Epilepsy In Teenagers

Having epilepsy often complicates life for the high school student looking for a job after completing their education and university. But there are ways to minimise its effects, and to improve chances of success at school, at work and in every day contact with other people. Thousands of people with epilepsy have learned to cope effectively with the challenges it offers. Often that process begins in school, with the help of caring, well informed guidance counsellors.

Like all young people, youngsters with epilepsy have individual talents and abilities, strengths and weaknesses. In general, their potential to achieve at school and succeed in life will not be limited by having this disorder. Advances in treatment mean young people who have epilepsy can live normal lives and accomplish their goals.

Despite these positive developments, however, the youngster with epilepsy has to cope with several unique problems at school. Unless these are understood by school personnel, and appropriate steps to counter them are taken, they may severely limit the students’ scholastic and social development.

School counsellors in particular can help:

• By learning more about epilepsy.
  
• By recognising that it may vary in its effects.
  
• By helping students cope with any associated physical and social problems.
  
• By helping them plan their academic and vocational choices to achieve a satisfying and fulfilling future.
  
• By making other school personnel more aware of the nature of epilepsy and the potential of young people who have it.

The Nature of Epilepsy
Epilepsy is an umbrella term covering many kinds of seizure disorders:

Generally, the person with epilepsy is in otherwise excellent health and does not seem to have any disability – except when a seizure occurs.

Having a seizure is the outward sign that the electrical system controlling the brain is not working properly. For a minute or so it produces a disorderly discharge of electrical impulses which may affect just one area or sweep through the whole brain to disrupt all physical and mental processes. The result may be a convulsion, a brief stare, a period of confusion, uncontrolled movements, muscle spasms, automatic behaviour or sudden falls. Susceptibility to seizures may by produced in many ways – through injury to the brain, as lasting effect of certain viral diseases, or by an inherited or acquired tendency to have seizures more easily than the average person.

Treatment
Today epilepsy can usually by treated successfully with regular use of seizure-preventing medication. This means that everyday the teenager with epilepsy must take his medicine on time just as his doctor has ordered. He may have to be more careful about when he eats and how much sleep he gets than the average youngster his age. He may feel he is being “slowed down” by the medication. Sometimes students rebel against the treatment by missing doses or taking less than prescribed.

Occasionally a youngster with epilepsy will even stop taking the medicines altogether. This puts him at risk of status epilepticus, non-stop seizures that require emergency treatment. Young people with epilepsy need to see some tangible value in staying on the medicines. Sometimes a counsellor (or parent) can use the goal of staying seizure free to qualify for a drivers’ license as a way to encourage a youngster to keep taking pills.

Social Impact
The social impact of epilepsy may vary according to how long the disability has been present. If a teenager has had epilepsy since early childhood, he may have been over–protected by well-meaning parents and have lost confidence in his ability to function on his own. He may even have learned to use the possibility of having a seizure to get his own way at home and avoid work at school.

The student with epilepsy (and his family) realise that he has to accept responsibility for his own success or failure in life. Sometimes a teenager will try to hide the condition. Or he may turn a hostile face to the world in an effort to discourage name–calling. He may decide he’ll reject others before they reject him. His social contacts have been reduced. Low self–esteem may be reflected in careless dress and grooming. Drug side effects may slow his speech or aggravate facial blemishes, setting him further apart from the other students.

If he has just recently developed epilepsy, he has to make the painful adjustment from being a person with no physical limitations to being someone who may have to take medicines for the rest of his life, someone who is not always completely in control of himself, someone who must deal with a society which often seems only too ready to restrict his activities and limit his ambitions.

Public Misunderstandings
Young people with epilepsy have to deal with the fact that most people do not realise how much progress had been made in treating epilepsy. Many, including school personnel, still cling to the myths of the past. Having a medical re-evaluation, changing the time when medicine is taken (if the doctor agrees), or extending time available for a test, may all help improve the student’s academic performance. Teachers often have low expectations of their students with epilepsy. Classmates may be injured because of it (they won’t). The fact is that at least 50% and perhaps as many as 85% who have seizures can get complete, reliable, long term control through current therapy. That means months, even years will pass without their having a seizure of any kind.

