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Seizures and Epilepsy in Children Systemsby Renee Gallo
Epilepsy is a brain disorder that causes neurons in the brain to signal abnormally, causing odd sensation, emotions, convulsions, and sometimes loss of consciousness. It was first identified in ancient Babylon, more than 3,000 years ago. The word epilepsy is derived from the Greek word for "attack," which refers to the neurons tendency to fire electrical signals as many as 500 times a second, up to hundreds of times a day. It wasn't until 4,000 B.C. that Hippocrates identified epilepsy as a brain disorder (National Institute of Neurological Disorders and Stroke, 2004). This brain disorder can be caused by high fever, damage to the brain caused by trauma or illness, or the cause can be unknown, resulting in idiopathic epilepsy. Epilepsy is usually diagnosed after a child has two or more seizure (www.epilepsy.com, 2004). The seizures are classified as either focal or generalized (Brown, 2004). A focal seizure occurs in one part of the brain. About 60 percent of children with epilepsy have focal seizures. During a focal seizure, the child will remain conscious, and may experience unexplainable feelings of joy, anger, nausea, or sadness. In complex focal seizures, the child loses consciousness, and may display twitching and muscle spasm, and these seizures last only a couple of seconds. Interestingly, children with focal seizures, sometimes experience auras, or unusual sensations that warn of an impending seizure (NINDS, 2004). Some symptoms that cue the onset of a seizure are displayed in the table below.
Generalized seizures are the result of abnormal functioning in both sides of the brain. These seizures are known to cause loss of consciousness, muscle spasms, and falling (NINDS, 2004). This class of seizures can exist in many forms. In absence seizures, also known as petit mal seizures, the child may appear to be staring into space, and have twitching muscles. Tonic seizures cause stiffening of the muscles of the arms, legs and back. Clonic seizures have twitching on both sides of the body, while myoclonic seizures cause jerking of the muscles in the upper body only. Atonic seizures cause lack of muscle tone, and the child will fall to the ground. Tonic-clonic seizures are a mixture of the above symptoms, and are sometimes referred to as grand mal seizures (NINDS, 2004). The most common form of epilepsy that affects children today is TLE, or temporal lobe epilepsy. TLE begins in childhood, and is associated with the shrinking of the brain structure known as the hippocampus, which is important for memory and learning (NINDS, 2004). Those who suffer from this form of epilepsy, which greatly contributes to his lack of mucle coordination, and lack the ability to concentrate in school. Children may also suffer from Lennox-Gastaut syndrome, and Rasmussen's encephalitis. These two forms of epilepsy also begin in childhood, and are associated with atonic seizures, and inflammation of the brain, respectively. (NINDS, 2004) Juvenile myoclonic epilepsy and Lennox-Gastaut syndrome are often present for the remainder of the person’s life once they appear. Absence epilepsy in children of young ages tends to stop entirely by the time the child enters adolescence and puberty (Brown, 2004). Diagnosing Epilepsy An electrocephalogram, also known as an EEG is the most common diagnostic test for epilepsy. The EEG records the child's brain waves through electrodes that are placed on the scalp, monitoring for abnormal brain activity. Computed tomography, or CT scans, and magnetic resonance imaging, also known as MRI scans, reveal the structures of the brain and are helpful in finding tumors, and other abnormalities (www.epilepsy.com, 2004). However, one of the best methods of diagnosing epilepsy is through recording and analyzing a detailed medical history of the child. Questions regarding past illnesses, and the suffering of seizures help to conclude whether a child suffers from this disorder (NINDS, 2004). Psycho-Social and Physical Affects of Epilepsy After the child has been diagnosed with epilepsy, physical education objections should be made in order to maintain the health and safety of the child. The first priority of a health care provider for a child who suffers from epilepsy is to have a first aid protocol for a child when having a seizure (Stopka, 1997). Below are the steps that one should follow if a child is having a seizure: Figure 1: First Aid for Seizures (www.epilepsy.com, 2004)
