Teachers’ and School Professionals’ Knowledge and Attitudes Towards Epilepsy in Greece: Misconceptions and Management Options for Affected Students—A Survey Study

Abstract

Epilepsy remains one of the most prevalent neurological disorders affecting school-aged children, often accompanied by social stigma and misconceptions that can hinder their academic and social development. Background and Objectives: Given the critical role of teachers and school professionals in the daily lives of children with epilepsy, this study aimed to assess the knowledge, attitudes, and behaviors of primary school teachers and professionals in Greece regarding epilepsy. The findings are intended to identify gaps and inform the development of targeted educational interventions that support managing epilepsy effectively. Materials and Methods: A cross-sectional survey was conducted with 546 primary education teachers in Western Greece using a questionnaire adapted from a validated Italian study. This survey collected demographic information and assessed knowledge, attitudes, and school-related practices concerning epilepsy. Data were analyzed with IBM SPSS, employing descriptive and inferential statistics to explore relationships between demographics and responses. Results: Although most participants were generally aware of epilepsy, considerable gaps persisted in knowledge about prevalence, causes, and proper seizure management. Notably, over half of the participants were unsure how to manage an epileptic episode, and misconceptions about the effects of antiepileptic drugs on learning and behavior were prevalent. Participants with special education experience displayed more accurate knowledge and greater confidence in handling epilepsy-related situations. Conclusions: This study underscores the need for enhanced epilepsy education among primary school teachers and school professionals in Greece to address knowledge gaps, reduce stigma, and better support the educational and social needs of students with epilepsy. Coordinated efforts with educational authorities and health organizations are recommended to implement specialized teacher training programs.

1. Introduction

Epilepsy is a non-communicable disease that can affect individuals of all ages, including school-aged children. Epidemiological data indicate that the global prevalence of epilepsy is approximately 0.5–1%, with its incidence rate ranging between 49 and 139 per 100,000 individuals annually (World Health Organization, 2019). This variability in rates is influenced by geographic and socioeconomic factors, such as the economic status of a country’s population, which also determines their access to medical services (Beghi, 2020; Kampra et al., 2016).

Despite advances in understanding and treating epilepsy, the condition continues to be associated with social stigma, prejudices, and misconceptions, which can negatively impact the quality of life for affected children and their families (Dantas et al., 2001; World Health Organization, 2019). Specifically, the presence of epilepsy among primary school students can lead to challenges in both academic performance and social adaptation due to the condition itself and the side effects associated with antiepileptic drugs (Baker et al., 2008; Mecarelli et al., 2011).

Teachers working in schools play a significant role in the daily lives of the children attending these institutions. Specifically, students with epilepsy could be harmed and suffer physical injuries following seizures. Teachers should take part in the management of epilepsy and provide first-aid measures that could protect these students (Kolahi et al., 2018; Mecarelli et al., 2015; O’Hara, 2007). In addition, a seizure could allow teachers to educate the other classmates, who witness a seizure in the classroom, on proper first-aid measures, while also increasing students’ level of knowledge about epilepsy (Limotai et al., 2018).

However, teachers often lack the appropriate training to manage disorders such as epilepsy. This can sometimes result in incorrect or even dangerous approaches to handling epileptic seizures (Toli et al., 2013). For this reason, the development of training programs aimed at informing teachers about epilepsy is crucial, as proper knowledge can reduce negative attitudes and prejudices toward students with epilepsy (Al-Hashemi et al., 2016; Almarwani et al., 2023; Bhesania et al., 2014; Elmazny et al., 2023; Jones et al., 2018; Mecarelli et al., 2011; Okumura et al., 2020; Sansa et al., 2021; Sulena et al., 2023).

International studies suggest that while teachers are generally aware of epilepsy, they often harbor misconceptions about specific aspects of the disorder (Bhesania et al., 2014; Iannone et al., 2021; Jones et al., 2018; Kampra et al., 2016; Mecarelli et al., 2011; Toli et al., 2013). For instance, in Italy, approximately 17% of teachers considered epilepsy to be a psychiatric disorder, 43.9% viewed it as an incurable condition, and 47.5% believed they were unable to manage an epileptic seizure (Iannone et al., 2021). Studies conducted in Kuwait, Bahrain, Tunisia, Japan, and Saudi Arabia revealed that teachers lacked knowledge about proper seizure management and the broader implications of the condition on students (Al-Hashemi et al., 2016; Almarwani et al., 2023; Elmazny et al., 2023; Okumura et al., 2020; Sansa et al., 2021). Moreover, a study in Iran indicated that the knowledge of teachers about epilepsy was insufficient (Kolahi et al., 2018).

In the last fifteen years, several studies have been conducted on this topic worldwide. Brabcova et al. (2012) investigated the familiarity and attitudes of primary school teachers towards epilepsy in the Czech Republic. The results showed that teachers with personal experience or sub-specialization in health-related areas had greater knowledge and more supportive attitudes regarding the inclusion and self-realization of students with epilepsy (Brabcova et al., 2012). In the study by Zanni et al. (2012), beliefs and attitudes among Brazilian teachers were investigated. The study revealed misconceptions among both general and special education teachers, with no significant differences between the two groups (Zanni et al., 2012). Bhesania et al. (2014) conducted a survey among schoolteachers in Karachi, Pakistan. The results showed that although most participants had heard of epilepsy, many still believed that it was contagious and were reluctant to help a student who was having a seizure. These findings highlighted the need for health education programs to improve teachers’ perceptions of epilepsy and reduce the associated stigma (Bhesania et al., 2014).

In Nepal, Khanal et al. (2015) surveyed teachers in Kathmandu, and the results showed that while knowledge of epilepsy was relatively high, there was inadequate management of seizures (Khanal et al., 2015).

Mecarelli et al. (2011) found that, in Italy, targeted educational interventions led to some improvements in teachers’ knowledge of epilepsy, but there was still uncertainty and poor seizure management, highlighting the need for continued training efforts (Mecarelli et al., 2011).

