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An aspect of the Center for Children and Families

Topic: epilepsy
Researched and written by: Stephanie Sfrisi
                                                I attest that the following report is a product of my own original work.

Summary
Full Report
Related Websites

References
 


Summary
 

Epilepsy, a brain disorder characterized by seizures is present in 2.5 million people in the United States, including 315,000 school children. Seizures are abnormal electrical brain activity.   There are three main types of epilepsy: partial, generalized idiopathic and generalized symptomatic.  Partial epilepsies occur in an obvious region of the brain whereas both types of generalized epilepsies have no obvious brain region.  There are six main types of partial epilepsies.   There are five main types of generalized idiopathic epilepsies and three main types generalized symptomatic epilepsies.  Research is ongoing for a cure for epilepsy but as of today, there is still no cure.  Three methods of treatment to help decrease or eliminate seizures are medication called AEDs (antiepileptic drugs), surgery and the ketogenic diet which is high in fat and low in cholesterol. 
 
Full Report

Overview/definition of disability/disorder
  “Epilepsy is a brain disorder in which clusters of nerve cells, or neurons, in the brain sometimes signal abnormally.  In epilepsy, the normal pattern if neuronal activity becomes disturbed, causing strange sensations, emotions, and behavior or sometimes convulsions, muscle spasms and loss of consciousness.” (National Institution of Neurological Disorders and Stroke [NINDS], 2001)  About 25% of epilepsies have a known cause and they include prenatal brain injury, birth complications, head trauma, brain tumors, stokes, poisoning, hypoglycemia, and meningitis.  The other 75% of cases have no known cause.
            Epilepsy is characterized by seizures which are abnormal electrical charges in the brain’s neurological functioning.  There are two types of seizures one can have.  They are generalized and partial.  Generalized seizures affect the whole body and cause a lack of consciousness.  The abnormal neurological functioning can happen anywhere in the brain.  Partial seizures happen where there is abnormal neurological functioning in a specific area of the brain and consciousness is not affected.
            Generalized seizures are categorized as tonic-clonic (formerly referred to as grand mal seizures) and absent seizures (formerly referred to as petit mal seizures).  During a tonic-clonic seizure, the student experiencing the seizure will lose consciousness, fall to the ground and start convulsing (sudden involuntary muscle contractions) and foam at the mouth.  Absent seizures can cause a lack of consciousness for up to 30 seconds.  These seizures can go unnoticed to the student, teacher and parents and can occur as frequently as up to 140 times a day.
            Partial seizures can be categorized as temporal lobe or complex partial seizures, focal motor seizures, focal sensory seizures, and myoclonic seizures. Complex partial <>
seizures cause the student to look as if they are daydreaming.  During the seizure, they may make random movements such as picking at their clothing or stuttering.  During a focal motor seizure, the student will experience sudden jerking movements in one part of their body.  Students experiencing focal sensory seizures will hear and see things that are not really there.  Lastly, during myoclonic seizures, which mostly affect infants and young children, will cause the student to appear as if they are in pain.  They may drop their head forward and shoot up their arms.
            Epilepsy has three main types.  These types are: partial epilepsies, generalized idiopathic epilepsies, and generalized symptomatic epilepsies.  Partial epilepsies occur when they are in evidently defined regions of the brain.  The six main partial epilepsies are: benign occipital, benign rolandic, frontal lobe, occipital lobe, mesial temporal lobe, and parietal lobe epilepsies. 
            Generalized idiopathic (no apparent cause) and generalized symptomatic (structural abnormality in the brain) epilepsies occur when there is no evidently defined region of the brain.  The five main generalized idiopathic epilepsies are: benign myoclonic (in infants), juvenile myoclonic, childhood absence, juvenile absence, and epilepsy with generalized tonic clonic seizures in childhood.  The three main generalized symptomatic epilepsies are: infantile spasm (West syndrome), Lennox-Gestaut syndrome, and progressive myoclonus epilepsies.
 
