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This chapter will acquaint you with seizure disorder (epilepsy) and its signs and implications. The goals are to recognize a seizure when it is occurring and to respond appropriately. It is as important to know what not to do as to know what to do if you believe a student is having a seizure.

The chapter contains several sections. The first describes what may cause or trigger a seizure and discusses the significance of a seizure disorder––its prevalence in the population and its potential impact on social, educational, and vocational functioning. Subsequent sections describe how to recognize when a seizure is likely occurring, how to respond, and how a history of seizures may or may not affect a student’s experience in the classroom. The chapter concludes with brief section on ELL (English Language Learners), accommodations and resources.

What is a Seizure?

We know that everything that keeps us alive and helps us function is controlled by the brain. It takes in information, processes it, and directs our responses, whether they are internal reactions such as thoughts and emotions or visible movements such as facial expressions and actions.

The brain accomplishes its tasks through complex electro-chemical processes that pass messages from one brain cell to another and from brain cells to nerves and muscles throughout the body. A seizure occurs when the electrical aspect of message transmission suddenly increases in magnitude and temporarily “seizes” control of part or all of the brain.

What Causes a Seizure?

Any source of brain injury can cause seizures—e.g., trauma to the head, infections and toxins, tumors, stroke, and neonatal (birth) injury/loss of oxygen—along with high fever, especially in children, and congenital malformations (abnormal brain development before birth). Sometimes scar tissue in the brain will later precipitate a seizure; but in many cases, the brain damage is too small to detect.

For more than 70% of the people experiencing a seizure, the cause cannot be identified. For a few of them, it is associated with a known or suspected genetic source.

Video games have been known to trigger seizures in children and teenagers, primarily through sensitivity to visual stimulation (photo-sensitivity) but other mechanisms, as well. It is hard to anticipate who is vulnerable to seizures from video input, since those who experience them generally (1) already have epilepsy of unidentified origin (idiopathic) and/or (2) have experienced a number of precipitating factors at the time (e.g., sleep deprivation, hunger/thirst, prolonged playing, emotional elevation, provocative game content). Individuals may experience low-threshold seizures (undetected by electro-encephalogram or EEG) under similar circumstances.

A seizure is sudden and unexpected. It can occur at any time, though some individuals with seizure disorder may experience them in daily, monthly, seasonal, and/or annual cycles. Precipitating factors such as those described in the preceding paragraph may increase their likelihood. Use of over-the-counter or recreational drugs may cause a seizure by interfering with the action of prescribed medication.

Seizure Disorder (Epilepsy)

Epilepsy is characterized by the tendency to have recurring, unprovoked seizures. This diagnosis is not applied until 2 or more verified seizures have occurred. In the U.S., 1 in 100 people develop epilepsy for a current total of about 3 million. The disorder is more common than expected; but even more surprising is that 1 in 10 people will have a seizure during their lifetime.

Fortunately, for most people seizures are controlled by medication with limited side effects. Most people remain cognitively intact with no obvious physical or emotional impairments. Those who require higher doses of medication to control their seizures are likely to experience reduced cognitive functioning along with mild to major life-altering impact on social, emotional, and/or vocational-educational outcomes.

When seizures are frequent and difficult to control, the impact is multifold:  An individual lives with uncertainty about when the next seizure will occur and where. Some types of seizures produce additional loss of functioning. People experiencing repeated seizures are at risk for impaired self-image and self-confidence, low self-esteem, anxiety, and delayed social development. These effects may be even more important than the seizures themselves for some individuals.

Children with epilepsy may get control of their seizures, but for many children and for adults the disorder continues for a lifetime. One of the challenges in treating epilepsy over many years is that a particular medication may lose its effectiveness, which sets the stage for “breakthrough seizures” among people taking medication as prescribed. At higher doses, the medication may become toxic to internal organs.

As a result, epilepsy always requires physician monitoring over the course of the disorder, and it may require periodic changes in treatment. During such a transition, the person may be more vulnerable to seizure. When available medications and other noninvasive treatments do not offer reasonable seizure control, a physician may recommend an implanted device or brain surgery to reduce their frequency and magnitude.

Because of the disabling features just described and dramatic movements associated with what is commonly called a grand mal seizure or generalized tonic-clonic, epilepsy is a label often associated with stigma and fear. Thus, Seizure Disorder is the synonymous and preferred name for this condition. It is important to remember that most people with a seizure disorder are able to live normal lives with appropriate medication; and many never experience seizures as dramatic as the one called grand mal.