Recent studies in Nigeria and Palestine (Eltibi & Shawahna, 2022; Toudou-Daouda & Ibrahim-Mamadou, 2020) identified widespread misconceptions, gaps in seizure management skills, and a need for culturally adapted health interventions.

Similar results are also presented in studies that studied the knowledge of and attitudes about epilepsy among school professionals and school staff. More specifically, in their study in Italy, Iannone et al. (2021) showed that 16.8% of schoolteachers considered epilepsy to be a psychiatric disorder, 43.9% considered it to be an incurable disease, and 47.5% could not manage an epileptic seizure (Iannone et al., 2021). Their findings also highlight the need for educational programs that dispel myths and prepare school staff and students for seizure management (Iannone et al., 2021). Furthermore, the study by Renzetti et al. (2020) aimed to train school staff in the proper management of seizures. The program included two-hour educational sessions covering basic information about epilepsy, seizure management, and emergency medication administration. The results showed improvements in staff knowledge and confidence, a reduction in inappropriate emergency calls, and increased safety for students with epilepsy (Renzetti et al., 2020). Moreover, within the framework of the research program “What I Need in School” (WINS), the surveys “Epilepsy in schools: Views on educational and therapeutic provision, understanding of epilepsy and seizure management” and “Knowledge about, and attitudes towards epilepsy among school staff: A UK-based survey” by Johnson et al. (2021, 2023) in the United Kingdom revealed that general attitudes towards children with epilepsy from school staff were positive; however, only 30% felt confident about managing an epileptic seizure in the classroom, while only 15% of children with epilepsy had received psychological support, even though 60% showed symptoms indicating a need for such support (Johnson et al., 2021, 2023). Finally, in 2000 in Taiwan, the knowledge of epilepsy as a disorder in the brain there were similar between nurses (92%) and school staff members (71%). There were differences in attitudes toward epilepsy. Staff members were more afraid of having students with epilepsy than nurses. The findings underlined that both school staff and nurses need to improve their knowledge, attitudes, and practices toward epilepsy (Lin et al., 2004).

Studying the above international research, there is a constant recommendation for the design and implementation of health education programs that aim to improve teachers’ knowledge and attitudes towards students with epilepsy, as well as the proper provision of first aid in the event of an epileptic seizure.

Schools are a key pillar of socialization, development, and health promotion for children with epilepsy. For this reason, proper information and awareness-raising of educational staff is considered essential and necessary (Bhesania et al., 2014; Brabcova et al., 2012; Eltibi & Shawahna, 2022; Kampra et al., 2016; Khanal et al., 2015; Mecarelli et al., 2011; Toudou-Daouda & Ibrahim-Mamadou, 2020; Zanni et al., 2012).

Regarding the level of teachers’ knowledge about epilepsy in Greece, the existing research is notably limited. Specifically, the study by Toli et al. (2013) highlights significant gaps in the knowledge of primary school teachers, both regarding the nature of epilepsy itself and the appropriate management strategies during epileptic seizures. The findings emphasized that many teachers lacked accurate information on recognizing the symptoms and responding appropriately during seizure episodes, which could potentially endanger students’ safety if mishandled (Toli et al., 2013).

Furthermore, the study conducted by Kampra et al. (2016) also demonstrated substantial deficiencies in teachers’ abilities to identify seizures and provide first aid measures during a seizure event.

The study’s results indicated that although a majority of teachers were aware of the term “epilepsy,” they often lacked the specific training and practical knowledge necessary to manage seizure emergencies properly. This gap underscores the urgent need for continuous educational interventions targeting teachers, particularly focusing on emergency response protocols in school settings (Kampra et al., 2016).

Similarly, the research conducted by Kaleyias et al. (2005) revealed analogous findings regarding the inadequate knowledge of providing first aid during epileptic seizures among teachers. Their study found that misconceptions and incorrect practices were common, including dangerous behaviors such as attempting to restrain a person during convulsions or inserting objects into their mouth. These findings reinforce the necessity of structured health education programs aimed at improving teachers’ readiness to handle epileptic seizures safely (Kaleyias et al., 2005).

The aforementioned findings from these studies indicate an issue across the Greek education system, with insufficient emphasis on health literacy for illnesses like epilepsy. The educational authorities in several countries do not fully recognize the critical role of teachers in epilepsy management, and in many cases, the teachers do not generally receive any formal instructions on epilepsy (Al-Hashemi et al., 2016; Bhesania et al., 2014). Therefore, the current knowledge and attitudes about epilepsy among teachers in Greece need to be assessed to determine their educational needs.

Based on the previous literature and the limited research on the topic in Greece, the present study aims to evaluate the knowledge, attitudes, and behaviors of primary school teachers in Greece regarding epilepsy.

2. Materials and Methods

A literature review was conducted to identify appropriate tools for this study, resulting in the selection of the questionnaire from the Italian study, “Knowledge and Attitudes toward Epilepsy among Primary and Secondary Schoolteachers in Italy” (Mecarelli et al., 2011). Permission was obtained from the authors, and the questionnaire was translated and adapted into Greek. Specifically, the translation of the questionnaire in Greek was carried out according to the guidelines set by the minimal translation criteria from the Scientific Advisory Committee (SAC) of the Medical Outcomes Trust (Aaronson et al., 2002). The questionnaire was entrusted to two proficient native speakers of Italian with expertise in the specific topic. The next step was to have a professional bilingual translator translate the Greek version back into Italian. The back-translation and cognitive debriefing procedures were reviewed. The final version included a pilot study. A pilot study was conducted with a sample of 15 primary school teachers to ensure the clarity and reliability of the research instruments. The pilot phase revealed no omissions, errors, or ambiguities in the questionnaire, confirming its suitability for the main study. Based on this, no modifications were deemed necessary, and the tool was considered ready for broader application. The questionnaire that was ultimately used was a structured form consisting of 6 demographic questions and 28 questions that explored three main topics: (A) general and specific knowledge about epilepsy, (B) attitudes towards the social and individual impacts of epilepsy, and (C) attitudes related to school life.

