Epilepsy and employment

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Epilepsy can affect employment for a variety of reasons. Many employers are reluctant to hire a person they know has epilepsy, even if the seizures are controlled by medication. If the employee has a seizure while at work, they could harm themselves (but rarely others, contrary to popular belief) depending on the nature of the work. Employers are often unwilling to bear any financial costs that may come from employing a person with epilepsy, i.e. insurance costs, paid sick leave etc. Many people whose seizures are successfully controlled by a medication experience a variety of side effects, most notably drowsiness, which may affect job performance. Many laws prohibit or restrict people with epilepsy from performing certain duties, most notably driving or operating dangerous machinery, thereby lowering the pool of jobs available to people with epilepsy. People with epilepsy are also prohibited from joining the armed forces, though they may work in certain civilian military positions.

Contents

Employment issues are responsible for 85% of the cost of epilepsy on society. [1] In the United States, the median income for people with epilepsy is 93% that of all people. The unemployment rate for people with epilepsy has been reported to be between 25% and 69%. The high school graduation rate has been reported at 64%, compared with an overall national average of 82%. [2]

Issues

The following issues exist for people with epilepsy in their quest for and performance of employment:

Barring from employment

People with epilepsy may be barred from various types of employment, either by law, by company regulations, or by common sense[ clarification needed ], thereby lowering the pool of jobs available to the job seeker. [3]

Those barred from driving by the laws of the land in which they reside cannot perform any jobs that involve operating a motor vehicle. Even if the patients are permitted by law to drive their own vehicle, they may be barred by local and national laws from driving a vehicle for the purpose of certain types of employment, such as getting a Commercial Driver's License or driving a school bus or being the engineer of a train (even if a person who has not had a seizure in a certain time period is not permanently banned, they may still have to be able to stay seizure-free for a year or more even without medication). [4]

Most countries bar those who have ever had a seizure from flying an aircraft, except perhaps for a private craft, especially if the aircraft in question is a commercial or military aircraft or is any type of jet, making a career in aviation or in space extremely unlikely. Some people who have been seizure-free without medication for a considerable time period, usually at least a year, are allowed to fly – even jets – in some cases, if they can remain seizure-free for at least a year without using anticonvulsant drugs. [4]

Jobs involving the operation of dangerous machinery may pose a problem to people with epilepsy, including construction and industrial work. [4]

Many places have laws barring those with epilepsy whose seizures are not entirely controlled from working in positions that involve a high degree of responsibility to the well-being of others. This includes police officers, teachers, and health care workers. [4]

Occupational hazards

There are many hazards that people with epilepsy, including those whose seizures are fully controlled by medication, face in the workplace. Those with active seizures face the obvious risk of loss of consciousness or muscle control, and those with side effects face diminished concentration or physical strength. Some of the hazards include: [5]

Transportation

Even if a person with epilepsy is able to safely perform job duties him/herself, many are limited where they can work if they cannot provide their own transportation to the job site. Since some cannot drive themselves to work, they cannot travel to a place of employment. [6] [7]

Some people with epilepsy who cannot drive may also be unable to safely walk, use public transportation, or otherwise independently travel safely due to their seizure risk, further preventing them from reaching a place of employment. Such people may be at risk for having seizures while on or waiting for a public transport vehicle or while crossing the street. [1]

Stigma

Stigma alone can make it more difficult for people with epilepsy to find jobs. Even if one's seizures are fully controlled by medication, or if the condition has been completely cured by surgery, many employers are reluctant to hire a person with epilepsy. [8]

United States law does not require an applicant for a job to disclose one's condition to the employer. If an applicant voluntarily reveals one's condition, the employer is only allowed to ask whether the employee requires any special accommodations, and if so, what types. [9]

If an employer learns of an epileptic condition after making a decision to hire an employee, the employer is not legally permitted to withdraw the decision to hire as a result of this information unless the employee's duties will pose a risk to public safety. If this is the case, the employer is permitted to require the employee to obtain information from a physician regarding this.

Federal law in the United States requires that federal government agencies and employers receiving federal funding cannot discriminate in hiring against a prospective employee with epilepsy unless the duties one would be performing can be unsafe with a seizure disorder. [10]

Special accommodations

Employees who have epilepsy may require special accommodations from their employers. Although against the law, some employers may feel reluctant to provide these accommodations. Some special needs include: [11]

Safety

  • Safety shields around pieces of equipment (which should be considered standard for all workers)
  • Carpeting on concrete or other hard floors

Hours

  • Extra breaks for one who is often drowsy or fatigued as a result of one's condition
  • Extended breaks following a seizure, should one occur
  • Days off from work in the event a longer recovery is needed

Seizures while on duty

According to the law of the United States, an employer is permitted to inquire into an employee's epileptic condition if the employee has one or more seizures while on duty only if they affect safety or job performance. [9]

The employer is permitted to require the employee to take a leave of absence or reassign the employee until the issues are resolved if the seizures pose a threat to the safety of others.

