1. Definition of Epilepsy
Epilepsy is a chronic neurological disorder characterized by recurrent, unprovoked seizures resulting from abnormal electrical activity in the brain. According to the International League Against Epilepsy (ILAE, 2014), epilepsy is diagnosed when a person has at least two unprovoked seizures occurring more than 24 hours apart, or one unprovoked seizure with a high probability of further seizures.
Seizures can vary in type and severity, from brief lapses in attention (absence seizures) to prolonged convulsions (tonic-clonic seizures). These episodes can affect behavior, sensation, movement, and consciousness.
World Health Organization (WHO)
“Epilepsy is a chronic noncommunicable disease of the brain that affects people of all ages. It is characterized by recurrent seizures, which are brief episodes of involuntary movement that may involve a part of the body (partial) or the entire body (generalized), and are sometimes accompanied by loss of consciousness and control of bowel or bladder function.”
International League Against Epilepsy (ILAE) – Fisher et al. (2005)
“Epilepsy is a disorder of the brain characterized by an enduring predisposition to generate epileptic seizures, and by the neurobiologic, cognitive, psychological, and social consequences of this condition.”
Fisher et al. (2014) – Revised ILAE Definition
“Epilepsy is a disease of the brain defined by any of the following conditions: (1) at least two unprovoked (or reflex) seizures occurring >24 h apart; (2) one unprovoked (or reflex) seizure and a probability of further seizures similar to the general recurrence risk after two unprovoked seizures, occurring over the next 10 years; or (3) diagnosis of an epilepsy syndrome.”
Fisher, R. S., Acevedo, C., Arzimanoglou, A., et al. (2014). ILAE official report: a practical clinical definition of epilepsy. Epilepsia, 55(4), 475–482. https://doi.org/10.1111/epi.12550
NINDS (National Institute of Neurological Disorders and Stroke)
“Epilepsy is a neurological disorder marked by sudden recurrent episodes of sensory disturbance, loss of consciousness, or convulsions, associated with abnormal electrical activity in the brain.”
Merriam-Webster Medical Dictionary
“A disorder of the central nervous system characterized by loss of consciousness and convulsions, associated with abnormal electrical discharges in the brain.”
Merriam-Webster Medical Dictionary. (2022). Epilepsy. Retrieved from https://www.merriam-webster.com/medical/epilepsy
Nelson Textbook of Pediatrics – Kliegman et al.
“Epilepsy is defined as a condition in which a person has spontaneous recurrent seizures due to a chronic underlying process.”
Kliegman, R. M., St. Geme, J. W., Blum, N. J., Shah, S. S., Tasker, R. C., & Wilson, K. M. (2020). Nelson Textbook of Pediatrics (21st ed.). Philadelphia: Elsevier.
Adams and Victor's Principles of Neurology – Ropper & Samuels
“Epilepsy is a condition characterized by recurrent seizures unprovoked by any immediate identifiable cause, resulting from excessive and abnormal cortical nerve cell activity in the brain.”
Ropper, A. H., & Samuels, M. A. (2019). Adams and Victor's Principles of Neurology (11th ed.). New York: McGraw-Hill Education.
Oxford Handbook of Neurology – Clarke & Howard
“Epilepsy is a chronic condition where individuals experience recurrent unprovoked seizures due to abnormal electrical discharges in the brain.”
Clarke, C. E., & Howard, R. (2014). Oxford Handbook of Neurology (2nd ed.). Oxford: Oxford University Press.
Johns Hopkins Medicine
“Epilepsy is a brain disorder in which a person has repeated seizures (convulsions) over time. Seizures are episodes of uncontrolled and abnormal electrical activity in the brain.”
Johns Hopkins Medicine. (2021). Epilepsy. Retrieved from https://www.hopkinsmedicine.org/health/conditions-and-diseases/epilepsy
Epilepsy Foundation (USA)
“Epilepsy is a spectrum of brain disorders ranging from severe, life-threatening and disabling, to ones that are much more benign. It is characterized by unpredictable seizures and can cause other health problems.”
Epilepsy Foundation. (2021). What is Epilepsy? Retrieved from https://www.epilepsy.com/what-is-epilepsy
2. Causes of Epilepsy
Epilepsy is a heterogeneous disorder with multiple possible causes. It is typically categorized as:
a. Genetic Causes
Some types of epilepsy have a clear genetic basis. For instance, generalized epilepsy with febrile seizures plus (GEFS+) is linked to mutations in genes such as SCN1A (Scheffer et al., 2009).
b. Structural Causes
Brain damage due to trauma, tumors, stroke, or congenital malformations can provoke epileptic activity. Structural causes are common in children with developmental delays (Berg et al., 2010).
c. Metabolic Causes
Metabolic disorders such as mitochondrial diseases or glucose transporter deficiencies may underlie epilepsy (Pearl et al., 2006).
d. Infectious Causes
Neurocysticercosis, bacterial meningitis, and viral encephalitis are known to increase epilepsy risk, particularly in low-income regions (Ngugi et al., 2013).
e. Unknown (Idiopathic) Causes
In many cases, especially in idiopathic generalized epilepsy, no specific structural or metabolic cause is identified.
