EPILEPSY

During the internship programme, a number of cases were dealt with involving learners with
Epilepsy who required school placement. Notably, the majority of the children experienced learning
problems related to their seizures. Several major factors may contribute to their learning difficulties.
These are seizure – related effects, medication – related effects, psycho- educational factors and
developmental disorders.

Definition

Epilepsy is a group of related disorders characterised by a tendency for recurrent seizures. There are
different types of epilepsy and seizures.

What is a seizure?
 An abnormal movements or behaviour or due to unusual electrical activity in the brain.
However, not all people who appear to have seizures have epilepsy.
 A group of related disorders characterised by a tendency of recurrent seizures.

Types of Seizures

Non- epileptic seizures (also called pseudo-seizures)

These are accompanied by abnormal electrical activity in the brain and may be caused by
psychological issues or stress. They may be mistaken for true seizures, making diagnosis and
management more difficult. Normal EEG readings and lack of response to epileptic drugs are two
clues that they are not true epileptic seizures. These types of seizure may be referred to the
psychiatrist.

Provoked seizures
These are single seizures that may occur as the result of trauma, low blood sugar (hypoglycaemia),
low blood sodium, high fever or alcohol or drug use. Fewer-related(or febrile) seizures may occur
during infancy but are usually outgrown by age 6.

Seizure Disorder
A general term used to describe any condition in which seizures may be a symptom. Seizure
disorder is a general term that is often used in place of ‘epilepsy’

What causes Epilepsy?

Epilepsy occurs as a result of abnormal electrical activity originating in the brain. Brain cells
communicate by sending electrical signals in an orderly pattern. These electrical signals become
abnormal; giving rise to an ‘electrical storm’ that produces seizures. These storms may be within a
specific part of the brain or generalised, depending on the type of epilepsy.

Understanding
In individuals with epilepsy, certain triggers can lead to seizure. Certain behaviours, environments or
physical and emotional signs that precede attacks. It’s common for an individual to feel annoyed or
elated several hours prior to a grand- mal-seizure and immediately before the attack. The person
may become aware of a ‘warning’(aura), that comes in the form of a taste or a smell. Therefore,
there is need for the Psychologist to educate the teachers and caregivers on the need to identify the
aura and take precautionary measures on the child. For example, the child may be asked to or lie
down.
Types of Epilepsy

People living with epilepsy may experience one seizure type. Basing on the type of behaviour and
brain activity, seizures are divided into two broad categories: generalised and partial (also called
local or focal) Classifying the type of seizure helps doctors diagnose whether or not an individual has
epilepsy.

Generalised seizures are produced by electrical impulses from throughout the entire brain, whereas
partial seizures are produced(at least initially) by electrical impulses in a relatively small part of the
brain. The part of the brain generating the seizures is sometimes called the focus. The most
common type of seizures are;

Generalised Seizures Symptoms

(produced by the entire brain)
‘’Grand Mal’’ or Generalised tonic -clonic Unconsciousness, convulsions, muscle rigidity
Absence Brief loss of consciousness
Myoclonic Sporadic(isolated), jerking movements
Clonic Repetitive, jerking movements
Tonic Muscle stiffness, rigidity
Atonic Loss of muscle tone

Generalised Seizures
There are six types of generalised seizures. The most common and dramatic and therefore the most
well- known, is the generalised convulsion, also known as the Grand-mal- seizure. In this type of
seizure, the patient loses consciousness and usually collapses. The loss of consciousness is followed
by generalised body stiffening (called the ‘tonic’ phase of the seizure) for 30 to 60 seconds, then by
violent jerking (the ‘clonic’ phase) for 30 to 60 seconds, after which the patient goes into a deep
sleep(the ‘postictal’ or after-seizure phase) During grand-mal seizures, injuries and accidents may
occur, such as tongue biting and urinary incontinence.

Absence seizures
They cause a short loss of consciousness (just a few seconds) with few or no symptoms. The patient,
most often a child, typically interrupts an activity and stares blankly. These seizures begin and end
abruptly and may occur several times a day. Patients are usually not aware that they are having a
seizure, except that they may be aware of ‘’losing time’’.

Myclonic seizures
These consist of sporadic jerks, usually on both sides of the body. The individuals sometimes
describe the jerks as brief electrical shocks. When violent, these seizures may result in dropping or
involuntarily throwing objects.

