Epilepsy

(see also "Epilepsy Guidelines for Teachers")

What is Epilepsy?

People with epilepsy have recurrent seizures, the great majority of which can be controlled by medication.  Around one in 130 children in the UK has epilepsy and about 80% of them attend mainstream schools.  Parents may be reluctant to disclose their child’s epilepsy to the school.  A positive school policy will encourage them to do so and will ensure that both the pupil and the school staff are given adequate support.  If schools have a child with epilepsy they may request an Epilepsy Awareness Update and a pupil Personal Epilepsy Profile - contact Jo Campbell, Children's Epilepsy Liaison Nurse, Tel: 01224 559528, E-mail: jo.campbell@nhs.net

Not all pupils with epilepsy experience major seizures (commonly called fits).  For those who do, the nature, frequency and severity of the seizure will vary greatly between individuals.  Some may exhibit unusual behaviour (for example, plucking at clothes, or repetitive movements), experience strange sensations, or become confused instead of, or as well as, experiencing convulsions and/or loss of consciousness.

Seizures may be partial (where consciousness is not necessarily lost, but may be affected), or generalised (where consciousness is lost).  An example of some types of generalised seizures are:

• Tonic Clonic Seizures

During the tonic phase of a tonic clonic seizure the muscles become rigid and the person usually falls to the ground.  Incontinence may occur.  The pupil’s colour may change to a dusky blue colour.  Breathing may be laboured during the seizure.  During the clonic phase of the seizure there will be rhythmic movements of the body which will gradually cease.  Some pupils only experience the tonic phase and others only the clonic phase.  The pupil may feel confused for several minutes after a seizure.  Recovery times can vary - some require a few seconds, where others need to sleep for several hours.

• Absence Seizures

These are short periods of staring, or blanking out and are non-convulsive generalised seizures.  They last only a few seconds and are most often seen in children.  A pupil having this kind of seizure is momentarily completely unaware of anyone/thing around him/her, but quickly returns to full consciousness without falling or loss of muscle control.  These seizures are so brief that the person may not notice that anything has happened.  Parents and teachers may think that the pupil is being inattentive or is day dreaming.

• Partial Seizures

Partial seizures are those in which the epileptic activity is limited to a particular area of the brain.

• Simple Partial Seizures
  (when consciousness is not impaired)

This seizure may be presented in a variety of ways depending on where in the brain the epileptic activity is occurring.

• Complex Partial Seizures
  (when consciousness is impaired)

This is the most common type of partial seizure.  During a temporal lobe complex partial seizure the person will experience some alteration in consciousness.  They may be dazed, confused and detached from their surroundings.  They may exhibit what appears to be strange behaviour, such as plucking at their clothes, smacking their lips or searching for an object.

Medication and Control

The symptoms of most children with epilepsy are well controlled by modern medication and seizures are unlikely during the school day.  The majority of children with epilepsy suffer fits for no known cause, although tiredness and/or stress can sometimes affect a pupil’s susceptibility.  Flashing or flickering lights, video games and computer graphics, and certain geometric shapes or patterns can be a trigger for seizures in some pupils.  Screens and/or different methods of lighting can be used to enable photosensitive pupils to work safely on computers and watch TVs.  Parents must tell schools of likely triggers so that action can be taken to minimise exposure to them.

Pupils with epilepsy must not be unnecessarily excluded from any school activity.  Extra care and supervision may be need needed to ensure their safety in some activities such as swimming or working in science laboratories.  Off-site activities may need additional planning, particularly overnight stays.  Concern about any potential risks should be discussed with pupils and their parents, and if necessary, additional advice sought from the GP, paediatrician or school nurse/doctor.

Some children with tonic clonic seizures can be vulnerable to consecutive fits which, if left uncontrolled, can result in permanent damage.  These children are usually prescribed Diazepam for rectal administration.  Teachers may naturally be concerned about agreeing to undertake such an intimate procedure and it is important that proper training and guidance is given.  For advice on intimate/invasive treatment see paragraph 70.  Diazepam causes drowsiness so pupils may need some time to recover after its administration.  For information on the administration of rectal Diazepam see (Form Med 4) and Appendix B.

When drawing up health plans, parents must tell schools about the type and duration of seizures their child has, so that appropriate safety measures can be identified and put in place.

Nothing must be done to stop or alter the course of a seizure once it has begun except when medication is being given by appropriately trained staff.  The pupil should not be moved unless he or she is in a dangerous place, although something soft can be placed under his or her head.  The pupil’s airway must be maintained at all times.  The pupil should not be restrained and there should be no attempt to put anything into the mouth.  Once the convulsion has stopped, the pupil should be turned on his or her side and put into the recovery position.  Someone should stay with the pupil until he or she recovers and re-orientates.  See Appendix C.

Call an ambulance if the seizure lasts longer than usual or if one seizure follows another without the person regaining consciousness, or where there is any doubt.  (See Form Med 6).