This study was conducted from October 2022 to June 2023 in Western Greece. The questionnaire was distributed to primary education teachers (both general and special education) through personal contact or via Google Forms sent to school email addresses. The sample comprised 546 teachers who agreed to participate. The inclusion criteria required participants to be currently employed as primary school teachers and to have at least one year of teaching experience. Exclusion criteria included substitute teachers, part-time teachers, and those with a personal or family history of epilepsy, to minimize potential bias.

Participants were informed about the study’s purpose and provided written consent. The study received ethical approval from the Bioethics Committee of the University of Patras (approval number 14787/24-11-2022).

The statistical analysis was performed using IBM SPSS Statistics (version 28.0) for Windows 11. Descriptive statistics were conducted for both quantitative and qualitative data. For quantitative data, the mean and standard deviation were calculated, while absolute and percentage frequencies were determined for qualitative data. Frequencies were also estimated for the responses to each item of the questionnaire.

The chi-square test of independence, also called Pearson’s chi-square test, was used to examine associations between categorical demographic variables (such as sex and experience in special education) and responses to selected items of the questionnaire. That test examined whether distributions of categorical variables differed from each other. The level of significance was set at α = 0.05 for all the analyses, with p-values of less than 0.05 considered statistically significant and those equal to or greater than 0.05 considered non-significant. This survey study’s analysis aimed to examine teachers’ knowledge and attitudes toward epilepsy and the impact of these attitudes on the educational process and psychosocial integration of students with epilepsy.

The analyses were conducted to draw conclusions about teachers’ knowledge and attitudes toward epilepsy and the impact of these attitudes on the educational process and the psychosocial integration of students with epilepsy.

3. Results

3.1. Participant Characteristics

Table 1. Baseline characteristics of the study’s participants.

	Mean	Standard Deviation
Age	40.6	±10.3
Years of teaching	13.9	±10.8
	n	%
Sex
Men	124	22.8
Women	421	77.2
Experience in special education
Yes	163	29.9
No	382	70.1
Attended courses on disabilities
Yes	203	37.2
No	342	62.8
Specialty
Primary schoolteacher	371	68.1
Nursery	46	8.4
Philology	19	3.5
Special education teacher	19	3.5
Psychology	18	3.3
Social worker	17	3.1
Art/music class	15	2.8
Physical education	10	1.8
Other 1	30	5.4

¹ Baby nursery, special support staff, kindergarten, theology, speech therapy, physiotherapy, occupational therapy, and informatics.

presents the baseline demographic characteristics of the study’s participants. Participants ranged in age from 23 to 64, and they had, on average, more than 10 years of teaching experience. In addition, most were women (n = 421), primary school teachers (n = 371), with no experience in special education (n = 382), and no courses on special education (n = 342).

3.2. Knowledge of Epilepsy

Regarding teachers’ general and specific knowledge about epilepsy, a summary of their responses is presented in

Table 2. Teachers’ knowledge of epilepsy.

Question	n	%
1. Do you know of a disease named epilepsy?
Yes	541	99.3
No	4	0.7
2. If yes, how?
Have heard of it	290	53.2
Scientific pamphlets	59	10.8
Friends/acquaintances	75	13.8
Personal experience	24	4.4
Discussion with doctors	31	5.7
Other	62	11.7
3. Have you ever witnessed a seizure
Yes	255	46.8
No	290	53.2
4. If yes, where?
Public	81	14.9
Classroom	64	11.7
TV/film	68	12.5
Home	13	2.4
Other	29	5.3
5. How many people are affected by epilepsy in Greece?
1/10	7	1.3
1/100	55	10.1
1/1000	61	11.5
1/10,000	13	2.4
Don’t know	407	74.7
6. What is the cause of epilepsy?
Genetics	95	17.4
Traumatic brain injury	43	7.9
Brain tumor	17	3.1
Infections	6	1.1
Psychiatric disease	2	0.4
Other	113	20.7
All the above	21	3.9
Don’t know	248	45.5
7. What is the age of onset of epilepsy?
Childhood	52	9.5
Adulthood	0	0.0
All ages	368	67.5
Don’t know	125	23.0
8. Do you think epilepsy is a form of psychiatric disease?
Yes	19	3.5
No	343	63.0
Don’t know	183	33.5
9. Do you think epilepsy is treatable with:
Drugs	310	56.9
Neurosurgery	12	2.2
Other	22	4.0
Don’t know	201	36.9
10. Do you consider epilepsy to be a curable disease?
Yes	131	24.1
No	178	32.7
Don’t know	236	43.2

. The vast majority of the responders reported being aware of the disease, while only 4 (0.7%) of them reported that they did not know about epilepsy. In addition, almost half of them (46.8%) reported having witnessed a seizure, and around 12% had witnessed it in the classroom. However, only 10% of the teachers were aware of the real prevalence of epilepsy in Greece. Nearly half of the responders (>40%) managed to identify at least one of the causes of epilepsy, and the majority (67.5%) knew that epilepsy could show onset at any age. Most of the participants (>60%) were also aware that epilepsy is not a psychiatric disease, and more than half of them identified treatment options for the disease. However, only 33% of the sample were aware that epilepsy is not curable, while most of them (>40%) reported that they did not know the answer.

3.3. Attitudes Toward the Social and Individual Burden of Epilepsy

About 9% of the participants believed that epilepsy did not affect personal and social life, and about 16% reported that they did not know the answer. The rest of them reported at least one limitation of epilepsy in recreational or social activities. More specifically, 28% and 29% of them reported that epilepsy can limit sports activities and driving ability, respectively, while 15% of them said that epilepsy may limit employment.

