This brochure has especially been prepared for school teachers, who frequently have to deal with children falling down and becoming unconscious; in class, play-ground or in the school assembly. Such attacks are more commonly due to fainting or as a result of an emotional reaction, but may also be due to a less common condition called ‘epilepsy’. Due to lack of public health education, some school authorities may refuse admission of such children to their school. Per force, parents of children with medical problems may conceal these conditions in order to get their child admitted. Of all the medical disorders, epilepsy seems to be the most feared one. It is because of this reason that a school teacher may be the first ‘outsider’ to witness an epilepsy attack.

It is an established fact that every child in this world is born with 1-2% possibility of developing epilepsy attacks. That one child may be mine, yours or of anybody’s. It is extremely unfortunate that children with epilepsy are discriminated in this manner. The vast majorities of children with epilepsy have normal intelligence and brain capacity and succeed in all spheres of life. Alexander the Great (King of Macedonia),  Caesar (Emperor of Rome),

Napoleon Bonaparte (French General and Emperor), Joan of Arc, Peter (Czar of Russia), Alfred Nobel (scientist and pioneer of the Noble Prize), Isaac Newton (English scientist), Socrates (Greek philosopher), Pythagoras (Greek mathematician and philosopher), Lord Byron (English poet), Dostoyevsky (Russian writer), Lord Tennyson (English  poet), Agatha Christie (English mystery novel-writer), Charles Dickens (English novelist), Tolstoy (Russian writer), Leonardo da Vinci (Italian sculptor and painter of Mona Lisa),

Michelangelo (Italian sculptor and painter), Vincent van Gogh (Dutch painter), Richard Burton (English actor), Tony Greig (English cricketer) and many others have found place in the annals of history for achieving heights in their respective careers. They all suffered from epilepsy, which in no way affected their education and learning and hey managed to live with outstanding achievements.

About 2% percent of all children in any country of the world suffer from epilepsy; so is the case in Pakistan. This is a totally controllable and treatable condition with medicines, when taken regularly.

Now let us look at the various forms of loss of consciousness that a school teacher may encounter. The following descriptions include advice on ‘first-aid’ measures.

1. COMMON FAINTING ATTACKS

School teachers are most frequently encountered with this form of loss of consciousness and must be familiar with its associated features. They commonly occur during school assemblies where children have to stand; more so in the hot sun. The child feels ‘dizzy’ or ‘light-headed’ and gradually crumbles to the ground with limp muscles, pale skin and cold perspirations. This is accompanied by loss of consciousness, which may last a few seconds. In fact, the consciousness is lost only upto the point when the child is standing and during the period of falling down. As soon as the head touches the ground, consciousness is regained. If, for some reason, there is not enough space for the child to lie down or is supported by others to maintain a standing or a sitting posture, the loss of consciousness may continue of more than a few seconds.

It needs to be emphasized that fainting attacks occur only when a child has been standing or gets up from a sitting position. In the event the attack occurs while a child is sitting, then it is not a fainting attack and an attack of epilepsy is more likely.

First-Aid measures

• Let the child lie down flat on the ground with feet slightly raised and later be carried in the same horizontal plane to a shaded spot, preferably under a fan.
• If allowed to reset in the lying position for 15-20 minutes, complete takes place except some weakness in a few children.
• The child should be seen at the nearest Satellite Epilepsy Centre or by a neurophysician to assess the cause of fainting.

2. EMOTIONAL ATTACKS

Some children may complain of ‘dizziness’, weakness, blurred vision or other such symptoms as a reaction to an emotional distress or tension, either due to studies or some problem at home. An emotionally disturbed child can unconsciously produce many different types of ‘attacks’, including those which look like common fainting attacks or epilepsy.

First Aid measures

• Same as described above for common fainting attacks.
• These children need to be handled with a lot of care and affection.
• The parents should be advice to seek help from the nearby Satellite Epilepsy Centre or a neurophysician.

3. EPILEPSY ATTACKS

An attack of epilepsy can occur at any time, place or in any body posture (Standing, sitting or lying down). Epilepsy attacks are of many different forms and duration but for the sake of simplicity we can divide them into two main types; ‘major attacks’ and ‘minor attacks’. The following is the usual sequence of events on an attack

MAJOR ATTACKS

An otherwise ’normal’ child suddenly falls to the ground. In some children a ‘cry’ or a ‘shriek’ may precede the attack. The child becomes unconscious, the body muscles becoming stiff while the face and fingers turn a little blue. After 5-10 seconds of stiffness, the body starts convulsing, A little froth may accumulate at the mouth, which in some may be blood stained. These convulsions last from 30-60 seconds. The child may become incontinent of urine/faeces. They may sustain some injury or bruise their skin. This may be follow by a period of irritation and confusion in which the child may get up and try to walk but lacks balance. Some children may get a headache or vomit after such ‘major attacks’. Usually they become drowsy and go into a deep slumber for a few hours. On awakening they are normal.

