Reader's Corner

Ans. Parents do not like to tell others that their child has epilepsy because of social implication. They fear that their child will encounter a fair amount of prejudice from teachers and schoolmates. School principal, class teachers and schoolmates as a matter of fact, should be informed about their child's epilepsy. Children with frequent attacks of petitmal or absence seizures are likely to be scolded by teachers about their poor attention in class. Teachers should be informed about the type of epilepsy e.g. Petitmal, partial, myoclonic or grandmal and how to take care of the child during a grandmal attack. They should be taught how to prevent child from falling down and keep the child on the side to prevent the tongue falling backwards and in case the child vomits there is no danger of contents entering the trachea and lungs. We have seen quite a few cases where teachers did not know what to do during the attack. All that they did was to just send for the parents. They should not get panicked, control the other classmates from fear and noise and call the nearby doctor to do needful. We have also seen a case where a child was removed by parents from a good school and given home tuitions. Such attitude will create many behaviour and social problems in a child and should be discouraged.

2. Should children with epilepsy take part in various school activities?

Ans. Majority of schools have various extra-curricular activities and various indoor and outdoor sports. It should be remembered that a child with epilepsy is abnormal only during the attacks and hence should be encouraged to participate in all school activities unless the attacks are very frequent. Over exhaustion should be avoided and sports teacher should be well informed about the attacks, so that he can supervise the child during these activities. If attacks are well controlled, swimming under expert supervision is permitted.

3. Do they require admission in special schools?

Ans. In our experience majority of children with epilepsy can be educated in regular schools. Only those cases with very frequent attacks or where epilepsy is secondary to diseases of the brain and children are mentally retarded, require special schools. In our experience, approximately 20% with resistant epilepsies are in need of such schools. Unfortunately in our country, there are no specialized schools for epilepsy and such children are looked after by parents at home.

4. How do we adjust drug dosage timings, now that the school and special classes have long hours?

Ans. Antiepileptic drugs (AEDs) i.e. Phenobarbitone and Phenytoin can be given in a single daily dose and carbamazepine in twice a day schedule so usually there is no compliance problem, but a drug which sometimes requires three doses daily to control the epilepsy eg. Sodium Valproate may create problems. When children remain for long hours out of home eg. school hours, tuitions and sports after the regular school hours; these children tend to forget to take AEDs in time and even may not prefer to take them in presence of other children. They need a lot of motivation and timings can be adjusted to approximately at 7am, 7p.m. and 10 p.m. or give drug in twice a day schedule to avoid missing of middle dose.

5. What about side effects of AEDs and their impact on scholastic performance?

Ans. Side effects of various AEDs are not uncommon but usually tolerable. Hyperactivity is observed in 30-40% of children on Phenobarbitone. Such children are hyperactive with poor attention span. They are restless and destructive and beat other children and are difficult to manage at home as well as in school. It disappears once the drug is discontinued. Excessive sleepiness and giddiness are observed in some. Mild impairment in cognitive functions is seen with Phenobarbitone, Phenytoin and can occur with any AEDs. All these side effects may affect scholastic performance to some extent. Selection of the ideal drug for the type of epilepsy according to the ILAE classification, proper dose, with therapeutic monitoring if necessary, monotherapy etc. certainly reduce the side effects. Teachers should be explained the side effects to AEDs and requested to adopt an empathetic attitude towards such children. In any case, whenever side effects are recognized, one should not discontinue the drugs on their own. All should remember that control of seizures is the first requirement and side effects is a lesser evil than the seizures.