Facts on the Condition
General description including types, causes, prevalence, signs and symptoms
Epilepsy is the most common serious brain disorder in the world. Current estimates suggest that over 142,000 Victorians will have epilepsy before the age of 70 (approximately 3% of the population).
Epilepsy is a tendency to have recurrent seizures. A seizure occurs as a result of a sudden, usually brief, excessive electrical discharge in a group of brain cells. Seizures can vary from person to person. A seizure can consist of any of the following: a blank stare, tremors or jerks, a convulsion with a total loss of consciousness, strange feelings and sensations, unusual tastes, lip-smacking and chewing, visual disturbances, aimless wandering, fiddling with clothes or objects. These behaviours and how they present all relate back to the area of the brain from which the seizure is originating.There are two main groups of seizures – partial and generalised. Partial seizures start in one part of the brain and what happens to someone during a partial seizure will depend on where the seizure occurs in the brain and what function that part of the brain controls. There are two types of partial seizures – simple partial & complex partial and the distinction between the two is important in a school setting.
Simple Partial Seizures:
During simple partial seizures the person remains fully aware. The seizure may involve involuntary movement or stiffening of a limb, feelings of de ja vu, an unpleasant smell or taste or sensations in the stomach such as ‘butterflies’ or nausea. The key feature about simple partial seizures is that full awareness is maintained throughout the seizure and injury is less likely to occur as a consequence. These seizures are usually brief, often lasting less than a minute.
Complex Partial Seizures:
Complex partial seizures are more serious because they involve impaired awareness. This means that the person doesn’t know who they are, where they are or what they are doing for the duration of the seizure and therefore the potential for injury is much greater. The person may appear confused and dazed and may do strange and repetitive actions such as fiddling with clothing, making chewing or lip smacking movements or uttering unusual sounds. The seizure usually lasts for one or two minutes but the person may be confused and drowsy for sometime after the seizure ends and will need close supervision until they have regained full awareness.
Generalised seizures involve the whole brain at the outset and always involve unconsciousness or impaired awareness even though some of these seizures are very brief. There are a number of generalised seizures but the most relevant for a mainstream school setting are absence and tonic-clonic seizures. The Epilepsy Foundation of Victoria and other State epilepsy organisations can provide much more detailed information about the different types of seizures and epilepsy syndromes.
(previously called petit mal) During this type of seizure the student will momentarily lose awareness of what is happening around them but they rarely fall to the ground. They simply stare and their eyes may roll back or their eyelids flutter. It can sometimes be difficult to tell the difference between absence seizures and daydreaming. Absence seizures begin suddenly, last only a few seconds and then stop suddenly usually with no confusion after the event. Although these seizures last only a few seconds, they can occur several times daily and can be very disruptive to learning. This type of epilepsy usually responds successfully to treatment. Early detection and treatment is essential to minimise disruption to educational progress.
(previously called grand mal) During the tonic phase of tonic-clonic seizures a person’s body stiffens, air is forced past the vocal cords, which often causes a cry or groan, and they fall to the ground. This is followed by the clonic phase which involves jerking of their arms and legs in strong, symmetrical, rhythmic movements. The person may dribble from the mouth, go blue or red in the face and may lose control of their bladder and/or bowel as the body relaxes at the end of the seizure. As consciousness returns, the person may be confused, drowsy, agitated or depressed. They may have a headache and want to sleep. This drowsiness can last for a number of hours.
Treatments, including role of specialists, effects of treatments, use of devices, daily routines
A variety of anti epileptic drugs (AED) are available and used in the treatment of epilepsy. Up to 70% of people will achieve good seizure control with AED therapy. More complex management is required for some, and this often consists of multiple medications. Some people who do not respond well to AED therapies will be offered treatments such as surgery, a vagal nerve stimulator or the ketogenic diet.
Most children are referred to a paediatrician for diagnosis & treatment by their local general practitioner. Children with more complex epilepsy will often be referred by the paediatrician to a paediatric neurologist. If this happens the paediatrician usually maintains an active role in the medical management of the child’s epilepsy.