The answers regarding the recreational and sports activities of children with epilepsy were mixed. Around 36% reported that they should be normal, and around 35% said they did not know. When participants were asked about sports activities that should not be recommended for children with epilepsy, almost 60% of them reported at least one activity, and most of them (17.9%) reported that swimming or boxing should not be recommended (

Table 3. Teachers’ and school professionals’ attitudes towards the social and individual burden of epilepsy.

Question	n	%
11. Do you think epilepsy limits:
Having children	5	0.9
Employment	83	15.2
Driving	159	29.1
Sports activities	153	28.1
All the above	5	0.9
None	51	9.3
Don’t know	89	16.2
12. In your experience, recreational and sports activities of a child with epilepsy must be:
Normal	197	36.1
Limited	155	28.4
Don’t know	193	35.5
13. Which of the following sports do you think should not be recommended for a child with epilepsy?
Soccer	37	6.8
Tennis	6	1.1
Swimming	98	17.9
Skiing	25	4.6
Boxing	98	17.9
Cycling	21	3.9
All	36	6.7
Don’t know	224	41.1

).

3.4. School Life-Related Attitudes

Most (65%) reported that they had never had a child with epilepsy in their classroom, but more than 8 in 10 reported being informed by parents in the case of a child with epilepsy. However, more than 50% of the participants admitted to not knowing how to manage a child experiencing an epileptic attack. With regard to the actions they would take in case of an epileptic attack in a child, calling an ambulance was the most popular answer (>40%). When they were asked if there were difficulties in administering antiepileptic drugs during school hours, most of them (48.3%) reported that they did not know the answer, and 43.3% of them gave a positive answer. Also, >40% of the sample did not know if epilepsy can affect learning ability. Also, most participants believe that children with epilepsy require school support sometimes (>50%), and almost half of them (47%) did not know the answer to the question if children with epilepsy have mental disorders, and 4 in 10 did not know if children with epilepsy might experience behavioral disorders.

When the participants were asked about the possible effects of antiepileptic drugs, more than 40% of them reported that they do not know if they can affect the learning or behavior of children with epilepsy. Again, more than 40% reported that sometimes children with epilepsy have relationship problems with their peers. Moreover, when asked how children with epilepsy should be treated in comparison to their classmates, most of them (>70%) reported the same, while when they asked about how they should be treated according to their demands, this percentage fell to 48%. Additionally, the participants reported that other classmates behave normally towards children with epilepsy at a percentage of 44.6%. A detailed summary of these answers is presented in

Table 4. Teachers’ school life-related attitudes.

Question	n	%
14. Have you ever had children with epilepsy in your classroom?
Yes	158	29.0
No	356	65.3
Don’t know	31	5.7
15. If yes, how many?
1	118	21.7
2	23	4.2
3	16	2.9
>3	1	0.2
16. Are you often informed by parents of the child’s epilepsy?
Yes	451	82.7
No	53	9.8
Don’t know	41	7.5
17. Do you know how to manage a child experiencing an epileptic attack?
Yes	243	44.6
No	302	55.4
18. In the case of a seizure in class, what do you do?
Call an ambulance	219	40.2
Have the child lie down and wait until the attack ends	161	29.3
Place something in the child’s mouth	31	6.4
Block the spasms of the limbs	37	6.7
Administer medications endorectally	9	1.5
Don’t know	88	16.0
19. In your school, are there difficulties in administering antiepileptic drugs during school hours?
Yes	236	43.3
No	46	8.4
Don’t know	263	48.3
20. In your opinion, does epilepsy impair children’s learning?
Always	18	3.3
Sometimes	216	39.6
Never	82	15.1
Don’t know	229	42.0
21. In your opinion, do children with epilepsy require support in school?
Always	89	16.3
Sometimes	313	57.5
Never	22	4.0
Don’t know	121	22.2
22. In your opinion, do children with epilepsy have mental disorders?
Always	3	0.6
Sometimes	149	27.3
Never	136	24.9
Don’t know	257	47.2
23. In your opinion, do children with epilepsy have behavioral disorders?
Always	15	2.7
Sometimes	217	39.8
Never	87	16.0
Don’t know	226	41.5
24. In your opinion, to what extent do antiepileptic drugs affect learning?
Always	18	3.3
Sometimes	219	40.2
Never	65	11.9
Don’t know	243	44.6
25. In your opinion, to what extent do antiepileptic drugs affect behavior?
Always	13	2.4
Sometimes	198	36.3
Never	73	13.4
Don’t know	261	47.9
26. In your opinion, do children with epilepsy have relationship problems with their peers?
Always	11	2.1
Sometimes	244	44.9
Never	55	10.1
Don’t know	234	42.9
27. Compared with their classmates, how should children with epilepsy be treated?
Same	400	73.4
Differentiated	103	18.9
Don’t know	42	7.7
28. How should the demands on children with special needs be compared to those on their classmates?
Same	263	48.3
Differentiated	236	43.3
Don’t know	46	8.4
29. According to your experience, how do classmates behave toward a child with epilepsy?
Normally	243	44.6
Try to help	161	29.5
Tend to marginalize	44	8.1
Don’t know	97	17.8

.

3.5. Differences in Knowledge and Attitudes According to Gender and Special Education Experience

Analysis of the responses between male and female teachers and other school professionals revealed some significant differences. A higher proportion of men reported knowing how to manage a child experiencing an epileptic seizure compared to women (χ² = 21.805, p = 0.001). Additionally, more male participants believed that epilepsy could impair children’s learning ability (χ² = 18.616, p = 0.002) and that antiepileptic drugs could affect both learning (χ² = 12.065, p = 0.017) and behavior (χ² = 22.887, p = 0.001) (Appendix A,

Table A1. Comparison of frequencies of answers between men and women for key questions regarding epilepsy.