Statistics on how many are affected and any gender/ethnicity based statistics 
      Epilepsy is present in between 1 to 2 percent if the American population (about 2.5  million) and three percent are likely to develop epilepsy before the age of 75.  The highest incidents of cases occur in persons under the age over 2 and over the age of 65.  Statistically, of the 181,000 new cases of epilepsy diagnosed each year. 45,000 are children under the age of 15 and 315,000 of school children under the age of 14 are diagnosed as having epilepsy.  The most common type of seizure that children under the age of 10 experiences is generalized.

        Males are more likely to be affected than females.  African Americans and persons living in socially underprivileged populations show a higher incidence rate.  Individuals from certain populations are predisposed for a greater risk of epilepsy.  These populations include: children with mental retardation (10%), children with cerebral palsy (10%), children with both mental retardation and cerebral palsy (50%), children of mothers with epilepsy (8.7%), and children with fathers with epilepsy (2.4%).  A small percentage of children with autism may develop epilepsy. 
        Not all countries take time to research epilepsy and help persons with epilepsy.  In developing countries, such as India, persons with epilepsy are stigmatized.  This affects about 24 million children.  These children face extremely limited social opportunities in both the home and school.  In the rural areas of these countries, as many as 85% of these children are not schooled.  They are not allowed to play with their peers and their parents think negatively about them.  When they grow up, if their child does not have epilepsy, they would not want their child to marry someone with epilepsy.  Just recently, schoolteachers and community leaders have made it possible for children with epilepsy to enter school for the first time.  
       Common psychiatric co-morbid (co-occurring) disorders of persons with epilepsy are depression and anxiety.  Bipolar disorder and cognitive disorders may also occur more frequently in individuals with epilepsy compared to the general population.
Characteristics of the disability
        Epilepsy has many external characteristics and pertain to the type of seizure that is happening.  Tonic-clonic seizures can be characterized by loss of consciousness, violent reactions, involuntary jerking, disorientation, vomiting, staring, and momentary pauses in breathing.  Absence seizures cause the student to stare and experience a brief cessation of consciousness.
            Complex partial seizures are characterized by a distorted state of consciousness, drooling, stuttering, and random movements.  Simple partial seizures are characterized by twitching movements.
            Internal characteristics are seen in electrocephalogram (EEGs).  This is the most useful test for autonomic seizures and is used to reveal sharp and slow abnormalities.  The spikes are often high in aptitude but can also be small and seem to cause no worry.  About 68% of patients show extra occipital spikes.  The remaining 32% show no spikes at all.
 