After a seizure, a child may experience a period of semi-consciousness known as a postictal state, and should not be disturbed (Brown, 2004). Often children awake feeling exhausted and want to be left alone. Many have expressed feelings of embarrassment when surrounded by their classmates, and some eventually develop behavioral and emotional problems after seizing in front of their peers. They feel frustrated because they are often teased or bullied (Brown, 2004). Thus, the very act of seizing not only contributes to a lack of physical strength and loss of coordination, but also to feelings of social inadequacy. Psycho-Social and Physical Affects of Treatments The most common method of treatment for children with epilepsy is the prescription of anti-epileptic drugs. Although many of these medications prevent potentially harmful seizures, the adverse effects of these drugs interfere with a child's cognitive processes, and neuromuscular coordination (NINDS, 2004). For example, children who suffer from absence seizures are prescribed ethosuximide, a drug that is known to impair the mental and/or physical abilities required for the performance of tasks that require a great deal of attention (Walia, Khan, Ko, Raza, and Khan, 2004). Also, a randomized study found that Phenobarbital, the most commonly prescribed anti-epileptic drug also contributes to cognitive and behavioral side effects (Kwan, and Brodie, 2004). Many of these medications are taken in combination with other drugs increasing the severity of these adverse effects (NINDS, 2004). The child then experiences difficulty using basic loco motor skills such as walking, hopping, and pulling. Also, the child is unable to acknowledge game rules, safety measures, and proper etiquette while playing with other children, making him or her feel socially inept. Other drugs, such as carabazapine, valproate, and phenytoin, have been found to contribute to a loss of bone mineral density, increasing the risk of bone fractures in children and adults with epilepsy (Vastergaard, Rejnmark, and Mosekilde, 2004). Although many new anti-epileptic drugs have been modified in order to decrease the risk of many mental and physical side effects, dizziness, drowsiness, mental slowing, weight gain, and behavioral disorders are among the most prevalent in all anti-epileptics drugs (Walia, et al, 2004). Another method used to control seizures in children is obtained through the administration of the ketogenic diet. This diet severely limits carbohydrates and increases calories from fat. The ketogenic diet may allow seizure medications to be reduced or eliminated over time, which in turn reduces the adverse side effects experienced by children taking the drugs. The ketogenic diet has helped many children return to a more normal lifestyle that is less affected by seizures and medications (Brown, 2004). Finally, doctors recommend surgery for children suffering from TLE when anti-epileptic drugs are not effective. However, it has not been determined how long seizures should occur, how severe they should be, or how many medications should be tried before doctors consider surgery for the child (NINDS, 2004). Developmental Objectives of Physical Education (the good stuff!) According to the American Alliance for Health, Physical Education,
Recreation and Dance, the five major developmental objectives of physical
education should be applied to children with epilepsy in order to address
and maximize the potentials of these individuals (Stopka, 1997). Due
to the fact that most seizures are not harmful to brain function, or
the body, the primary objectives that should be applied are social,
and emotional. Once the child feels comfortable enough to participate in physical activities with his or her peers, such as sports, the organic and neuromuscular objectives can be assessed. Most physical activity should be monitored by the healthcare provider due to the loss of physical coordination that a child experiences from his or her medications. (Brown, 2004). A study of 26 children with epilepsy, found that 77% of the children had fewer epileptic fits when participating in physical activity. It has been proven that a feeling of overall fitness and well-being has reduced seizure frequency (Sriven, 1999). Increasing physical fitness though cardio activities such as running, playing soccer, or swimming not only increase loco motor skills, but it also enhances muscular endurance and flexibility. Bone mass is then increased through the strength training of different muscles (Stopka, 1997). Exercise will allow the child with epilepsy to find a niche in his or her social environment at school, while increasing and improving the quality of physical activity that could be delayed due to medications that are consumed. As a result of the 1975 Equal Education for All Handicapped Children Act, children with special needs are involved in special education programs in public schools (Stopka, 1997). Developmental objectives should be established for every child who suffers with epilepsy, and should be followed in the home and at school. Most recently, the IDEA, or Individuals with Disabilities Education Act (2004) states that physical education is a required service for children and youth between the ages of 3-21 who qualify for special education because of a specific disability. Adapted Aquatics This area of physical education is one that I hold very close to my heart. This incredible program can change the lives of children with epilepsy, and should be implemented in to the curriculum for a child who has seizures. I have watched children with epilepsy amongst children with other physical and mental disabilities gain self confidence, improve communication skills, and learn to swim in the adapted aquatics program offered through Dr. Stopka's program here, at the