Epilepsy Action: Positive Action in Education
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Positive action in education Contents Foreword . 4 Some facts about epilepsy . 5 Seizures . 7 Types of seizure . 8 Possible triggers for seizures . 11 Diagnosis and treatment - some background information . 12 Supporting the pupil: the role of the school . 15 School organisational issues . 18 The role of school staff . 20 Educational implications of epilepsy . 21 The role of the teacher . 23 Teaching and learning strategies . 25 Activities . 28 Examinations and career options . 31 Emotional issues and developing self-esteem . 32 Creating effective home/school/health liaison . 34 Appendices . 35 Appendix 1: Issues for consideration Appendix 2: A whole school epilepsy policy Appendix 3: Staff INSET: Supporting pupils with epilepsy in mainstream schools Appendix 4: Record of seizures occurring during the school day Appendix 5: Individual Healthcare Plan for pupils with epilepsy Appendix 6: Materials to support personal, social and health education Bibliography . 43 Useful contacts . 44 3 Foreword This booklet is based on material produced by the Educational Service for Physical Disability (ESPD), the Special Educational Needs Support Service (SENSS) in Hull and a specialist paediatric epilepsy nurse. The information is for teachers and support staff for children of school age. It is intended to increase their knowledge and understanding of epilepsy and provide a guide to best practice for the support of pupils living with the condition. Between half and three quarters of pupils with epilepsy have seizures that can be controlled with medication. This booklet should help schools develop plans to support all pupils with epilepsy, but will be particularly useful for those pupils whose epilepsy is not under control. The booklet will also raise awareness of the possible educational implications of epilepsy and suggest strategies to overcome any difficulties. Introduction Research shows that children and young people with epilepsy can be disadvantaged at school, partly because many teachers and educational professionals are unaware of the impact that epilepsy can have on a child’s education. Some children miss out on significant periods of learning, are excluded from physical activities and experience social exclusion because of their epilepsy. Ultimately this can lead to disappointing academic results, impaired social development, restricted career opportunities and reduced quality of life. Some Local Authorities (LAs), teachers and other professionals have developed knowledge and expertise in supporting pupils with epilepsy. This resource draws on that existing expertise to help LAs develop better services and support for pupils with epilepsy. The terms “school” and “pupil” are used for convenience throughout this guide, although the content is applicable to other types of educational establishments and learners, such as colleges of further education and their students. The term “parent” implies any person or body with parental responsibility, such as a foster parent, guardian or local authority. 4 Some facts about epilepsy • Epilepsy affects about one in 279 children of school age in the UK. • Epilepsy is the most common serious neurological condition. • A single seizure does not normally indicate that a person has epilepsy (one in 20 individuals may experience a single seizure in their lifetime). • Epilepsy can affect anyone regardless of age, sex, ethnic origin or intelligence. • Every day about 75 people in the UK will be told that they have epilepsy. Definition Epilepsy is a neurological condition. It can be described as “a tendency for the brain to experience recurrent seizures during which total or partial consciousness is lost.” Seizures can happen in any part of the brain. As the brain is responsible for all the functions of our mind and body, what any person experiences during a seizure will depend on where in the brain the seizure is happening. Over 40 different types of seizures have been identified and a person may have more than one type. Seizures can be classified into two main groups: • partial seizures – involving epileptic activity in part of the brain; and • generalised seizures – involving epileptic activity in most or all of the brain. There are many types of epilepsy, including some epilepsy syndromes. (A syndrome is a group of signs and symptoms occurring together in a specific pattern). The different epilepsy syndromes are identified using the following criteria: • the type or types of seizures experienced; • the age at which the seizures started; • the person’s development or learning abilities; and • the results of an electroencephalogram (EEG) examination. An EEG records patterns of electrical activity in the brain and is an important tool in the diagnosis of epilepsy. 