Classroom issues:  How the disability affects the classroom and vice versa
          Teachers and school personnel should be notified if a student has epilepsy.  Under Individuals with Disabilities Education Act (IDEA), students with epilepsy are categorized under “other health impairments” and if needed, classify students as eligible for special education and related services.  Due to frequency of seizures, students’ learning may be impaired so additional assistance may be needed to keep their studies up to par with their classroom peers.  These assistances may include revisions to the classroom, counseling and first aid training for the teachers and should be written in an Individualized Education Program (IEP).
            Not much research has been done on how epilepsy affects the classroom.  One reason may be that it is hard to tell if a student has epilepsy unless they tell you or experience a seizure in the classroom.  If a student or teacher has never seen anyone experience a seizure before, this can be very scary.  According to Turnbull, Turnbull, Shank & Smith (2004), a few ways to avoid triggering a students’ seizure are to eliminate environmental factors such as bright lights, certain sounds and odors.  The student will need to give a list of factors that trigger their seizures.  Other factors are fatigue, extreme stress, and infectious diseases.  Parents and teachers need to be cautious when the child shows any of these signs.
            Turnbull et al., (2004) also give a list of first aid guidelines for seizures.  If a student is experiencing a tonic-clonic seizure, lay them on their side, move dangerous or fragile objects, place a pillow under their head and never attempt to restrain them or put something in their mouth.  The possibility of injury is fairly high due to bumping into objects during the event.  If a student is having an absence seizure, reassure them after the seizure.  The possibility of injury is low.
            If a student is experiencing a simple partial seizure, their possibility of injury is low and reassure them after the event.  If a student is experiencing a complex partial seizure, their possibility of injury is fairly low, unless there is physical activity; therefore, give verbal reassurance during the event.
            After any type of seizure, assist the student to the nurse and notify the parents.  Seek medical attention immediately    if it is the student’s first seizure, especially if it is a
tonic-clonic, if tonic-clonic seizures repeat one after another, if tonic-clonic seizures last more than 2-3 minutes or if there was injury during the seizure.
            One of my friends has had epilepsy for 22 years and experienced a seizure in her middle school classroom.  She had a complex partial seizure in which she stared and stuttered with a chewing motion.  This lasted for about 30 seconds and though she could hear what was going on, she could not respond.  Her recovery time was about 10 minutes and then she could respond and communicate properly. 
            Since she has no warning that a seizure will be coming on, fellow students stared and later teased her about her seizure.  Her teacher then intervened and spoke with the class about epilepsy and what happened and why.  Another way to talk about the subject is if they are comfortable, have the student talk about their condition and answer any questions that fellow students may have.
            Since she has dealt with this all her life, she was not embarrassed or offended but this is not the case with every child in a classroom setting that experiences epileptic seizures.  In order to avoid embarrassment or hurting the students’ feelings, the student and teacher should talk with the classmates about the condition.
            In France, there are three types of schooling: normal (group I), adapted (group II), and special education (group III).  French children unusually start school at 3 years of age.  In a study by Bulteau, Jambaque, Viguier, Kieffer, Dellatolas, and Dulac (2000) of 251 (98 girls and 153 boys) French school children, students with generalized idiopathic and localization-related epilepsies had a higher IQ than students with generalized symptomatic and undetermined epilepsies.  IQ was not significantly different between boys and girls.  When the whole sample was looked at, in all, verbal IQ on Wechsler scales was higher than performance IQ.  This was noticed dramatically in students with generalized symptomatic epilepsies. 
       Of the entire study, students with IQs greater than 90 were in mainstream schools and consisted of 188 of the 251 students.  Students with IQs less than 50 were placed in adapted schools and special education.  Twenty-seven of the students were in adapted schools and the remaining 32 were placed in special education.  Another significant finding in the study besides the IQs was that 81% of students in adapted and special education were taking 2 or more AEDS (antiepileptic drugs) whereas only 59% of mainstream students were taking 2 or more AEDs. 
Treatment issues as they relate to the classroom
     
There are many effective treatments for epilepsy.  They include medication, brain surgery and diets that are high in fat and cholesterol.  The first step that is taken is medication.  There are many and some have recently been released.  The older AEDs are Phenytoin (Dilantin/Phenytek), Phenobarbital, Carbamazepine (Tegretol/Carbatrol), Primidone (Mysoline), Ethosuximide (Zarontin), Valproic acid (Depakene), Divalproex (Depakote ER/depakote), and Diazwpam (Valium).  Newer AEDs are Felbatol, Gabitril, Keppra, Lamictal, Neurontin, Topamax, Zarontin, and Zonegran.  A warning for medications is that even though they are newer, it does not necessarily mean that they are more effective.  They are also more effective.
            Proper evaluation will be needed to specify which medication is suitable because some medications are for specific types of epilepsies.  Zarontin is the best choice for absence epilepsies.  Phenobarbital, Carbamazepine, and Primidone are the best suited for complex partial epilepsies.   
         Possible side effects depend on the amount of dosage, type of medication and length of treatment.  Drowsiness, depression, nausea, vomiting, headaches, dizziness, loss of appetite, blurred vision, diarrhea, dry mouth, and weakness are possible side effects of AEDs.
            The second type of treatment is brain surgery.  Before any kind of surgery is performed, EEGs – measures electrical activity if the brain and Wada test – method of putting half the brain to sleep in order to test the other half, are taken and evaluated.  These tests are taken in order to make sure the patient qualifies for the surgery.  The surgeries are categorized in different ways, depending on what section of the brain the seizures occur in.  It has been reported that about 30,000 epilepsy surgeries are performed a year.  Surgery happens most frequently with partial epilepsies.  During the procedure, the part of the brain that is causing the seizures is removed.  Two main surgeries that happen in childhood epilepsies are hemispherectomy (removing a large part of one side of the brain) and corpus collosotomy (cut the corpus collosum – nerve fibers that connect the hemispheres of the brain).  Surgeries may completely rid the patient of seizures, some may still need medication and others may need more surgeries.
            The last treatment for persons suffering from epilepsy is the ketogenic diet.  This is the most successful in young children and is kept up for between 2 to 3 years.  A ketogenic diet is one that is high in fats and low in carbohydrates.  It takes a long time and a lot of effort from the whole family but overall, it helps 2 out of 3 who try it and can eliminate seizures completely in 1 out of 3 patients.
Conclusion 
        Epilepsy is a brain disorder that affects 315,000 school age children under 14.  There are three main types.  It is characterized by seizures which are categorized into two main types with many different types within these two classifications of epileptic seizures.  Some children with epilepsy are placed in special education due to type of epilepsy, frequency and type of seizures.  Most children with epilepsy have normal IQ scores and are placed in general education classrooms.
 


