Seizures and Work:

An Excerpt from Epilepsy: 199 Answers

Using case studies of patients like Karen, who was able to continue working despite her epilepsy, and Jack, who wasnít, Andrew N. Wilner, MD, FACP, presents practical information for individuals with epilepsy in his book 199 Answers.

Originally published in 1996, the second edition of Epilepsy: 199 AnswersĖA Doctor Responds to His Patientsí Questions was released by Dr. Wilner, an epileptologist and frequent CNS News contributor, this year. The following is an excerpt from his updated book.

Chapter 9: Seizures and Work

Treatment with phenytoin and carbamazepine didnít stop Bobís seizures. After several years of trial and error, we finally succeeded with a combination of divalproex sodium (Depakote, Abbott), gabapentin (Neurontin, Pfizer) and acetazolamide. Bob also made lifestyle changes (gave up drugs and alcohol) and improved his compliance with medication.

For the past year, Bob has been seizure-free and gainfully employed. Trained as an aircraft engineer, he repairs Teflon strips on propeller blades using chemicals, adhesives and glues.

Last month, I received a letter from his employer noting that Bob had "poor memory for details, increased scrap rate, difficulty following instructions, and multiple mistakes." The employer asked for my advice.

Can people with epilepsy work?

A large number of people with epilepsy hold successful careers and work steady jobs. On the other hand, many cannot work. A chart review of 306 of my patients with well-documented epilepsy revealed that 18% of them received disability compensation. Unemployment is approximately twice the national average.

Why canít people with epilepsy work?

The most frequent problem I see is that seizures interfere with the job. One of my patients worked for the local utility company, maintaining power lines. He pruned trees with a chain saw while standing in a bucket supported two stories above the street by a crane. When he developed epilepsy, it was impractical for him to continue working at this dangerous job.

Many of my patients work in textile mills here in North Carolina. When they develop seizures or their seizures become uncontrolled, it becomes unsafe to continue working with dangerous machinery.

Certain jobs require driving: chauffeuring a taxi or bus, making deliveries or regional sales. These are all impossible professions for people with uncontrolled seizures.

Do people with epilepsy take more sick days than other people?

No. There is no significant difference in days off due to illness. However, patients with epilepsy do use employee health facilities more often.

I know someone with epilepsy who doesnít have seizures any more, but she still canít get a job. Why is that?

In some cases, other disabilities associated with epilepsy limit employment.

In children with epilepsy, approximately 9% have mental retardation. This additional problem limits their educability and job opportunities in the future.

One of my patients didnít develop epilepsy until he was 20 years old, but he had never worked. He said it was because of his birth defect, a type of cerebral palsy. He has slurred speech and a mild paralysis of his right side with a clumsy right hand.

Sometimes, as in Bobís case, side effects from medication interfere with job performance.

It is also possible that discrimination because of epilepsy can limit job opportunities.

How can I keep discrimination from preventing me from getting a job?

Discrimination in employment is outlawed by the Americans with Disabilities Act of 1990, Public Law 101-336. This law supplements the Rehabilitation Act of 1973, which prohibits discrimination by federal contractors, federal agencies or recipients of federal financial assistance. These laws prevent discrimination in employment on the basis of prejudice and ignorance.

The Americans with Disabilities Act applies to private businesses with more than 15 employees. Just as it is illegal to discriminate on the basis of race or sex, this law makes it illegal to discriminate on the basis of epilepsy. However, the person applying for the job must be willing and able to do the job.

What if they ask for a drug test? Do I have to take it?

Yes. Drug tests are designed to screen for drug abuse and can be required before or after a job offer is given. However, the presence of epilepsy drugs in your result cannot be used to disqualify you for the job.

What about a medical examination?

An employer is not permitted to ask health-related questions during an interview or on a job application. A medical history and examination can only be required after a job offer is made. It is illegal for an employer to use the fact that you have epilepsy to disqualify you.

How does the Americans with Disabilities Act protect me?

Another feature of the Americans with Disabilities Act is the "reasonable accommodation" provision. This language requires the employer to make changes in the work environment or job description if the applicant can otherwise fulfill all the "essential functions" of employment.

My patient Karen was in her early 40s and had a successful banking job. She worked in administration, where her monthly partial complex seizures were not a major problem. She usually would have a brief warning and sit down at her desk or go to the ladies room until the seizure was over. She did her work well and was advancing in management.

