Inclusion and participation of children with epilepsy in schools: Views of young people, school staff and parents

Academic performance of pediatric epileptic patients at King Abdulaziz University Hospital

Background

Epilepsy is a prevalent neurological condition affecting children worldwide, with a particularly high incidence in Saudi Arabia. Children with epilepsy can experience poor school performance due to cognitive deficits and frequent absences. This study investigates the impact of seizures on school attendance among children with epilepsy.

Methods

This cross-sectional study was conducted at King Abdulaziz University Hospital (KAUH) in Jeddah, Saudi Arabia, including pediatric epilepsy patients from 2016 to 2022. Data were collected via an online questionnaire and analyzed using IBM SPSS. Factors examined included seizure frequency, medication use, comorbidities, teacher awareness, and absenteeism.

Results

The study included 207 pediatric epilepsy patients, predominantly Saudi nationals (87%). Most parents had higher education backgrounds (70%). Participants' mean age was 9.66 years, with 57% diagnosed before the age of 5. Most (45%) patients took daily medication with 57% experiencing no side effects. Over half (56%) of the population reported focus and memory problems, significantly related to age at diagnosis (P < 0.001). Comorbidities were reported by 35%, with a significant relationship to absenteeism (P < 0.01). Teacher awareness was reported in 58% of cases. Regarding absenteeism, over half (57%) were absent fewer than 10 days during the past academic year, with 41% attributing absenteeism to non-seizure reasons. Seizure attacks at home caused 22% of absences. A significant relationship existed between the etiology of absenteeism and seizures (P < 0.001). Bullying at school due to seizures was reported, with a significant relationship to absenteeism (P = 0.02).

Conclusion

This study highlights the complex relationship between epilepsy, school attendance, and associated factors among pediatric patients in Saudi Arabia, shedding light on the importance of poor academic experience to improve the quality of life for children with epilepsy.

"One size does not fit all" - Barriers to and facilitators of physical activity in adolescents with epilepsy

OBJECTIVE

To explore the barriers to physical activity and to identify the support needed to facilitate physical activity in adolescents with epilepsy (AWE).

METHODS

AWE (aged 11-16 years) and their caregivers completed survey-based open questions regarding perceived barriers to, and facilitators of physical activity in young people with epilepsy. The responses were analysed using Thematic Analysis.

RESULTS

Themes concerning barriers to physical activity included concerns about seizure safety, general anxiety and anxiety related to seizures, stigma/negative attitudes associated with having epilepsy, tiredness, and perceived lack of physical competence. Themes regarding the support needed to facilitate physical activity included better education amongst staff/coaches about epilepsy (e.g., seizure management/prevention, associated fatigue/tiredness), improvements in societal attitudes towards epilepsy, flexibility/tailoring of activities to the child's needs (e.g., need for breaks), and peer support for young people with epilepsy to encourage engagement in physical activity.

CONCLUSIONS

There is a perception among AWE and caregivers, that significant barriers exist with regard to engaging in physical activity for young people with epilepsy. Barriers are related to concerns about seizure management but also wider safety and social issues. A number of facilitators were identified to promote physical activity engagement in AWE, including education for staff and caregivers, peer support, and tailoring activities to the adolescent's needs. There is a need to develop interventions to reduce barriers to physical activity in young people with epilepsy.

Knowledge, awareness, and attitudes towards epilepsy among elementary schoolteachers in the Kingdom of Bahrain

BACKGROUND

Teachers' awareness of epilepsy and attitudes toward students with epilepsy (SWE) largely affect their health, behavior, and academic performance. This study aimed to assess elementary schoolteachers' background knowledge and attitudes toward epilepsy in the Kingdom of Bahrain.

METHODS

A 23-item online questionnaire was distributed to elementary school teachers in all public schools in Bahrain between September 2022 and February 2023. The questionnaire included three sets of questions about teachers'1) demographics and teaching experience, 2) knowledge and experience with epilepsy, and 3) attitude towards SWE.

RESULTS

Three hundred and sixty-seven teachers responded to the questionnaire. Only 82 participants (22.3%) thought they had enough information about epilepsy. Approximately 25% had previously taught SWE. Even though 9.3% have witnessed a seizure before, only 2.2% received seizure first aid training courses. Most respondents (68.7%) knew that epilepsy is caused by abnormal brain electrical activity and is not contagious (95.1%). Regarding seizure types, 76.6% were aware of uncontrollable jerky movements, while staring spells were recognized by 45%. Most first-aid responses were inappropriate, as 59.7% would open the patient's mouth. Only 39.5% agreed on patient transfer to the hospital if the seizure lasted ≥5 min. Epilepsy was thought to cause mental retardation by 32.4%. Also, the belief that SWE were more prone to bullying was reported by 57.2%.

CONCLUSION

The knowledge and attitudes of schoolteachers in Bahrain towards epilepsy are relatively good but with remaining improvement potential. They do not fully grasp all seizure types nor adequate first-aid measures promoting future epilepsy educational programs.

Physical exercise for children and adolescents with epilepsy: What have we learned?

PURPOSE

Although clinical and experimental studies have extensively evidenced the positive effect of physical exercise on epilepsy, these benefits in children and adolescents with epilepsy have been less investigated. We explored the published literature evaluating the impact of long-term exercise programmes on seizure frequency and quality of life in children/adolescents with epilepsy.

METHODS

A scoping review of the literature was performed in accordance with PRISMA guidance with suitable search terms. A comprehensive search of PubMed, PEDro, Web of Science, Scopus, Google Scholar and SPORTDiscus with Full Text (EBSCO) was performed from March to April 2023. A methodological quality assessment was completed for the included studies. The included studies were analysed qualitatively to identify key themes and provide a narrative description of the evidence by two reviewers.

RESULTS

Of 1,316 papers screened, 13 studies were selected for full reading. Only six studies evaluated the seizure frequency and quality of life in children and adolescents with epilepsy after a long-term exercise programme. Two studies observed positive findings in seizure frequency and three in quality of life. No study was classified with strong methodological quality. Three studies presented good quality 78-61%, one study presented adequate quality 57%, and two studies presented poor methodological quality (39% and 43%).

CONCLUSIONS

Our review highlights a limited number of investigations evaluating the long-term effect of exercise in children and adolescents with epilepsy. Longitudinal investigations with good methodological quality may be performed to examine the effectiveness of exercise in this population.