A little knowledge ... a big difference
Please Miss, Craig's having a fit in the playground!" A child drops to the ground and convulses for two minutes on the hard ground. After a moment in a non-communicating coma, he comes round ready to nurse his wrenched muscles and very sore head before getting back into classwork.
Primary 7 pupil Craig Smith was one of six pupils at Wallacestone Primary in Falkirk last year who suffered from epilepsy. Normally associated only with classic seizures, epilepsy takes many different forms and teachers at Wallacestone have learned how to care for all its pupils during and after their own brand of seizure.
Just as importantly, they can also identify the onset of a disorientating absence seizure and recognise it as more than a dreamy moment. Formerly known as "petit mal", absence seizures are short, lost snatches of time in which normal reality is thrown on its head and the learning process abruptly interrupted.
When P3 pupil Meghan Tutty was first diagnosed with epilepsy in nursery her mother, Lisa, sought help and advice from Christine Landells, field officer of the Central Scotland Epilepsy Support Service.
Mrs Tutty found the fact sheets and guidance on care so useful, she suggested that Wallacestone Primary, with its unusually high number of epilepsy sufferers, should make use of the information from the support service and the Epilepsy Association of Scotland for in-service training.
With the help of a primary teacher friend, Mrs Landells adapts general materials for delivery in school. Videos provide a good medium for allowing teachers to see a child having a seizure. One video designed for children, using puppets to convulse, was particularly enjoyed by the younger pupils.
The children who suffer from epilepsy themselves are the most effective communicators about the condition, says Mrs Landells. She believes Wallacestone Primary has become a "shining example" of how epilepsy should be dealt with on a day-to-day basis. The headteacher, Margaret Stirling, says: "Most teachers do know basically what to do but with epilepsy there is always understandable fear."
She was quite protective of both staff and pupils and requested supervisory assistants for some of the pupils. The teacher, she says, feels reassured when there is another adult present. In purely practical terms, if a seizure goes on too long and goes into "status" there can be a need for rectal diazepam to be administered.
Following school protocol, the teacher moves the other pupils away quietly, while the supervisory assistant alerts the office by walkie-talkie that the child's "special box" with pillow, blanket and essential medication is required. The assistant as named person then administers the diazepam, using the blanket to maintain the child's dignity.
Although Meghan's condition is now well controlled and she has never had a seizure in school, her mother explains that for her, rectal diazepam is essential to prevent the seizure continuing for up to a damaging 20-minute period.
Mrs Tutty is happy about the protocol for this in the primary classroom, but she is already beginning to be concerned about how the immediacy of this action will be applied in the larger setting of secondary school.
She explains that Meghan has a good awareness of her condition and is encouraged to talk openly about it. Meghan herself offered to give a talk to the class about her epilepsy because her classmates had never seen her having a seizure.
"Meghan's a bright girl," says her teacher, Eleanor Stewart, "and she was really confident and knew exactly what she wanted to say." Although her condition is well controlled with medication, Meghan does suffer some absence seizures which, her mother explains, often happen in the evening when she is tired.
"Sometimes I notice a difference in her homework, such as in the quality of her writing, and she can look very pale. Then I know that she's probably had an absence seizure without even really realising it."
Meghan has a supervisory assistant with her at all times, and her teacher says she can feel a bit restricted by being constantly accompanied. For the most part Meghan is happy to enjoy the security of an assistant, but from time to time would prefer to be completely alone in the playground with her friends.
At school discos and parties, Meghan's mum takes over the role of supervisory assistant and goes along too. Meghan has to take constant medication, and is "happy that the tablets work" but also regularly asks when she can stop taking them. Her mother is often aware of the sedative effect of Meghan's medication, which makes her noticeably sleepy after a normal day at school.
Craig Smith was diagnosed as having primary generalised epilepsy last December. For teacher Ann Kerr, his first seizure at school in the playground was also her first experience of epilepsy in 18 years of teaching. She admits to having been relieved to have the support of a quick-thinking P1 mother who moved the other children, giving her time to think what to do.