Epilepsy as a disability

Depending on the severity, epilepsy can be considered a disability which makes employment very difficult or even impossible for many with the condition for a variety of reasons. Those with seizures that cannot be controlled may find themselves unable to perform job duties of any type because their consciousness is constantly interrupted by the seizures. The aftermath of an often unpredictable seizure may leave a patient too fatigued to work for a period of time, or may temporarily impair the patient's memory. Seizures may pose a hazard to the employee or others in the event the employee loses consciousness while performing certain duties. Even if the seizures are completely controlled by a medication, side effects, such as drowsiness or fatigue, may make the performance of duties impossible or more difficult.

In the United States, while the Americans with Disabilities Act does not fully protect people with epilepsy from discrimination in hiring practices, the Social Security Administration only considers people with epilepsy "disabled" and thereby eligible to receive benefits if the condition severely limits one or more major life activities. [12] Employment may be hard to find or perform for many people with epilepsy, but not all are eligible for government-sponsored disability payments.

To qualify, documentation to the Social Security Administration of an EEG detailing a typical seizure is required, though a normal diagnosis does not rule out benefits. A seizure diary, including times and dates of seizures, and the effects the seizures have had is required. A person may qualify either if the seizures themselves have debilitating effects, or if the drugs used to treat the disorder have side effects that make employment impossible or difficult. [13]

Armed forces

Many countries restrict people with epilepsy from joining their armed forces.

In the United States, in order to enroll in military service in a combat role, one must be seizure-free since age five and off all medications. [14]

In the United Kingdom people with epilepsy who have had multiple seizures after the age of six are barred from joining the military. [15]

See also

Related Research Articles

<span class="mw-page-title-main">Epilepsy</span> Group of neurological disorders causing seizures

Epilepsy is a group of non-communicable neurological disorders characterized by recurrent epileptic seizures. An epileptic seizure is the clinical manifestation of an abnormal, excessive, and synchronized electrical discharge in the neurons. The occurrence of two or more unprovoked seizures defines epilepsy. The occurrence of just one seizure may warrant the definition in a more clinical usage where recurrence may be able to be prejudged. Epileptic seizures can vary from brief and nearly undetectable periods to long periods of vigorous shaking due to abnormal electrical activity in the brain. These episodes can result in physical injuries, either directly such as broken bones or through causing accidents. In epilepsy, seizures tend to recur and may have no detectable underlying cause. Isolated seizures that are provoked by a specific cause such as poisoning are not deemed to represent epilepsy. People with epilepsy may be treated differently in various areas of the world and experience varying degrees of social stigma due to the alarming nature of their symptoms.

<span class="mw-page-title-main">Seizure</span> Period of symptoms due to excessive or synchronous neuronal brain activity

A seizure is a period of symptoms due to abnormally excessive or synchronous neuronal activity in the brain. Outward effects vary from uncontrolled shaking movements involving much of the body with loss of consciousness, to shaking movements involving only part of the body with variable levels of consciousness, to a subtle momentary loss of awareness. These episodes usually last less than two minutes and it takes some time to return to normal. Loss of bladder control may occur.

Absence seizures are one of several kinds of generalized seizures. In the past, absence epilepsy was referred to as "pyknolepsy," a term derived from the Greek word "pyknos," signifying "extremely frequent" or "grouped". These seizures are sometimes referred to as petit mal seizures ; however, usage of this terminology is no longer recommended. Absence seizures are characterized by a brief loss and return of consciousness, generally not followed by a period of lethargy. Absence seizures are most common in children. They affect both sides of the brain.

<span class="mw-page-title-main">Myoclonus</span> Involuntary, irregular muscle twitch

Myoclonus is a brief, involuntary, irregular twitching of a muscle, a joint, or a group of muscles, different from clonus, which is rhythmic or regular. Myoclonus describes a medical sign and, generally, is not a diagnosis of a disease. It belongs to the hyperkinetic movement disorders, among tremor and chorea for example. These myoclonic twitches, jerks, or seizures are usually caused by sudden muscle contractions or brief lapses of contraction. The most common circumstance under which they occur is while falling asleep. Myoclonic jerks occur in healthy people and are experienced occasionally by everyone. However, when they appear with more persistence and become more widespread they can be a sign of various neurological disorders. Hiccups are a kind of myoclonic jerk specifically affecting the diaphragm. When a spasm is caused by another person it is known as a provoked spasm. Shuddering attacks in babies fall in this category.

An open shop is a place of employment at which one is not required to join or financially support a union as a condition of hiring or continued employment.

<span class="mw-page-title-main">Temporal lobe epilepsy</span> Chronic focal seizure disorder

In the field of neurology, temporal lobe epilepsy is an enduring brain disorder that causes unprovoked seizures from the temporal lobe. Temporal lobe epilepsy is the most common type of focal onset epilepsy among adults. Seizure symptoms and behavior distinguish seizures arising from the medial temporal lobe from seizures arising from the lateral (neocortical) temporal lobe. Memory and psychiatric comorbidities may occur. Diagnosis relies on electroencephalographic (EEG) and neuroimaging studies. Anticonvulsant medications, epilepsy surgery and dietary treatments may improve seizure control.