Clonic Seizures

They are repetitive, rhythmic jerks that involve both sides of the body at the same time.

Tonic seizures are characterised by the stiffening of the muscles.

Atonic Seizures consist of a sudden and general loss of muscle tone, particularly in the arms and
legs, which often results in a fall.

Partial Seizures Symptoms

(produced by a small area of the brain)
Simple (awareness is retained) Jerking, muscle rigidity, spasms, head-turning
Simple Motor Unusual sensations affecting either the vision,
Simple Sensory hearing, smell taste or touch.
Simple Psychological

Complex Automatisms such as lip smacking, chewing,

(Impairment of awareness) fidgeting, walking and other repetitive,
involuntary but coordinated movements.
Partial seizure with secondary generalisation Symptoms that are initially associated with a
preservation of consciousness and convulsions.

Seizures and Learning

Factors that affect academic performance in relation to seizures include;

 the age of onset of the seizures.

 the seizure types one experiences.
 what part of the brain is affected by the seizure activity.
 the frequency of the seizures. Different seizures can have different impacts on a child’s
school performance. For example the generalised tonic- clonic (grand- mal) seizures or a
complex partial seizure may adversely affect a child’s memory. Absence seizures, which are
characterised by brief loss of consciousness, may prevent a student from hearing and seeing
what is happening in his class whilst experiencing the seizures. This loss of contact with his
surroundings can therefore impede his learning. Children may also fall behind from missing
school for doctor’s appointments, tests or while recovering from a major seizure.

Medication and learning

The type of medication, the strength of the dosage and the number of medications a child may be
taking can affect learning. Some commonly prescribed medications have side effects which may
include drowsiness, inattention or restlessness, all of which can have an adverse impact on a
student’s learning potential. If a child is taking multiple medications to control her seizures or taking
the medication at a very high dosage level, he/she may experience more learning difficulties than
children taking only one drug or taking a lower dose of a medicine.

Family coping strategies, school and parent expectations and behavioural or emotional problems can
all impact the learning of a student who has epilepsy. These factors can be both a cause and a
consequences of academic difficulties. The stigma that still surrounds epilepsy in some communities
can lead to stress in a student’s life, resulting in poor school performance. A student’s self-esteem
and confidence can also suffer due to the effects of epilepsy in her life. A continuing downward
spiral of decreased school performance and diminished self-esteem can prove to be very
problematic for some students living with epilepsy.

C0hildren with epilepsy may also have developmental disorders that can impact their school
performance. These disorders may include learning disabilities, attention deficit/hyperactivity
disorder (ADHD), developmental delay, mental retardation and autism.

Developing a Management Plan

 The sooner a child’s learning disabilities are identified; the sooner school personnel and
parents can develop effective strategies that will help the child succeed academically. There
needs to be an open communication between the family and the school about the
challenges the student is facing. This is critical in this development process. Tutoring and
counselling may be effective in helping the student succeed with her schoolwork in additions
to modifications and accommodations made by her teachers within the classroom setting.
 The Epilepsy Foundation can be useful in giving the right information on how to manage the
seizure.
 The Psychologists will make follow ups on the learners to see how best they can be assisted
to cope with their cases in their learning environments.
 There is need for the teacher to monitor the schedule for taking medication in a learner with
Epilepsy.
 Some medications make the children drowsy so there is need for the teacher to be advised
on the best course of action to take when the child is dosing in the classroom.
 Monitoring outdoor activities such as swimming is important in order to avoid fatal
accidents and deaths.


Comment on observations made during the internship programme in relation to Epilepsy

It was noted during the internship programme that the majority of cases dealt with involving
children with Epilepsy that was acquired in infancy, led to some of the children being among
the learners with mental challenges. Some of the children also had learning difficulties and a
low self- esteem that was associated to Stigma. The few children that performed well during
 the assessment had developed the disease at a later stage in life, either in junior primary
school or in secondary school. This has led the Psychologist to the conclusion that the
problems associated with the disease impact negatively on an individual’s learning such that
poor academic performance becomes the end result in some cases.

Compiled by: Munhuwa M. Supervised By: Maisiri H.

Intern Educational Psychologist Registered Educational Psychologist