Last year, the bank acquired its first out-of-town branch office, which required an inspection every three months. Branch supervision was part of Karenís responsibility. She had never had a problem with this before, as she could take a cab to all the local branches. In order to inspect this new rural acquisition, she would have to take a short flight and then rent a car. Because of her seizures, traveling presented a problem.

Although it was her responsibility, this particular branch inspection could be performed by one of her colleagues. It was also a very small part of her job, not an "essential function." Consequently, when Karen asked her boss to relieve her of this obligation, the only aspect of her job she could not do, she was protected by the Americans with Disabilities Act. It was possible for her boss to make a "reasonable accommodation" by assigning this trip to someone else and letting Karen continue doing her good work at the home office.

Does the Americans with Disabilities Act keep me from getting fired?

Jack worked at a nature museum. Initially, his seizures were controlled, but as he got older his epilepsy became more severe. Despite increasing doses of medication, he began having seizures at work and would become confused and wander off.

Jackís primary job was feeding the animals and cleaning their cages. Some of the animals, such as raccoons and foxes, were potentially dangerous. One day, while bringing breakfast to a valuable arctic fox, he had a seizure and left the cage open. When his mind cleared and he realized what had happened, he searched all over the museum, but he couldnít find the fox.

The next day, the animal was found dead on a nearby highway. Jack was fired when the details of the incident became clear to his employer.

Jack was furious over losing his job and contacted a lawyer. He said he wanted to sue because of discrimination. The attorney advised Jack that the law did not protect him in this case. He was not being discriminated against because he had epilepsy. He was let go because his uncontrolled seizures did not allow him to do his job properly or safely.

Who should I contact if I have a concern about discrimination?

Call your state affiliate or the national office of the Epilepsy Foundation (EF). They will be able to provide you with more information and direct you to the proper legal resources. An informative booklet, "The Americans with Disabilities Act, A Guide to Provisions Affecting Persons with Seizure Disorders," is also available from the EF.

Who at work should I tell?

If it is likely that you will have a seizure at work, you should inform your supervisor and close co-workers. Otherwise, after your first seizure on the job, you will probably get whisked off to the emergency room. Your co-workers will be best prepared to help you if they are forewarned.

When you discuss your epilepsy, you will have an opportunity to educate your co-workers about appropriate first aid. You can also give them guidelines regarding when to call an ambulance. If your supervisor wants more information, you can suggest that he call your doctor, a local epilepsy center, or the EF.

Should I wear a MedicAlert bracelet?

This is a personal decision. Some people are private about their seizures. Others, particularly those with frequent seizures, have learned that communication about their disorder can benefit them. For example, if a police officer finds you confused in a parking lot late Saturday night, he is likely to consider epilepsy rather than alcohol intoxication when he sees a MedicAlert bracelet.

What if I canít find a job?

Finding the right job is difficult for everyone. Frequent seizures increase the likelihood of unemployment. Work with your doctor to control your seizures.

If you continue to have difficulty finding a job, look to others who may be able to help you. If you are in school, career counselors are available. If you have finished school, ask your doctor for a referral to a social worker or vocational rehabilitation. Ask about a referral to JobTech.

What is JobTech?

JobTech is a new employment program developed by the Epilepsy Foundation and sponsored by the U.S. Department of Labor and the U.S. Social Security Administration. JobTech helps people with epilepsy find jobs in the technology-based customer service field.

JobTech had its first program year in 2000-1 and is currently administered by four epilepsy affiliates: Camden, N.J., Kansas City, Mo., Mobile, Ala. and Rockford, Ill . Other local affiliates also offer assistance with job finding.

(JobTech replaces a prior program, Training Applicants for Placement Success [TAPS], which was funded by the U.S. Department of Labor and had been in operation since 1976.)

My seizures are perfectly controlled. Are there any jobs I still canít qualify for?

The federal Department of Transportation prohibits anyone with a history of seizures from obtaining a federal commercial driverís license. Similarly, the Federal Aviation Administration disqualifies anyone with a history of epilepsy from becoming a commercial pilot.

There are no other legal restrictions that prevent people with controlled seizures from working.

What about the armed forces?

Enlistment in one of the branches of the armed forces is possible if you are seizure-free without medications for at least five years.

What happened to Bob? Did his work performance improve?

I made sure his drug levels werenít toxic, and Bob tried without success to boost the quality of his work. I wrote a letter on his behalf, but Bob lost his job. Even though he wasnít having seizures, he was not able to meet the required standards of his position. Now he works for another company as a fluid hydraulics mechanic and seems to be doing fine.