Epilepsy, Part 2 — Medications, restrictions, and implications for school
Medications
There are numerous medications used for treating seizures. Some of the more commonly-used
ones in children are
- Carbamazepine
- Ethosuxamide
- Lamotrigine
- Oxcarbazepine
- Phenobarbital
- Phenytoin
- Topiramate
- Valproic acid
Vagus nerve stimulation (VNS) is a type of treatment in which short bursts
of electrical energy are directed into the brain via the vagus nerve,
a large nerve in the neck. The energy comes from a battery, about the
size of a silver dollar, which is surgically implanted under the skin,
usually on the chest. Leads are threaded under the skin and attached to
the vagus nerve in the same procedure. The physician programs the device
to deliver small electrical stimulation bursts every few minutes. This
is a relatively new type of treatment. It may be tried when other treatment
is not effective. Just how it works to prevent seizures is being studied.
Surgical removal of seizure-producing areas of the brain has been an
accepted form of treatment for over 50 years when medicines fail to prevent
seizures. However, because of new surgical techniques and new ways of
identifying areas to be removed, more of these operations are being done
now than ever before, and with greater success. Surgery can be performed
on both children and adults. However, it is not a suitable treatment for
everyone who has epilepsy, or for everyone with poor seizure control.
Possible medication side-effects
Almost all seizure medications can cause the person to feel tired or sleepy, or
to be dizzy, “off-balance” and clumsy. Some of these
medications may increase or decrease the person’s appetite. Rarely,
they can cause stomach upset. Some can cause extra hair growth, or cause
some of the hair to fall out. Rarely, a medication can affect
the liver or the blood counts, and these may need to be checked on a regular
basis. Any medication may potentially cause an allergic reaction, which might involve a rash, swelling of any part of the body, and even difficulty
breathing. An allergic reaction to a medication is potentially very serious,
and should be discussed with your physician or seen in an emergency room
as soon as possible.
What should I do if I see a friend having a seizure?
It is important to remember that, during a seizure, a person may not
be in control of his body, and needs to be kept safe –
by preventing him from falling or hitting any part of the body against
anything hard.
- The person should be helped into a safe position –
lying down, preferably on the floor (so he cannot fall any further) and
away from walls or furniture.
- He should also be observed for choking.
- If possible, he should be on
his side, so that if he drools or vomits, the contents of his mouth will
drip out easily.
- Even though he may not seem to be breathing, if he is
not turning dusky or blue around the lips, he is getting enough oxygen
and is probably just breathing shallowly.
- If a person is not breathing, he
needs CPR until emergency services can arrive.
- We no longer recommend putting something in the patient’s mouth to prevent a tongue
bite – this is not usually a serious injury and you risk being bitten
or breaking his tooth.
- If a seizure lasts more than 5 minutes, this is considered an emergency
and an ambulance should be called.
- If the patient’s caregiver is
present and has emergency medication available, he should give it.
Once
the seizure ends, the person may be dazed and disoriented, and will probably
want to sleep for at least a few hours. The witnesses should again make
sure to keep the patient in a safe position until help arrives.
Physical, dietary and other restrictions
There are no overall restrictions for persons with epilepsy in terms
of diet, physical activity or other areas. Physical activity may need
to be modified for certain individuals with epilepsy, and some students
with epilepsy, especially if there are other, underlying diagnoses or
medication side effects that include dizziness and clumsiness. It is important
to ensure that, if a person has a seizure, the area around them is free
of items that may cause them harm or injury during the seizure.
Implications for school
The possible side effects of seizure medication may cause some significant
implications for school. The medications may cause the person to feel sleepy,
dizzy, “off-balance”, or clumsy, which may
result in the need for adaptations or modifications at school. For example,
the student with epilepsy may need a rest period in the nurse’s
office, may need to have the amount of work modified to a quantity that
he/she can complete in a reasonable amount of time, or may need adaptive
physical education or modifications in physical activity during the school
day. The child’s parent, physician, nurse or hospital school teacher
would be a good source of information regarding any special physical modifications
needed. It is important for the child with epilepsy to be included, to
the maximum extent possible, in activities at school.
The side effect of increased appetite, caused by some seizure medications,
may require that the child have a morning and/or afternoon snack. Again,
checking with parents or medical caregivers will help you determine what
an individual child’s needs may be.
Socialization is sometimes challenging for children with epilepsy due
to a social stigma that is still attached to the diagnosis. Peers and
others may be frightened by a seizure, and, thus, exclude the child from
activities. Education about seizures and epilepsy is an important facet
of enabling all children to understand this disease.
With consent of the
student and his/her parents, an educational session on epilepsy should
be provided to all classmates and educators who interact with the child
with epilepsy. This results in the ability of all parties to understand
epilepsy and, thus, lend support to the student with the diagnosis. Many
young people with epilepsy lead active lives, involved in the same activities
as classmates.
Epilepsy, Part 2 — Medications, restrictions, and implications for school
For more information, please contact:
Kathy Davis, MSEd, PhD
kdavis2@kumc.edu
(913) 588-6305