Academic Achievement
Having epilepsy is, by itself, no bar to high academic achievement. Many successful professional people including writers, journalists, teachers, lawyers and scientists have epilepsy and have no lessening in their intellectual powers or lowering of academic achievement. Although students with epilepsy generally test within the normal IQ range, studies show many of them achieve a lower level than expected.

When youngsters with high IQ scores perform substantially below expectations, family tension of all kinds may result, especially if the parents are college educated with strong ambitions for their children. To them it looks as if the youngster is lazy and not trying.

Functional problems may be related to where the seizure activity is located in the brain.
Epilepsy is a disruption in the way brain cells communicate. Since learning, processing information, and memory are all products of cell communication, it’s not surprising that having epilepsy may sometimes be linked to disruptions of the learning process.

When the seizure area is in the brain’s left temporal lobe, language, verbal skills and maths may be affected and so many skills like recognising and remembering what is heard. The problem may be intermittent, depending on whether a small unnoticed seizure occurred at the time when key skills were needed - while doing homework, for example, or during a test. The “off-on” nature of the disability adds to the puzzle, since the student sometimes does well and at other times does very poorly.

Seizure activity from the right side of the brain can affect recognition of shapes and patterns. A student with this problem may misinterpret mathematical symbols and sometimes have a difficult time picking up on visual clues in social situations. He may also be clumsy and find sports activities difficult. Young people trying to cope with this kind of disorder in their lives may become very attached to one way of doing things in an attempt to establish order. They may find it hard to adjust to change. Special neuropsychological testing may identify some of these problem areas. Knowing what is wrong helps teachers work out ways to minimise the problem. The fact that such disabilities exist need not rule out higher education since many colleges will make similar arrangements.

Side effects of medication.
The second possibility when achievement is lower than expected is that the student is being affected by the drugs that prevent his seizures. Some medications have a sedative effect and may make it more difficult for a student to complete a timed test as quickly as his classmates. He may know the answer but take longer to think them out and write them down.

Missed Schooling.
The third possibility to consider when academic performances are poor, is the lingering effect of being absent from school in previous years. Treatment of medical problems and the need for tests and hospitalisations may have meant weeks off from school in the past. A related problem results from undiagnosed absence seizures. These brief lapses in awareness may have gone on for years before a major seizure led to the epilepsy being recognised. Frequent breaks in attention may have seriously interfered with the learning process.

Young people who have had these experiences may lack the basic skills and understandings that everyone else got in the primary school. Private tutoring may help them catch up.

Recent diagnosis.
Sometimes a student who previously did well at school does poorly immediately after epilepsy is diagnosed. Epilepsy therapy requires careful tailoring of drug type and dose level. Sometimes even minor adjustments can produce major effects such as lethargy, mood swings, and a general feeling of discomfort. Later on, as treatment is stabilised and the youngster’s system adjusts to the drug, academic performance usually improves.

Behaviour

• Seizure-related behaviour.
  One type of seizure called a “complex partial seizure” produces automatic behaviour that is easily misinterpreted as deliberate acting out or may be handled in such a way as to produce the appearance of a struggle. This type of seizure is the most common form of epilepsy in teenagers and adults.
  
  It starts with a blank stare, followed by chewing movements and picking at clothing. Consciousness is suspended and the youngster goes through a series of trance–-like movements. He may walk, run, or shout, or bang on a table, or try to take off an article of clothing. He probably won’t respond to teachers telling him to sit down (even if he looks at them in response to his name being called) because he doesn’t know where he is or what is happening to him. For the minute or two that the seizure lasts he’s out of touch with his surroundings and later on he probably won’t remember what happened.
  
  Behaviour like this can easily be mistaken for deliberate provocation, or even drug or alcohol abuse. If someone grabs hold of the student while the seizure is going on he may strike out in a reflex action, at which point his behaviour may be recorded as “fighting”. A gentle, guiding approach by a calm teacher can avoid this response. It is therefore important for the counsellor to know whether the “discipline problem” standing in his office may in fact be a youngster whose seizures take this particular form.
  