Question	Sex n (%)		Statistics
	Men	Women	χ2	p-Value
Do you think epilepsy is a form of psychiatric disease?
Yes	1 (0.8)	18 (4.3)	10.258	0.114
No	90 (72.6)	253 (60.1)
Don’t know	33 (26.6)	150 (35.6)
Do you consider epilepsy to be a curable disease?
Yes	21 (16.9)	110 (26.1)	6.378	0.173
No	42 (33.9)	136 (32.3)
Don’t know	61 (49.2)	174 (41.6)
Do you know how to manage a child experiencing an epileptic attack?
Yes	70 (56.5)	173 (41.1)	21.805	0.001
No	54 (43.5)	248 (58.9)
In your opinion, does epilepsy impair children’s learning?
Always	8 (6.6)	10 (2.4)	18.616	0.002
Sometimes	61 (49.2)	155 (36.8)
Never	11 (8.8)	71 (16.9)
Don’t know	44 (35.4)	185 (43.9)
In your opinion, to what extent do antiepileptic drugs affect learning?
Always	9 (7.3)	9 (2.1)	12.065	0.017
Sometimes	57 (46.0)	162 (38.5)
Never	11 (8.9)	54 (12.8)
Don’t know	47 (37.9)	196 (46.6)
In your opinion, to what extent do antiepileptic drugs affect behavior?
Always	8 (6.5)	5 (1.2)	22.887	0.001
Sometimes	53 (42.7)	145 (34.4)
Never	8 (6.5)	65 (15.4)
Don’t know	55 (44.3)	206 (49.0)

).

Comparisons between participants with and without experience in special education also indicated important differences. Teachers and school professionals with special education experience were more likely to recognize epilepsy as a non-psychiatric disease (χ² = 61.879, p < 0.001) and demonstrated better knowledge in managing epileptic seizures (χ² = 138.310, p < 0.001). They were also more aware of the cognitive and behavioral effects of epilepsy and antiepileptic medications on students (χ² = 35.311, p < 0.001). Moreover, participants with experience in special education were more often informed by parents about students’ epilepsy (χ² = 32.333, p < 0.001), witnessed seizures more frequently (χ² = 47.490, p < 0.001), and reported fewer misconceptions regarding the limitations and social integration of children with epilepsy (Appendix A,

Table A2. Comparison of frequencies of answers between participants with or without experience in special education for key questions regarding epilepsy.