Related Websites
<>National Institute of Neurological Disorders and Strokes (NINDS)
http://www.ninds.nih.gov
<>Epilepsy Foundation
http://www.epilepsyfoundation.org
<>American Epilepsy Society
http://www.aesnet.org


References


<>Antiepileptic drugs.  Retrieved November 10, 2004, from 
       http://w3.ouhsc.edu/neuro/division/cope/aed.htm

Bulteau, C., Jambaque, I., Viguier, D., Kieffer, V., Dellatolas, G., & Dulcac, O.  (2000)
            Epileptic syndromes, cognitive assessment and placement: a study of 251
            children [electronic version].  Developemental Medicine & Child Neurology,
            42,  319-327.
  <>Epilepsy and seizure statistics.  Retrieved November 9, 2004, from
        http://www.epilespyfoundation.org/answerplace/statistics.cfm
Gilliam, F., Hecimovic, H., & Sheline, Y.  (2003).  Psychiatric comorbidity, health, and
            Function in epilepsy  [Electronic version].  Epilepsy & Behavior,  4.  S26-30.
Korkman, M., Granstrom, M. L., & Berg, S.  (2004).  Dichotic listening in children with
            focal epilepsy:  Effects of structural brain abnormality and seizure
            characteristics  [Electronic version].  Journal of Clinical and Experimental
            Neuropsychology,  26(1).  83-94.
NINDS epilepsy information page.  Retrieved November 1, 2004, from
            http://ninds.nih.gov/health_and _medical/disorders/epilepsy.htm
Pal, D. K. (2003).  Epilepsy control in the twenty-first century:  hidden impact on
            Children and families [Electronic version].  Child:Care, Health & Development,
            29(4).  233-236.
Panayiotopoulos, C. P.  (2004). Autonomic seizures and autonomic status epilepticus
            Peculiar to childhood:  diagnosis and management [Electronic version].  Epilepsy
            & Behavior,  5.  286-295.
Seizures in children.  Retrieved November 9, 2004, from
            http://www.healthscout.com/ency/68/675/main.htm
Turnbull, R., Turnbull, A., Shank, M., & Smith, S. J.  (2004).  Exceptional Lives: Special
            Education in Today’s Schools.  Upper Saddle River, NJ:  Merrill Prentice Hall
Types of epilepsy.  Retrieved November 10, 2004, from
            http://www.mychen.demon.co.uk/Epilespy/Types/Types%20of_epilepsy.htm Zelnick, N., Sa’adi, L., Silman-Stolar, Z., & Goikhman, I.  Seizure control and
            educational outcome in childhood-onset epilepsy [Electronic version].  Journal
            of Child Neurology.  16(11).  0883-0738.

 





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