First-Aid measures

• Do not panic! Calmly reassure the other children witnessing it and give support to the child having an epilepsy attack.
• Ensure the convulsing child does not harm him/herself; moving the child only if in range of dangerous objects.
• Do not restrain his/her movements.
• Try not to force open the mouth, as it is more likely to cause some damage than doing any good.
• Do not force down any liquids during the attack as It may choke the person.
• When the convulsions stop, the child should be made to lie down in a posture shown in the diagram.

• A towel or a folded cloth may be used as a pillow.
• Wipe off the secretions from around the mouth with a tissue paper or a cloth.
• Be reassuring and supportive during the period of confusion that may follow a convulsion.
• If the child has become incontinent, help him/her get over this embarrassment.
• Allow the child to reset/sleep; do not forcibly try to awaken.
• A Part from informing the parents/guardian, a doctor (preferably from the nearest Satellite Epilepsy Centre) may be called to see the child.
• In case the convulsions continue for more than 5 minutes or the child keeps on getting repeated attacks, one after the other, then rush the child to the nearest hospital.

MINOR ATTACKS

In these attacks the child may become ‘absent-minded’, appear to be ‘day-dreaming’ or a part of the body may take ‘brief jerks’ with things falling from the hands. In many of these attacks the child is not conscious i.e. does not respond to any questions or carry out any order. They usually last from a few seconds to a few minutes. Sometimes these attacks are so brief that no one can notice them. The teacher usually thinks that the child is inattentive in class; often reprimanding him, which would further affect his school performance.

First Aid measures

• In these ‘minor attacks’ the child does not fall or injure himself. They usually recover without much problem.
• The child should be allowed to reset for a while if needed. Most children would otherwise resume the activity they were doing earlier.
• In case of frequent recurrences during a short of time, they need to be seen by a doctor straightaway, else the parents should be advised to seek medical help from a nearby Satellite Epilepsy Centre or a neurophysician.

4. FEBRILE CONVULSIONS IN PRE-SCHOOL CHILDREN

Every five out of a hundred children, mostly under five years of age, suffer from febrile convulsion; 1-6 in number. These attacks are always associated with fever in which jerking movements, lasting for less than a minute, occur. If the jerking movements are prolonged or occur without fever, they are more likely to be epilepsy attacks. An attack of febrile convulsion looks like an attack of epilepsy but these are not called epilepsy attacks as by the age of 5 year they stop to occur spontaneously.

First-Aid measures

• It is a self liming condition, not requiring much treatment.
• Manage the febrile convulsion like an episode of major epilepsy.
• The temperature should be brought down with tap wate sponging and temperature lowering medications.
• Investigating and treating the cause of fever by a doctor must follow this.

It has been widely noticed that most children who have attacks of epilepsy are considered ‘different’ from others. People have doubts about their intelligence, school achievements, behavior and social interaction. As has been categorically stated above, these children are as normal and intelligent as any other children and are capable of achieving success in all spheres of life. It is very unfortunate that some school authorities deny admission to such students; this may be despite their knowing fully well that they possess normal intelligence.

There is a commonly prevalent misconception in the general public that people with epilepsy are ‘possessed’ by evil spirits/devils or are under the influence of black magic/curse. Some believe it to be a contagious disease. It must be emphatically stated that epilepsy is a medical disorder that is not contagious and can easily be treated with drugs. Diagnostic facilities (electroencephalogram, C.T scan, M.R.I, blood drug levels) are also available which help in the diagnosis of different types of epilepsy.

IMPORTANT ROLE OF A SCHOOL TEACHER

The most important duty of a teacher should be to inculcate a capacity of tolerability among all children. All of us need to realize that no one is born perfect. Each one of us has deficiencies of one kind or another. Some of these deficiencies may be obvious and noticeable while others are hidden. Children must be taught to respect others for what they are and not be little or make fun of the less persons. No one knows what the future holds oneself and they themselves may as likely to be laughed at.

The role of the teacher is pivotal. If epilepsy is dealt with clam understanding and reassurance, the child with epilepsy benefits manifolds. Also, the classmates tend to develop a healthy and accepting attitude towards this very misunderstood conditions; a positive step towards creating epilepsy awareness in the community.