Question	Experience in Special Education n (%)		Statistics
	Yes	No	χ2	p-Value
Do you know of a disease named epilepsy?
Yes	159 (97.5)	382 (100.0)	10.271	0.006
No	4 (2.5)	0 (0.0)
If yes, how?
Have heard of it	34 (20.9)	256 (67.0)	184.208	<0.001
Scientific pamphlets	45 (27.6)	14 (3.7)
Friends/acquaintances	22 (13.5)	53 (13.9)
Personal experience	15 (9.2)	9 (2.4)
Discussion with doctors	10 (6.1)	21 (5.5)
Other	37 (22.7)	29 (7.5)
Have you ever witnessed a seizure?
Yes	113 (69.3)	142 (37.2)	47.490	<0.001
No	50 (30.7)	250 (62.8)
If yes, where?
Public	23 (14.1)	58 (15.2)	174.201	<0.001
Classroom	56 (34.4)	8 (2.1)
TV/film	10 (6.1)	58 (15.2)
Home	10 (6.1)	3 (0.8)
Other	14 (8.6)	15 (3.9)
How many people are affected by epilepsy in Greece?
1/10	4 (2,4)	3 (0.8)	125.407	<0.001
1/100	42 (25.8)	13 (3.4)
1/1000	37 (22.7)	26 (6.8)
1/10,000	7 (4.3)	6 (1.5)
Don’t know	73 (44.8)	334 (87.4)
What is the cause of epilepsy?
Genetics	49 (30.1)	46 (12.0)	199.523	<0.001
Traumatic brain injury	23 (14.1)	20 (5.3)
Brain tumor	5 (3.1)	12 (3.1)
Infections	4 (2.5)	2 (0.5)
Psychiatric disease	0 (0.0)	2 (0.5)
Other	57 (35.0)	56 (14.7)
All the above	5 (3.1)	16 (4.2)
Don’t know	20 (12.3)	228 (59.7)
What is the age of onset of epilepsy?
Childhood	12 (7.4)	40 (10.5)	31.048	<0.001
Adulthood	0 (0.0)	(0.0)
All ages	132 (81.0)	236 (61.8)
Don’t know	19 (11.6)	106 (27.7)
Do you think epilepsy is a form of psychiatric disease?
Yes	5 (3.1)	14 (3.7)	61.879	<0.001
No	142 (87.1)	201 (52.6)
Don’t know	16 (9.8)	167 (43.7)
Do you think epilepsy is treatable with?
Drugs	135 (82.8)	175 (45.8)	118.931	<0.001
Neurosurgery	11 (6.7)	1 (0.3)
Other	10 (6.1)	12 (3.2)
Don’t know	7 (4.4)	194 (50.8)
Do you consider epilepsy to be a curable disease?
Yes	91 (55.8)	40 (10.5)	132.901	<0.001
No	39 (23.9)	139 (36.4)
Don’t know	33 (20.3)	203 (53.1)
Do you think epilepsy limits:
Having children	1 (0.6)	4 (1.0)	113.400	<0.001
Employment	33 (20.3)	50 (13.1)
Driving	14 (8.6)	136 (35.6)
Sports activities	90 (55.2)	67 (17.5)
All the above	2 (1.2)	2 (0.5)
None	21 (12.9)	30 (7.9)
Don’t know	13 (8.0)	76 (19.9)
Have you ever had children with epilepsy in your classroom?
Yes	121 (74.3)	37 (9.7)	241.782	<0.001
No	38 (23.3)	318 (83.2)
Don’t know	4 (2.5)	27 (7.1)
If yes, how many?
0	45 (27.6)	352 (92.1)	241.554	<0.001
1	84 (51.5)	24 (6.3)
2	20 (12.3)	3 (0.8)
3	13 (8.0)	3 (0.8)
>3	1 (0.6)	0 (0.0)
Are you often informed by parents of the child’s epilepsy?
Yes	153 (93.9)	298 (78.0)	32.333	<0.001
No	9 (5.5)	44 (11.5)
Don’t know	1 (0.6)	40 (10.5)
Do you know how to manage a child experiencing an epileptic attack?
Yes	133 (81.6)	110 (28.8)	138.310	<0.001
No	30 (18.4)	272 (71.2)
In your school, are there difficulties in administering antiepileptic drugs during school hours?
Yes	101 (61.9)	135 (35.4)	104.014	<0.001
No	33 (20.2)	13 (3.4)
Don’t know	29 (17.9)	234 (61.2)
In your opinion, does epilepsy impair children’s learning?
Always	2 (1.2)	16 (4.2)	44.551	<0.001
Sometimes	88 (54.0)	128 (33.5)
Never	35 (21.5)	47 (12.3)
Don’t know	38 (23.3)	192 (50.0)
In your opinion, do children with epilepsy require support in school?
Always	25 (15.3)	64 (16.8)	18.274	0.003
Sometimes	112 (68.7)	201 (52.6)
Never	2 (1.2)	20 (5.2)
Don’t know	24 (14.8)	97 (25.4)
In your opinion, do children with epilepsy have mental disorders?
Always	0 (0.0)	3 (0.8)
Sometimes	36 (22.1)	113 (29.6)
Never	67 (41.1)	69 (18.1)
Don’t know	60 (36.8)	197 (51.5)
In your opinion, do children with epilepsy have behavioral disorders?
Always	2 (1.2)	14 (3.4)
Sometimes	86 (52.8)	131 (34.3)
Never	35 (21.4)	52 (13.6)
Don’t know	40 (24.6)	186 (48.7)
In your opinion, to what extent do antiepileptic drugs affect learning?
Always	3 (1.8)	15 (3.9)	30.549	<0.001
Sometimes	88 (54.0)	131 (34.3)
Never	26 (16.0)	39 (10.2)
Don’t know	46 (28.2)	197 (51.6)
In your opinion, to what extent do antiepileptic drugs affect behavior?
Always	2 (1.2)	11 (2.9)	35.311	<0.001
Sometimes	79 (48.5)	119 (31.1)
Never	33 (20.2)	40 (10.5)
Don’t know	49 (30.1)	212 (55.5)
In your opinion, do children with epilepsy have relationship problems with their peers?
Always	1 (0.6)	10 (2.6)	18.205	0.001
Sometimes	94 (57.7)	150 (39.3)
Never	11 (6.7)	44 (11.5)
Don’t know	57 (34.9)	178 (46.6)
Compared with their classmates, how should children with epilepsy be treated?
Same	135 (82.8)	265 (69.4)	10.931	0.012
Differentiated	20 (12.3)	83 (21.7)
Don’t know	8 (4.9)	32 (8.9)
How should the demands on children with special needs be compared to those on their classmates?
Same	108 (66.3)	155 (40.6)	31.572	<0.001
Differentiated	48 (29.4)	188 (49.2)
Don’t know	7(4.3)	39 (10.2)
According to your experience, how do classmates behave toward a child with epilepsy?
Normally	104 (63.8)	139 (36.4)	43.343	<0.001
Try to help	43 (26.4)	118 (30.9)
Tend to marginalize	5 (3.1)	39 (10.2)
Don’t know	11 (6.7)	86 (22.5)
In your experience, recreational and sports activities of a child with epilepsy must be:
Normal	68 (41.7)	129 (33.8)	43.232	<0.001
Limited	69 (42.3)	86 (22.5)
Don’t know	26 (16.0)	167 (43.7)
Which of the following sports do you think should not be recommended for a child with epilepsy?
Soccer	11 (6.7)	26 (6.8)
Tennis	4 (2.5)	2 (0.5)
Swimming	36 (22.1)	62 (16.2)
Skiing	14 (8.6)	11 (2.9)
Boxing	41 (25.1)	57 (14.9)
Cycling	11 (6.7)	10 (2.6)
All	9 (5.5)	27 (7.1)
Don’t know	27 (16.6)	187 (48.9)

).

Appendix A, with the two tables, provides a complete overview of the statistically significant findings for the comparison of the frequencies of answers between men and women for key questions regarding epilepsy. It also compares the frequencies of answers between participants with or without experience in special education for key questions regarding epilepsy. Below follows the comparative

Table 5. Comparative table: accurate information vs. common misconceptions about epilepsy.

Accurate Scientific Information	Common Misconceptions Identified
Epilepsy is a neurological disorder, not a psychiatric illness.	Epilepsy is a form of psychiatric disease.
Epilepsy is usually not curable but is manageable with medication and sometimes surgery.	Epilepsy can be completely cured.
Seizures vary widely (e.g., blank stares, drooling, convulsions) and are not always dramatic.	All seizures involve violent convulsions.
Experiencing a seizure does not mean the person is “epileptic” as an identity; it is a medical condition.	A person who has one seizure is permanently “epileptic”.
Students with epilepsy can participate in sports and physical activities with reasonable precautions.	Students with epilepsy should not engage in physical activities.
During a seizure, do not restrain movements, offer water, or put objects (e.g., spoon, fingers) in the person’s mouth.	Insert objects into the mouth or restrain the person during a seizure.
The tongue does not “turn backward” during a seizure.	A seizure can cause the tongue to roll back and block breathing.
Epilepsy is not contagious.	Epilepsy can be transmitted to others.
Epilepsy does not inherently cause infertility.	Epilepsy causes infertility.
People with epilepsy can study, work, marry, and lead normal lives.	People with epilepsy cannot work or get married.
Antiepileptic drugs can affect learning and behavior but not necessarily in all cases.	Antiepileptic drugs severely and inevitably impair learning and behavior.

of accurate information vs. common misconceptions about epilepsy identified among primary school teachers and school professionals.

