are no other
disabilities, there is no reason to expect a child with epilepsy to under-achieve.
However, research does suggest that a number of children with epilepsy perform
less well than a formal assessment of their abilities would suggest. The causes
of this may be complex and require assessment from a multi-disciplinary team,
including an educational psychologist, to provide solutions.
The
following factors may be relevant:
Frequent major seizures
may lead to poor school attendance, particularly if a child
is removed from school inappropriately every time a seizure
occurs.
Frequent absence seizures,
which may be difficult to detect, can impair learning.
Children with more
severe epilepsy may have episodes of disorganised brain activity,
not sufficient to cause a seizure, but which may impair performance
and learning.
Although the majority
of children with epilepsy are of average intelligence, it
is also true that children with learning disability have a
high incidence of epilepsy.
If the epilepsy was
caused by some localised injury to the brain, this damage
may also cause other educational problems, such as poor verbal
skills if the dominant half of the brain is affected (usually
the left side), or poor practical skills if the non-dominant
side is involved.
Incorrect or excessive
drug treatment can also impair school performance, particularly
if it makes the child sleepy. However, drugs should not be
blamed for everything and it is often difficult to distinguish
between the effects of drugs and those due to ongoing epileptic
activity in the brain.
The child may have
a poor self-image and inadvertently be fulfilling low expectations
expressed by parents and teachers. Behaviour problems seen
in some children with epilepsy may be related directly to
the epilepsy but are also commonly due to difficulties in
relationships within the family and with other children.
2004