Challenges to the teacher arise from the sudden, unexpected, and the occasionally dangerous nature of a seizure. In the previous section, advice was offered on “What To Do” for each of the more common types of seizure. Here, some of this advice is revisited and further context offered.
Emergency or Not?
The first issue confronting a bystander is whether to call 911. The answer is generally no, but a teacher cannot be certain until she or he observes how the seizure progresses and ends.
If a seizure lasts 5 minutes, convulsions resume after a short inactive period, it is a first time seizure, or if they are pregnant or diabetic, call 911. Your student may have a specified doctor's orders when to call the ambulance. However, this does vary for each individual and is dependent on medical history. This is a national guideline from the Epilepsy Foundation of America. However, this does vary for each individual and is dependent on medical history.
This is a national guideline from the Epilepsy foundation of America. When in doubt, call 911.
Safety: If the person falls and is having a Generalized Tonic-Clonic (GTC) seizure, it is important to clear the area of objects he or she may strike during their uncontrollable movements. If the person does not automatically roll to one side, gently roll them yourself to help keep their breathing passage open. Do not worry about their biting themselves or swallowing the tongue. They cannot swallow their tongue.
There are two parts to this challenge:
- During the seizure: When there are visible signs of a seizure, especially a GTC or complex partial seizure, others in the classroom will likely become alarmed. Your first concern naturally is for the one experiencing the seizure, but you will also have to address onlookers. You can tell them the person appears to be having a seizure and that it will likely end soon. Use the same calm voice you offer the seizing person and briefly describe what you are observing or doing—for example, “I’m just going to keep her comfortable, move this out of the way, and wait for it to pass.” When the person is quiet but appears dazed or confused, you can encourage others to get back to work and tell them you will stay with the person until he or she is ready to get up or go home. Your calmness will encourage others to relax and find something else to do.
If possible, you can also cover the person who has lost bowel and/or bladder control during a GTC, to help them preserve their dignity.
- Subsequently: Help the person who had a GTC reduce embarrassment for him-/herself and others by inviting them to explain what happened and answer any questions others may have. It’s a chance for the person to appear “normal” again and avoid the stigma uninformed people sometimes assign to epilepsy. Even if the seizure is a one-time event, the person should have seen a physician before returning to class and can share what she or he learned if they choose. Someone experiencing a diabetic seizure may do the same.
A person with simple partial seizures and motor involvement may shake a limb to reduce numbness; and any jerking movement will be noticed. However, because the person is conscious during a simple partial seizure, they will probably make a joke of it or try another means to minimize social discomfort. Others may not notice a simple partial seizure with sensory involvement unless the person talks about the experience.
Return to Class
Most students experiencing absence seizures and simple partial seizures will generally continue with their work when the event has passed. Following a complex partial seizure, most students will want to leave and return to class the next day.
In the event of long or repetitive seizures (e.g., status epilepticus), the student may not be able to return for several days or more. When this kind of seizure occurring in the classroom precipitates prompt medical intervention, the long-term effects will be reduced. However, an immediate setback in cognitive processing may be noted along with greater lethargy and/or difficulty initiating tasks. These effects may follow from seizure severity or increased medication or both.
When changes in cognition or behavior are noted, the instructor may find helpful the chapter on Brain Injury in this manual. Seizures caused by acquired brain injury may exacerbate the damage done by the initial injury. Or they may constitute an acquired brain injury in themselves, by depriving the brain of oxygen during a lengthy seizure or altering brain chemistry in a way that reduces cognitive functioning, especially memory.
This chapter has emphasized the role of the instructor in understanding and responding to seizures that may be alarming. However, it is important to note that most people with a seizure disorder live productive and enjoyable lives, with no clear evidence of loss in their ability to learn and meet vocational goals.