Blog #52: Unrecognized Epilepsy in the Classroom

(This blog was originally posted on November 25, 2014)

 

            When I discuss my epilepsy novel, DINGS, occasionally parents or relatives of epilepsy patients have told me, “That story sounds just like what happened in our family; no one knew what was wrong with her for the longest time until a doctor finally diagnosed epilepsy.” DINGS features a mother whose bright, eight-year-old son, Conner, is failing third grade. Conner’s complex partial seizures are not recognized and he is too immature and inarticulate to complain about his confusing symptoms of blank-outs which are usually preceded by the classical (but not always present) hallucinating bad smells such as “burning rubber.” Meanwhile, the youngster’s teachers, friends and parents don’t notice the boy’s brief confusion episodes which last seconds to minutes. Since convulsive movements are not part of his epilepsy experience, his friends think he is just acting weird whenever he stares into space and makes chewing, swallowing and other small movements while he seems to be “in his own world” for the minute or two these seizures last.

            Educators can have difficulty recognizing this form of epilepsy and the other type of blank out—the petit mal seizure. Complex partial seizures are preceded by a difficult-to-describe confusing sensation in the belly—the aura―associated with a facial expression of fear. Then, awareness is lost associated with lip smacking and swallowing movements and movement of fingers such as picking at clothing. Humming and uttering short phrases or aimlessly walking can occur: none of these behaviors are recalled after the seizure and the person remains confused for a short while as the seizure slowly terminates.

            Unlike the complex partial seizure, the petit mal seizure differs in that it is not preceded by an aura. Furthermore, it lasts just 10-20 seconds during which time the patient (it is almost always a child or a teen) doesn’t fall but loses awareness with excessive blinking. The person will come out of the spell and will be immediately alert without any awareness that consciousness was lost.

            If either complex partial or petit mal seizures are frequent, concentration and learning are bound to suffer. If no one tries to interact with the child during these events teachers may incorrectly conclude that the child has a learning disorder or is daydreaming. Alternatively, educators may suspect that the child may have a hearing problem since the child may not respond when addressed. An intermittent stuttering problem may also be considered as speech may be stuttered during the spell. Finally, ADD and autism have been confused with these two types of epilepsy.

            If you are familiar with these types of seizures I recommend that these non-convulsive seizures and their mimics be brought to the attention of school personnel. Increasing teachers’ awareness can lead to earlier diagnosis and treatment resulting in more successful learning.

 

Lance Fogan, M.D. is Clinical Professor of Neurology at the David Geffen School of Medicine at UCLA. DINGS is his first novel. It is a mother’s dramatic story that teaches epilepsy.