Craig, like many others, has "grown into" epilepsy. Before having his first major seizure, it was noticed in school that he lacked concentration. Depute head Jill Genoe had observed that he often answered a question correctly, but after a two- or three-minute time lapse. His friends commented that he was sometimes "just not there".
Craig's mother, Liz Smith, who teaches at Alloa Academy in Clackmannanshire, says Craig has had some difficulties with language work and after checks for dyslexia and dyspraxia showed no obvious pattern, she concludes that absences could be to blame for at least some of the lost learning.
She is keen to point out that Craig copes very well with his condition, and has been helped by attending a school where there were so many fellow sufferers. "He has only once not returned to class after sleeping off the effects of a seizure," she says.
On a recent trip to the Millennium Dome, Craig tested the competence and understanding of his primary teachers when he had a seizure on the bus. Margaret Stirling was really hoping that he would be all right when they were in London.
"We hadn't got past Moffat, when he had a fit," she says. The children all remained very calm. Teachers checked there were no hard edges on the seats and Craig "just got on with it". Like many epilepsy sufferers, his first words on regaining consciousness were: "I don't feel well, but I didn't have a seizure."
The only person who seemed to be worried by the experience was the bus driver. Margaret Stirling decided not to contact Craig's mother about the seizure and waited till the group got home. Liz Smith was "delighted" because of the absolute confidence she had in the staff at Wallacestone and just wanted Craig to enjoy his holiday.
Asked how he feels about epilepsy, Craig says: "It doesn't stop me doing gym which is good." Liz Smith stresses that she does not restrict Craig's participation in sport, citing skiing and snow-boarding as two latest experiences.
Craig's fellow sufferer P7 pupil Brian Connelly, who has a more severe, progressive myoclonic epilepsy, says he "quite likes having it" because he can sometimes come into school late if he's suffered seizures the night before.
Brian's condition was diagnosed after he had a number of "drop attacks" in school. Teachers had noticed that he could be clumsy and, although his sudden drops to the ground did not look like convulsions, epilepsy was soon diagnosed.
Brian has a number of learning difficulties and lives with frequent attacks at all times of the day. He is proud of his desk with inbuilt cushion protecting him during a "head drop". Unlike Craig, he is treated with a heavy dose of medication which could also affect his learning process. His mother Maureen is happy that he has got a secondary school place at Carrongrange special school, where she feels he will be comfortable with the pace of learning.
His friend Craig faces new challenges in coping with his condition at Braes High, a large secondary school. As a secondary teacher herself, his mother is concerned that all his teachers should have sufficient knowledge of his particular form of epilepsy.
Conceding that she does not always remember full details of her own pupils' medical conditions, she explains that until Craig was diagnosed, she did not realise the potential implications of, for example, absence seizures on the learning process.
She believes there should be input on appropriate in-service days about the different forms of epilepsy. She says teachers need to know not only what to do when a child has a seizure in class but also to understand about the lasting effects of both seizures and anti-convulsant medication.
Her point was borne out shortly after saying this when the headteacher of her own school, Alloa Academy, informed her that they were expecting three new first-year pupils this term who suffer from epilepsy. Taking her lead from Wallacestone Primary, Mrs Smith now looks forward to raising awareness effectively at Alloa Academy.
Lack of knowledge, she says, is the biggest issue: "Teachers and children need to understand and not be frightened by the condition. It would be good if more well-known people would stand up and talk about their epilepsy as role models."
She welcomes the fact that the Epilepsy Association of Scotland is currently fundraising to produce a national education pack for all Scottish schools. The association has already benefited from a variety of fund-raising events at Wallacestone.
Participants in the school's sponsored aerobathon were joined by prison officers from the nearby Polmont Young Offenders Institution and proceeds from sponsored silences and carol concerts have gone towards the new education materials.
Headteacher Margaret Stirling strongly supports the dissemination of as much information as possible about this most misunderstood of conditions. Meghan Tutty's mother has been delighted to learn of Julius Caesar and "other brilliant people" who suffered from epilepsy, because her daughter "is just flying through school and really enjoying it".
Central Scotland Epilepsy Support Service, Christine Landells, tel: 01786 469916 Epilepsy Association of Scotland, 48 Govan Road, Glasgow G51 1JL, tel: 0141 427 5225