Frontal lobe epilepsy (FLE) is a neurological disorder that is characterized by brief, recurring seizures arising in the frontal lobes of the brain, that often occur during sleep. It is the second most common type of epilepsy after temporal lobe epilepsy (TLE), and is related to the temporal form in that both forms are characterized by partial (focal) seizures.

Epilepsy surgery involves a neurosurgical procedure where an area of the brain involved in seizures is either resected, ablated, disconnected or stimulated. The goal is to eliminate seizures or significantly reduce seizure burden. Approximately 60% of all people with epilepsy have focal epilepsy syndromes. In 15% to 20% of these patients, the condition is not adequately controlled with anticonvulsive drugs. Such patients are potential candidates for surgical epilepsy treatment.

Multiple subpial transections is a surgical treatment modality for epilepsy used in scenarios wherein epileptogenic brain regions cannot be removed safely. The surgeon makes a series of shallow cuts (transections) into the brain's cerebral cortex. These cuts are thought to interrupt some fibers that connect neighboring parts of the brain, but they do not appear to cause long-lasting impairment in the critical functions that these areas perform.

Geschwind syndrome, also known as Gastaut-Geschwind, is a group of behavioral phenomena evident in some people with temporal lobe epilepsy. It is named for one of the first individuals to categorize the symptoms, Norman Geschwind, who published prolifically on the topic from 1973 to 1984. There is controversy surrounding whether it is a true neuropsychiatric disorder. Temporal lobe epilepsy causes chronic, mild, interictal changes in personality, which slowly intensify over time. Geschwind syndrome includes five primary changes; hypergraphia, hyperreligiosity, atypical sexuality, circumstantiality, and intensified mental life. Not all symptoms must be present for a diagnosis. Only some people with epilepsy or temporal lobe epilepsy show features of Geschwind syndrome.

Epilepsy and driving is a personal and public safety issue. A person with a seizure disorder that causes lapses in consciousness may put themselves and the public at risk if a seizure occurs while they are operating a motor vehicle. Not only can a seizure itself cause a car wreck, but anticonvulsants often have side effects that include drowsiness. People with epilepsy are more likely to be involved in a traffic collision than people who do not have the condition, although reports range from minimally more likely up to seven times more likely.

Automatism is a set of brief unconscious or automatic behaviors, typically at least several seconds or minutes, while the subject is unaware of actions. This type of automatic behavior often occurs in certain types of epilepsy, such as complex partial seizures in those with temporal lobe epilepsy, or as a side effect of particular medications such as zolpidem.

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Epilepsy is a condition defined by unprovoked or reflex seizures, often occurring without warning. The condition impacts much of a patient's life, including personal safety, memory, and views by others. Those who have active seizures live with the fact that they can have a seizure at any time. Those whose seizures are controlled by medication live with the underlying side effects and the need to remember to take the medication at the correct times.

<span class="mw-page-title-main">Epilepsy in children</span>

Epilepsy is a neurological condition of recurrent episodes of unprovoked epileptic seizures. A seizure is an abnormal neuronal brain activity that can cause intellectual, emotional, and social consequences. Epilepsy affects children and adults of all ages and races, and is one of the most common neurological disorders of the nervous system. Epilepsy is more common among children than adults, affecting about 6 out of 1000 US children that are between the age of 0 to 5 years old. The epileptic seizures can be of different types depending on the part of the brain that was affected, seizures are classified in 2 main types partial seizure or generalized seizure.

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References

  1. 1 2 Epilepsy A to Z: A Concise Encyclopedia By William O. Tatum, Peter W. Kaplan, Pierre Jallon: page 112
  2. The treatment of epilepsy: principles & practice By Elaine Wyllie, Ajay Gupta, Deepak K. Lachhwani: page 1203
  3. Managing Epilepsy: A Clinical Handbook By Malcolm P. Taylor: page 114-15
  4. 1 2 3 4 Living Well with Epilepsy By Robert J. Gumnit: page 174
  5. Epilepsy A to Z: A Concise Encyclopedia By William O. Tatum, Peter W. Kaplan, Pierre Jallon: page 113
  6. Living Well with Epilepsy By Robert J. Gumnit: page 183
  7. Women with epilepsy: a handbook of health and treatment issues By Martha J. Morrell, Kerry L. Flynn: page 282
  8. Epilepsy: Patient and Family Guide By Orrin Devinsky: page 45
  9. 1 2 "Questions and Answers about Epilepsy in the Workplace and the Americans with Disabilities Act (ADA)". Archived from the original on 2010-09-26. Retrieved 2010-10-04.
  10. Living Well with Epilepsy By Robert J. Gumnit: page 218
  11. Epilepsy: Patient and Family Guide By Orrin Devinsky: page 287
  12. Epilepsy: Patient and Family Guide By Orrin Devinsky: pg 283
  13. Epilepsy: Patient and Family Guide By Orrin Devinsky: page 308
  14. Living Well with Epilepsy By Robert J. Gumnit: pages 173-74
  15. "Epilepsy and the UK Armed Forces". Epilepsy Action. British Epilepsy Association. Retrieved 2021-11-07.