4. Discussion

This study aimed to evaluate the knowledge, attitudes, and behaviors of primary school teachers and school professionals in Greece regarding epilepsy, a matter of particular importance given the significant impact epilepsy can have on children’s academic performance, social adaptation, and quality of life. The findings of our study reveal substantial gaps in the knowledge of primary school teachers and school professionals in Greece about epilepsy, along with various perceptions and attitudes that may influence their educational approach. These results align with other studies conducted in Greece and internationally, which confirm significant deficiencies in teachers’ knowledge about epilepsy and inadequate training in managing epileptic seizures (Al-Hashemi et al., 2016; Almarwani et al., 2023; Elmazny et al., 2023; Okumura et al., 2020; Sansa et al., 2021; Toli et al., 2013).

Demographic analysis of the participants indicates that the majority of teachers are women with an average age of approximately 40 years, a finding consistent with international data. Reports from global organizations such as UNESCO and OECD confirm that primary education in many countries is dominated by women, with the average teacher’s age ranging between 40 and 45 years (Global Education Monitoring Report Team, 2018; OECD, 2021). These results are comparable to other studies examining teachers’ knowledge and attitudes toward epilepsy. For example, a study in Italy identified similar demographic characteristics, confirming that teachers are predominantly women with an average age of around 40 years (Mecarelli et al., 2011).

Notably, most teachers were informed about epilepsy primarily through personal experiences with acquaintances or friends rather than formal training. This lack of formal education is concerning, as it may affect the effective management of seizures in classrooms. The absence of experience and knowledge about epilepsy was evident from the fact that a significant percentage of participants had never witnessed a seizure firsthand. Many teachers had only indirect experiences through media, highlighting a global lack of direct experience and sufficient training in epilepsy. Similar findings were reported in other studies, emphasizing the need to improve teacher education (Bhesania et al., 2014; Dantas et al., 2001).

Another area where knowledge gaps were apparent was the limited understanding of the causes of epilepsy and insufficient information about treatment options. Most teachers were unaware of the exact number of individuals with epilepsy in Greece, and many were not familiar with the causes of the condition (Kampra et al., 2016; Toli et al., 2013). For instance, some teachers believed that epilepsy was caused exclusively by genetic factors, reflecting misconceptions observed in other studies (Mecarelli et al., 2011). Similar beliefs were recorded in studies from other countries, such as Pakistan (Bhesania et al., 2014). Conversely, those who had received specialized training or worked in special education demonstrated a better understanding of the neurological nature of epilepsy. This underscores the importance of education, as teachers with appropriate training are less likely to harbor misconceptions about epilepsy. Similar findings have been documented in other studies, which show that specialized training contributes to improved understanding and management of epilepsy (Jones et al., 2018).

Furthermore, most teachers in the study believed that epilepsy significantly affects children’s daily lives, particularly in sports and driving. The majority of teachers thought that children with epilepsy should avoid certain sports, such as boxing and swimming. This view aligns with the study of Mecarelli et al. (2011), which indicates that teachers often lack awareness of modern guidelines encouraging children with epilepsy to participate in sports activities with appropriate precautions (Mecarelli et al., 2011).

Another key finding of the study is that teachers’ perceptions and attitudes varied based on gender. For example, male teachers more frequently reported having a higher level of knowledge about managing epileptic seizures compared to female teachers. This may reflect differences in educational opportunities or experiences between genders. Additionally, male teachers appeared to be more aware of the potential side effects of medications, suggesting they might have a better understanding of the impact of epilepsy on learning and behavior. These gender differences are consistent with the findings of Mecarelli et al. (2011) in Italy, where female teachers expressed less confidence in managing seizures and more concerns about the effects of epilepsy on learning (Mecarelli et al., 2011).

Teachers and school professionals, upon obtaining their academic degree, not only acquire theoretical knowledge but also undertake epistemic responsibility, which underpins their professional role. This responsibility implies the possession of valid and sufficient knowledge regarding key health issues that may affect students’ learning processes, such as epilepsy, diabetes, and mental health challenges (Fricker, 2013). The epistemic duty of teachers and school professionals is integrally connected to the institutional function of schools as pillars of development, socialization, care, and health promotion for children, beyond the mere transmission of academic knowledge (Ainscow, 2020).

Consequently, they are expected to provide basic first aid in emergency situations within the school setting and to maintain an ongoing commitment to updating their knowledge and competencies regarding health-related matters (UNESCO, 2017; WHO, 2019). Their epistemic responsibility can be further enhanced through systematic collaboration with health professionals such as doctors and school nurses, as well as through the integration of structured health education programs within school curricula (Sugai et al., 2016).

Furthermore, to prevent misconceptions and inappropriate management techniques during health crises, it is recommended that specific health crisis management protocols be established and implemented in schools (National Association of School Nurses, 2020). Teachers and other school professionals are also expected to operate within the framework of inclusive pedagogy, meaning they must observe, recognize, and address the diverse needs of all students, aiming to design flexible, adaptive, and collaborative educational programs. These should serve not only students with disabilities but also those with chronic illnesses, psychosocial difficulties, and diverse cultural identities (Florian & Black-Hawkins, 2011).

Achieving these goals necessitates the cultivation of teachers’ emotional intelligence and the fostering of a collaborative culture among educators, community members, parents, and students. These competencies are essential for promoting inclusive, health-aware school environments and positively influencing both educational and psychosocial outcomes for all learners (Jennings & Greenberg, 2009; Seligman et al., 2009).

In order for teachers and school professionals to effectively meet contemporary educational demands, they must develop a comprehensive set of professional competencies. These include subject-matter expertise, continuous updating of disciplinary knowledge, mastery of effective pedagogical and instructional strategies, emotional intelligence, communication and conflict management skills, and a strong commitment to fostering equality, diversity, and inclusion in the classroom (Davydovskaia et al., 2021; OECD, 2021). A critical dimension of teachers’ and school professionals’ preparedness is epistemic responsibility concerning students’ health conditions that may impact learning, such as epilepsy, diabetes, and psychosocial disorders. Moreover, they must be capable not only of recognizing health-related needs but also of implementing basic first aid measures and creating a supportive and inclusive educational environment (Global Education Monitoring Report Team, 2018; World Health Organization, 2019).