5 6 Seizures Seizures can be divided into two groups: generalised and partial (sometimes called ‘focal’). • In generalised seizures epileptic activity occurs across most or the whole of the brain and consciousness is lost. • In partial seizures epileptic activity is restricted to part of the brain (the ‘focus’) and consciousness may or may not be impaired. NB These seizure types can happen alongside one another, an episode may begin with a partial seizure which then becomes generalised across the whole of the brain (termed a ‘secondary generalised seizure’). This illustration shows the lobes of the brain and some of the possible symptoms occurring during seizures Frontal lobe (motor) Parietal lobe (sensory) Possible symptoms Possible symptoms • Uncontrolled jerking of one arm or leg • Tingling or warmth down one side of the body • Head and eyes turning to one side Temporal lobe (memory, emotions etc) Possible symptoms • Feeling of intense fear or happiness Occipital lobe (visual) • Vivid memory flashbacks Possible symptoms • Intense deja vu • Flashing lights, balls of light or colours in • Intense smells or taste one half of vision • Unpleasant sensation in the stomach 7 Types of seizure Generalised seizures In a generalised seizure, the epileptic activity affects both sides of the brain. There is a loss of consciousness, although in some cases this is very brief. Absence seizures (previously known as ‘petit mal’) This is one of the most common forms of childhood epilepsy. The pupil may look blank and stare, with possible twitching or blinking and a brief switching off lasting for a few seconds only. They may look pale but are able to continue normal activity almost immediately after the seizure has finished. NB Absence seizures can easily be mistaken for ‘day dreaming’. Action for absence seizures • Record the time of day and frequency (to see if a pattern emerges) and pass on to parents/doctor. • Reassure the pupil. • Note information that the pupil may have missed, and remind the pupil of the current task, if necessary. Tonic-clonic seizures (previously known as ‘grand mal’) This is the classic seizure of which most people are aware. The pupil loses consciousness, becomes stiff (the ‘tonic’ phase) and falls to the ground (with possible injury). They may gasp as air is expelled from the lungs in the initial muscle spasm. Upper limbs tend to be flexed and the child may stop breathing for a short time and become blue around the mouth. The ‘clonic’ phase that follows consists of short, sharp jerks caused by the muscles tightening and relaxing in turn. The pupil may be incontinent. Action for tonic-clonic seizures • Stay calm. • Protect the pupil from injury – remove sharp or hard objects nearby. • Place something soft under the pupil’s head, for example a cushion or coat. • Do not restrain or move the pupil unless they are in danger. • Do not put anything in their mouth or force anything between their teeth. • Aid breathing by gently placing them in the recovery position once the seizure has finished. • Stay with the pupil until you are certain the seizure is over. If the seizure lasts more than five minutes, call an ambulance or administer emergency treatment according to the individual healthcare plan. • Reassure and re-orientate the pupil. Tell the pupil that they have had a seizure and that they are safe. • Do not give them anything to eat or drink until they are fully recovered. • The pupil may need a period of rest/sleep at school or at home. Consider whether sending a pupil home is the only option, as they may be able to return to lessons within an hour or two. • Record that the seizure has happened and ensure parents have a copy of this record. This can aid diagnosis or influence treatment plans when the pupil visits the doctor. 8 Calling an ambulance Usually there is no need to call for medical assistance if a pupil’s seizure follows its usual pattern (where this is known). However, an ambulance should be called if: • you believe it is the pupil’s first seizure • a tonic-clonic seizure lasts for more than five minutes • one tonic-clonic seizure follows another without the pupil regaining consciousness between seizures • the pupil is injured during a seizure • the pupil may need urgent medical attention. Atonic seizures (or drop attacks) With this seizure there is a sudden loss of muscle tone and the child falls to the ground. Children with this type of epilepsy often wear a protective helmet to reduce the risk of head injury. This type of seizure is more common in children with additional neurological problems. Myoclonic seizures The term myoclonic comes from ‘myo’ meaning muscle and ‘clonic’ meaning jerk, Myoclonic seizures can affect the whole body, but are usually restricted to one or both arms and sometimes the head. As in absence seizures, the person is not conscious but the seizure is so brief that the person appears to remain fully conscious. Action for atonic and myoclonic seizures • Talk quietly and reassure the pupil. • Record time of day and number of seizures. • Check for injury and treat if necessary. • Give careful consideration to safety issues for these pupils. Partial seizures In a partial seizure, the epileptic activity affects just part of the brain.