  
• Social reaction behaviour.
  Having epilepsy puts severe emotional strains on young people because it produces temporary helplessness that often invites fear and ridicule. Treatment, as already noted, may restrict some activities. Isolation and loss of self esteem often results. Students who have had epilepsy for a long time may have been teased and taunted for years, often by the same youngsters who now sit near them in high school. If it’s a relatively new condition, there is likely to be a potent mix of anger and grief at what happened. The result may be an angry hostile individual with a short emotional fuse.
  
  
• Unrelated behaviour.
  Occasionally a youngster with epilepsy may have brief periods of impulsive, aggressive behaviour that are incorrectly assumed to be just another type of seizure. In the overwhelming majority of cases such behaviour is NOT related to the epilepsy. It is a separate problem which also occurs in youngsters who do not have epilepsy.

Avoiding Over–protection
One of the most difficult problems faced by adolescents with epilepsy is the well–meaning efforts of adults to protect them from harm by keeping them out of school and recreational programs in which injury might occur.

Driver’s Education.
There is no reason why a youngster with epilepsy who can qualify for a learner’s permit should be refused entry to the school’s driver’s education program. All states allow people with epilepsy to drive after a period of time (between 3 and 24 months, depending on their circumstances) in which they have had no seizures, and if their doctors will attest to that fact.

Physical Education.
There are many kinds of physical education programs, and students with epilepsy should (with medical approval) be able to participate safely even if they are still having seizures if reasonable modifications are made.

There should be virtually no school–imposed prohibitions if seizures are fully controlled, although swimming and rope climbing should always be carefully supervised and the staff should always be aware that the class includes a student who has epilepsy.

The Athletics Program.
Few things are as devastating to a 16 year old who has just developed epilepsy as hearing that it means he’s off the team.

The decision may rest with the coach or the athletic department, or it may be school policy. Whatever it is, we would suggest that it be looked at very carefully to see whether an injustice is being done to youngsters whose athletic abilities are not affected by their seizure disorder.

Industrial Arts.
Should young people with epilepsy be allowed to take “shop” courses that will teach them marketable skills but may expose them to moving machinery and the possibility of injury if a seizure occur? Should criteria for entrance to the courses be based on the degree of seizure control? The best answer is that there should be no blanket prohibition and that each case should be evaluated individually.

Careful attention should be given to the degree of seizure control, the type, frequency and time of seizures (if they’re still occurring), whether the student experiences a warning before the seizure, and so on.

Career Planning
The good news today is that the majority of people with epilepsy are successfully employed in a wide range of jobs. However, there are some limitations. A student who is still having some seizures will have to avoid jobs that would require driving an automobile as part of the job (at least for the time being) since this would not be possible until his or her seizures improve.

Students who have an occasional convulsive seizure or whose seizures take the form of brief lapses of attention a few times a day could do well in jobs in which there is time to compensate for a few lost seconds or minutes. When epilepsy is completely controlled, there are very few fields that are closed by law.

However, the issue of safety on the job is one that students with epilepsy will want to consider carefully as their career decisions are made, both for their own well being and to avoid a disappointing job search.

Building a Positive Attitude
The biggest barriers to employment for adults with epilepsy are their own feelings of hopelessness, built up by many years of disappointment and frustration. Students can avoid these by seeking out and gaining successful job experiences while they are still in high school.

For young people with epilepsy, it’s critical that such opportunities occur before negative thinking and low self esteem develop. Another important element in helping a student build a good attitude is his own knowledge of the condition, his developing the confidence to talk to an employer about it in a way that will increase the chance of getting a job.

This information provided by the Epilepsy Association of South Australia and Northern Territory Inc on the Internet is designed to provide basic information about epilepsy. It is not intended, nor does it constitute medical or other professional advice. Diagnosis and advice on medical care or other assessments should be sought from a medical practitioner or suitably qualified professional.