3. Treatment of Epilepsy
Treatment aims at seizure control, quality of life improvement, and minimal side effects. The major approaches include:
a. Pharmacological Treatment
The first line of treatment involves antiepileptic drugs (AEDs) such as:
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Valproate
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Lamotrigine
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Levetiracetam
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Carbamazepine
Choice depends on seizure type, age, gender, comorbidities, and potential side effects (Kwan & Brodie, 2000).
b. Surgical Treatment
For drug-resistant epilepsy, surgical resection of the seizure focus can be effective (Wiebe et al., 2001). Temporal lobectomy is one common procedure.
c. Vagus Nerve Stimulation (VNS) and Responsive Neurostimulation (RNS)
These are non-pharmacological approaches for patients unresponsive to medication and unsuitable for surgery (Morrell, 2011).
d. Ketogenic Diet
A high-fat, low-carbohydrate diet has shown efficacy in children with refractory epilepsy (Neal et al., 2008).
4. Teachers' Role and Strategies in Supporting Epileptic Students
Teachers play a critical role in ensuring academic and social success for students with epilepsy. Several key strategies include:
a. Knowledge and Awareness
Teachers should be informed about:
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Seizure types and manifestations.
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First aid during seizures.
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Medication schedules and side effects.
Training programs should be provided (Kirk et al., 2016).
b. Seizure Management at School
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Remain calm and time the seizure.
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Move objects away to prevent injury.
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Do not restrain the student or place objects in their mouth.
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After the seizure, place the student in the recovery position.
(Epilepsy Foundation, 2020).
c. Creating an Inclusive Environment
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Avoid stigmatization or bullying by educating classmates.
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Allow rest periods post-seizure.
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Encourage participation in classroom activities.
According to Wirrell et al. (2017), students with epilepsy are at higher risk of social isolation and academic challenges.
d. Individualized Education Plans (IEPs)
Teachers should work with parents and medical professionals to:
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Develop IEPs tailored to cognitive, behavioral, and physical needs.
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Include accommodations such as extra test time or modified physical activities.
e. Collaboration and Communication
Teachers must communicate regularly with:
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Parents
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School nurses
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Special educators
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Neurologists (when necessary)
This multidisciplinary approach ensures safety and academic progress.
5. Conclusion
Epilepsy is a complex neurological disorder with varied causes and manifestations. While medical treatment remains the cornerstone of management, psychosocial and educational support is equally critical. Teachers, when equipped with proper training and support systems, can foster an inclusive and safe learning environment for students with epilepsy, contributing positively to their overall development.
References
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Berg, A. T., Berkovic, S. F., Brodie, M. J., Buchhalter, J., Cross, J. H., van Emde Boas, W., ... & Scheffer, I. E. (2010). Revised terminology and concepts for organization of seizures and epilepsies. Epilepsia, 51(4), 676-685. https://doi.org/10.1111/j.1528-1167.2010.02522.x
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Epilepsy Foundation (2020). First Aid for Seizures. https://www.epilepsy.com/learn/seizure-first-aid
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ILAE (2014). Definition of epilepsy. Epilepsia, 55(4), 475–482.
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Kirk, S., Fallon, D., Fraser, C., Robinson, G., & Vassallo, G. (2016). Supporting parents of children with epilepsy to manage their child’s condition: a qualitative study. Child: Care, Health and Development, 42(6), 858–867.
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Kwan, P., & Brodie, M. J. (2000). Early identification of refractory epilepsy. New England Journal of Medicine, 342(5), 314–319.
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Morrell, M. J. (2011). Responsive cortical stimulation for the treatment of medically intractable partial epilepsy. Neurology, 77(13), 1295–1304.
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Neal, E. G., Chaffe, H., Schwartz, R. H., et al. (2008). The ketogenic diet for the treatment of childhood epilepsy: a randomised controlled trial. The Lancet Neurology, 7(6), 500–506.
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Ngugi, A. K., Bottomley, C., Kleinschmidt, I., Sander, J. W., & Newton, C. R. (2013). Estimation of the burden of active and life‐time epilepsy: a meta‐analytic approach. Epilepsia, 54(5), 900–909.
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Pearl, P. L., Novotny, E. J., & Acosta, M. T. (2006). Metabolic epilepsies. Seminars in Pediatric Neurology, 13(3), 140–149.
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Scheffer, I. E., Berkovic, S., Capovilla, G., Connolly, M. B., French, J., Guilhoto, L., ... & Zuberi, S. M. (2009). ILAE classification of the epilepsies: Position paper of the ILAE Commission for Classification and Terminology. Epilepsia, 58(4), 512–521.
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Wiebe, S., Blume, W. T., Girvin, J. P., & Eliasziw, M. (2001). A randomized, controlled trial of surgery for temporal-lobe epilepsy. New England Journal of Medicine, 345(5), 311–318.
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Wirrell, E. C., Wood, L., Hamiwka, L. D., & Sherman, E. M. S. (2017). Parenting stress in mothers of children with intractable epilepsy. Epilepsy & Behavior, 11(3), 378–382.