University of Florida. An adapted aquatics program is great for persons of all abilities. The program can be performed in an indoor or outdoor pool, and consists of cardiovascular and muscular endurance exercises (www.ucp.org, 2005). Although the concept of a child with epilepsy swimming in a pool seems to be very unsafe, if not absurd, it is actually a very realistic and beneficial idea. As long as the child is monitored by a safety buddy, or an adult, while the aquatic activities are in progress, the child is in very little to no danger. An aquatics program, delivered in junction with swimming lessons can be very helpful to a child who may suffer from emotional or social stress due to his/her epilepsy. A nicely heated pool has a calming affect on stressed children, and the weightless environment provides for greater range of motion and flexibility. As a student enrolled in an adapted aquatics class, I had the opportunity to work first hand with a local elementary aged child with epilepsy. The young boy had obvious behavioral problems, and did not communicate well with his peers. After a few sessions in the pool, however, he seemed like a different person. We practiced basic aquatic skills such as blowing bubbles, and floating on his back. Through simple encouragement and praise, the child left our program better behaved and more relaxed. Although an adapted aquatics program does not provide any medical procedure that will cure epilepsy, it does contribute to the organic, neuromuscular, interpretive, social, and emotional developmental objectives of physical education. Weight Training Programs The Living Well program offered here at the University of Florida trains local community students with mild to severe mental retardation, ranging from the ages of 13-22. This twice a week, weight training, and sports activity program has improved muscle coordination, strength, and has given students that are normally viewed as different by their peers and increased sense of self-worth, and overall health. Children with epilepsy, who are often also viewed as outsiders, could benefit socially, emotionally, and physically from such a program. Also, a modified weight training program can help fight weight gain and other side effects of anti-epileptic drugs. Recent evidence shows that exercise can reduce the risk of seizures, and the chance of having a seizure while exercising is very low. Children with epilepsy show an improved EEG reading during and after exercise. Theories for these improved readings include increased oxygen circulation to the brain, a reduction in stress which can trigger seizures, and also the release of neurotransmitters that calm the brain (www.betterhealth.vic.gov, 2005). It is important to note that some physical activities should be avoided if a child has epilepsy. These include contact sports such as football and boxing. It is vital that children with epilepsy participate in a weight training, and physical activity program. Starting healthy habits in young children with epilepsy will increase the likelihood that they are followed later in life. Incorporation of Math and Reading Skills in Physical Education Children with epilepsy often also suffer from learning disabilities, and are not always on the same academic level as the other students in their classes. A relatively new program, called Integrated Physical Education, incorporates math and reading skills in physical education which can help students with learning disabilities reinforce what they learn in the classroom. The National Association for Sport and Physical Education hosts an online forum that physical education teachers from around the country and even the world can post their ideas and games in which they incorporate math and reading skills in to their curriculum (http://www.aahperd.o http://www.aahperd.org/naspe/ rg/naspe/, 2005). Having the students keep score or tally sheets helps them use math, along with establishing a competitive atmosphere. Playing games such as spelling basketball, and math and word relays are easy to run and also reinforce motor skills and endurance. Children with epilepsy who have learning disabilities would benefit greatly from such programs because they could improve upon motor skills that could be greatly affected by a seizure, while also allowing the child to improve interpersonal skills, and increasing the value of self-worth that the child feels. Conclusion Fortunately, there are many adapted physical education programs that
a child with epilepsy may take part in and benefit from. Epilepsy, although
a very serious neurological disorder, does not alter the physical activity
abilities of its victim too greatly. The above programs mentioned would
be perfect for a child with epilepsy who may suffer from mild physical
and mental disabilities. However, the programs can also be modified
according to the child’s needs. It is important to note that any
educational, athletic or learning environment can and should be adapted
for any child of any disability.
PELINKS4U is a non-profit program
of Central Washington University dedicated to promoting active and healthy
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