To ensure that prospective teachers are adequately prepared, it is recommended that Initial Teacher Education (ITE) programs incorporate a structured module entitled “Health, Inclusion, and Emergency Management in Schools”. Within this module, competencies should include knowledge of common chronic diseases, basic first aid techniques, psychosocial support skills, the promotion of inclusive practices, and the ability to collaborate effectively with healthcare professionals. The module content should cover the fundamentals of child and adolescent health, mental health awareness, emergency management strategies for conditions such as seizures and anaphylaxis, principles of inclusive education, and stigma reduction interventions (De Vroey et al., 2019).

Pedagogical methodologies should focus on interactive workshops, simulations of health crises (e.g., seizure management drills), problem-based learning approaches, and projects encouraging interprofessional collaboration. Assessment strategies should include practical examinations through simulations, analysis of real-world case studies, compilation of reflective portfolios, and group-based projects. A time allocation of approximately 60 h spread over two semesters would ensure the development of both theoretical knowledge and practical skills (Davydovskaia et al., 2021; UNESCO, 2017).

For in-service teacher professional development, a mandatory “Introductory Seminar on Health Management and Inclusive Practices” should be introduced. This seminar would address critical issues such as major school health conditions, legal frameworks regarding teachers’ responsibilities, health crisis protocol development, building inclusive classroom environments, and fostering emotional resilience among teachers and students. Continuing professional development (CPD) should also include experiential learning opportunities such as participation in seminars, micro-teaching sessions, collaborative exercises, portfolio development, school-based training programs, and engagement with innovations from international educational networks (Darling-Hammond et al., 2017; Sharma & Salend, 2016).

These proposed interventions align with current national and international policies emphasizing the critical role of teacher preparedness in achieving inclusive and health-responsive schooling environments (OECD, 2021).

Overall, the study results indicate that specialized teacher training plays a crucial role in improving their knowledge and perceptions of epilepsy. Teachers who had attended educational seminars on epilepsy were better prepared to manage seizures and understand the impact of epilepsy on students’ learning and behavior. These findings are consistent with international literature, which highlights the importance of appropriate training in addressing epilepsy and reducing misconceptions about it (Jones et al., 2018; Mecarelli et al., 2011).

Nevertheless, the present study has certain strengths and limitations. Its primary strength is the size and representativeness of the sample, as a representative sample for the population of 64,000 teachers (EΛΣΤAΤ, 2023) working during that school year would require approximately 382 participants, with an acceptable margin of error of 5% and a confidence level of 95%, while the sample size of this study is 546 participants. Although the predominance of female participants limits the generalizability of the findings, this reflects the reality of Greek primary education, which is predominantly female according to statistical data. However, the first major limitation is the lack of gender diversity, which restricts the generalization of the findings to a broader teacher population. A second limitation is the geographic region, which limits the applicability of the results to other areas of Greece. A third major limitation is the type of questions used in the questionnaire, which may allow for different interpretations by participants, particularly due to the self-completion method, which could lead to inaccuracies in responses. A fourth significant limitation is the limited number of topics explored in the overall study, such as not investigating attitudes toward interaction with individuals with epilepsy or providing open-ended questions for responses. Finally, despite the relatively large sample size, subgroup comparisons were not possible due to small numbers in each teacher specialty category.

Our research highlights the urgent need to improve the education of primary school teachers in Greece regarding epilepsy. The data reveal significant gaps in their knowledge about the disease, its management, and the impact of epilepsy on children’s learning and behavior, which may lead to stigmatization and limit the full participation of students with epilepsy in school life. Comparisons with other studies, both in Greece and internationally, confirm that this issue is widespread and requires coordinated action.

To address these problems, our research suggests the implementation of comprehensive training programs for teachers, tailored to their needs, and the adoption of coordinated health promotion policies that involve various stakeholders to ensure optimal support and awareness.

Initially, it is crucial to organize educational seminars and workshops for teachers, students, and parents. These seminars should provide basic information about epilepsy, modern guidelines for physical activity, and the educational inclusion of students, as well as practical training in managing seizures. Educational authorities, in collaboration with experts from universities and clinical staff, can play a pivotal role in implementing these programs. Simultaneously, the development of inclusion programs in schools is essential for fostering a supportive and inclusive environment for students with epilepsy. Additionally, awareness campaigns through mass media can help reduce prejudices and misconceptions about epilepsy by presenting positive examples of individuals living and working normally with the condition.

Future research should focus on several important aspects to expand and deepen understanding of teachers’ and school professionals’ knowledge, attitudes, and practices regarding epilepsy. First, qualitative studies employing interviews or focus groups could explore in greater depth the underlying reasons for teachers’ misconceptions and the barriers they encounter in managing students with epilepsy. Second, longitudinal studies could evaluate the effectiveness of specific educational interventions over time, assessing how knowledge, attitudes, and behaviors evolve following targeted training programs. Third, comparative studies across different regions of Greece and other countries would offer valuable insights into cultural and systemic factors influencing teachers’ preparedness and perceptions. Fourth, comparative studies between the specialties of school professionals could show possible differences depending on their subject and their general perception and attitude towards children with epilepsy. Moreover, future research could examine the impact of collaboration between schools and healthcare professionals for improving epilepsy management in educational settings. Finally, the development and validation of standardized training modules on epilepsy and emergency management for teachers, adapted to national educational frameworks, represent an essential area for future investigation.

Finally, it is important to promote the participation of children with epilepsy in sports activities, with appropriate support and necessary precautions. Schools and sports clubs, in collaboration with physical education specialists, could develop programs that encourage active participation in sports, promoting the health and well-being of children with epilepsy. To implement these measures, cooperation between public and private entities at both the local and European levels is required, aiming to significantly improve the quality of life for people with epilepsy and create a social environment that fosters acceptance and support.