An aspect of the Center for
written by: Stephanie
I attest that the following
report is a product of my own original work.
a brain disorder characterized by seizures is present in 2.5 million
the United States,
including 315,000 school children. Seizures are abnormal electrical
activity. There are three main types
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
are six main types of partial epilepsies.
There are five main
generalized idiopathic epilepsies and three main types generalized
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),
and the ketogenic diet which is high in fat and low in cholesterol.
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,
strange sensations, emotions, and behavior or sometimes convulsions,
spasms and loss of consciousness.” (National Institution of
Disorders and Stroke [NINDS], 2001)
About 25% of epilepsies have a known cause and they
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
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
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
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,
sensory seizures, and myoclonic seizures. Complex
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
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
Generalized idiopathic (no apparent
cause) and generalized symptomatic (structural abnormality in the
epilepsies occur when there is no evidently defined region of the brain. The five main generalized idiopathic
are: benign myoclonic (in infants), juvenile myoclonic, childhood
juvenile absence, and epilepsy with generalized tonic clonic seizures
childhood. The three main generalized
symptomatic epilepsies are: infantile spasm (West syndrome),
syndrome, and progressive myoclonus epilepsies.
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
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
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
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
both mental retardation and cerebral palsy (50%), children of mothers
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
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
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
of the disability
has many external characteristics and pertain to the type of seizure
happening. Tonic-clonic seizures can be
characterized by loss of consciousness, violent reactions, involuntary
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,
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
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
issues: How the disability affects the
classroom and vice versa
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
and related services. Due to frequency
of seizures, students’
learning may be impaired so additional assistance may be needed to keep
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
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
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
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
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
If a student is experiencing a
simple partial seizure, their possibility of injury is low and reassure
after the event. If a student is
experiencing a complex partial seizure, their possibility of injury is
unless there is physical activity; therefore, give verbal reassurance
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
if tonic-clonic seizures repeat one after another, if tonic-clonic
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
Since she has no warning that a
seizure will be coming on, fellow students stared and later teased her
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
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
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
about the condition.
In France, there are three
schooling: normal (group I), adapted (group II), and special education
III). French children unusually start
school at 3 years of age. In a study by
Bulteau, Jambaque, Viguier, Kieffer, Dellatolas, and Dulac (2000) of
girls and 153 boys) French school children, students with generalized
idiopathic and localization-related epilepsies had a higher IQ than
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
IQ. This was noticed dramatically in
with generalized symptomatic epilepsies.
Of the entire study, students with IQs
greater than 90 were in mainstream schools and consisted of 188 of the
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
taking 2 or more AEDS (antiepileptic drugs) whereas only 59% of
students were taking 2 or more AEDs.
issues as they relate to the classroom
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,
(Tegretol/Carbatrol), Primidone (Mysoline), Ethosuximide (Zarontin),
acid (Depakene), Divalproex (Depakote ER/depakote), and Diazwpam
(Valium). Newer AEDs are Felbatol,
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
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
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
test – method of putting half the brain to sleep in order to test the
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
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
hemispherectomy (removing a large part of one side of the brain) and
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
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
in 1 out of 3 patients.
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
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.
drugs. Retrieved November 10, 2004, from
Jambaque, I., Viguier, D., Kieffer,
Dellatolas, G., & Dulcac, O. (2000)
Epileptic syndromes, cognitive
assessment and placement: a study of 251
children [electronic version]. Developemental
Medicine & Child Neurology,
seizure statistics. Retrieved November
9, 2004, from >
Hecimovic, H., & Sheline, Y.
Function in epilepsy [Electronic
& Behavior, 4.
Granstrom, M. L., & Berg, S.
(2004). Dichotic listening in
focal epilepsy: Effects of
structural brain abnormality and
of Clinical and Experimental
epilepsy information page. Retrieved
November 1, 2004, from
Pal, D. K.
(2003). Epilepsy control in the
twenty-first century: hidden impact on
Children and families [Electronic
version]. Child:Care, Health
C. P. (2004). Autonomic seizures and
autonomic status epilepticus
Peculiar to childhood: diagnosis
and management [Electronic
in children. Retrieved November 9, 2004,
Turnbull, A., Shank, M., & Smith, S. J.
(2004). Exceptional Lives:
Education in Today’s Schools. Upper Saddle River, NJ: Merrill
epilepsy. Retrieved November 10, 2004,
Sa’adi, L., Silman-Stolar, Z., & Goikhman, I. Seizure
educational outcome in
childhood-onset epilepsy [Electronic version].
Child Neurology. 16(11).
This website is a
service learning project by the students of "Psychology of the
Exceptional Child" at Frostburg State University. Manager of web
page and project:
Dr. Megan E. Bradley