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EPILEPSY, EMPLOYMENT AND THE LAW: EPILEPSY AND EMPLOYMENT

admin — Thu, 19 May 2011 13:45:51 +0000

There were two schools of thought about employers and epilepsy, Tom would say when any of his friends asked him if he had had any luck getting a job yet. One is that if you don’t tell them you have epilepsy and they find out you ’11 get sacked on the spot. The other is that if you do tell them, the chances are that they won’t employ you anyway. Tom was quite clear about where he stood. He was an up-front sort of chap, and he didn’t like anything that smacked of deception. So he always made it quite clear to any prospective employer that he had had epilepsy since he was a small boy and that he had to take drugs all the time to control it — in fact that he was likely to be quite a liability to any firm willing to employ him.The next time Tom went to see his doctor, he was asked the same question: ‘Isn’t it time you got a job, Tom? It’s over two years since you left school. You can’t spend the rest of your life hanging about.’ Tom was aggrieved. You couldn’t say he hadn’t tried. But he had to be honest about his epilepsy, didn’t he? Otherwise it wouldn’t be fair.’That’s all very well, Tom,’ said his doctor. ‘But don’t you think you might paint a slightly rosier picture for a prospective employer? Can I remind you that your seizures are well under control? You haven’t had one in two years, have you? And two seizure-free years means that you don’t actually have epilepsy. You could do pretty much any job you wanted to — I’m assuming you don’t want to be a steeplejack. Is it possible that you are actually not too keen to find a job? Think about it . . .’
If your seizures are well controlled, there is no reason why you should not work, or why you should have to seek ‘safe’ or sheltered employment, why you should be passed over for promotion, or why you should not work near machinery.Prejudice and misconceptions about epilepsy account for most of the difficulties you may have in getting employment. For example, although the drugs you are taking may make you less alert, your epilepsy itself will not affect your ability to handle machines. Much is made of the dangers of falling forward onto machinery during a fit, but in fact most people who fall during a fit fall backwards, not forwards.Unless your epilepsy is very severe or caused by serious brain damage there is no reason why your employment prospects should be limited. Probably about 85 per cent of people who have epilepsy should be able to find employment in normal jobs in the normal way. One study from Canada showed that when local doctors, social workers and epilepsy associations were prepared to support local business firms, it was very much easier for people with epilepsy to obtain employment, partly because such co-operation led to greater understanding and lack of prejudice. More important, local employers found that employees with epilepsy were more likely to be reliable as they valued their jobs and did not want to lose them.
RESTRICTIONS IN EMPLOYMENTThere are only a few occupations you will not be able to follow, including heavy goods vehicle or public service driving, becoming a commercial pilot or joining the armed services. A few potentially hazardous jobs, such as a steeplejack or deep-sea diver are also obviously precluded.You will not be able to become a merchant seaman if you have had any history of fits after the age of 5 years. If you are already a merchant seaman and then develop epilepsy you will be able to continue your employment once you have remained seizure-free for at least two years provided that you are working on a ship carrying a medical officer and are not directly involved with the safety of the ship or passengers.If you are currently having seizures you cannot be recruited for the police, or as a traffic warden. However, those with a past history of epilepsy are considered individually. Applicants for teacher training should have been free from seizures for two years at the time of applying.
SEEKING HELPIf your epilepsy is disabling, and you have problems finding work, you can seek help from the PACT — Placing, Assessment and Counselling Team. PACT can be contacted through your local Job Centre. One of their specially trained Disability Employment Advisors will help you decide what job you want to do and help you find it, and offer advice on a wide range of services, including job training, rehabilitation courses, and travel grants for getting to and from work.
VOLUNTARY WORKIf you have been trying, and failing, to get work for some time, it is worth thinking about the possibility of doing unpaid voluntary work for a while. This keeps you in touch with people and with the working world, and may also give you experience which will be valuable in your future job-seeking. Your local Council for Voluntary Services or Social Services office are the people to contact if the idea of voluntary work appeals to you.
APPLYING FOR A JOBWhen you are applying for a new job, you have to keep two clear aims in mind. First you must convince your prospective employer that you are perfectly capable of doing the job in question. Second, you must make them believe that your epilepsy does not play a particularly important part in your life; that for you it is no big deal.Unfortunately, many people with epilepsy have learnt through bitter experience that even to mention that you have epilepsy may lose them the job, but that not mentioning it may eventually have the same effect. It can be a no-win situation, but perhaps the best approach is to sell yourself and your abilities before even mentioning the fact that you have epilepsy. So do not mention it on your application form, unless you are specifically asked, or even during the initial phase of the interview. It should be your final disclosure, and when you make it, do so briefly and casually, as an aside. Then, if your interviewer asks you any further questions, answer them as honestly and straightforwardly as you can.’I take the attitude,’ one woman says, ‘that if a firm don’t want to employ me and my epilepsy, then I’m sure I don’t want to work for them.’
PENSION SCHEMESThe fact that you have epilepsy should make no difference to your inclusion in your employer’s pension scheme. The general advice of the Occupational Pensions Board is that if someone is suitable for a job, then they are also suitable for inclusion in the pension scheme.
ACCIDENT INSURANCEEmployers’ liability policies cover all employees. Those with epilepsy are no exception. Provided you have declared your epilepsy and you are not employed in a job for which your epilepsy makes you quite unsuitable, accident insurance should not be a problem for you or your employer.

THE DIFFERENT TYPES OF EPILEPTIC SEIZURE: PARTIAL SEIZURES

admin — Tue, 28 Apr 2009 12:27:15 +0000

The exact internal perception or external manifestations of partial seizures depend upon the site of origin of discharge of abnormal nerve cells. If these lie in the part of the brain called the motor cortex, a strip of brain concerned with movement, the initial manifestation will be a contraction of muscles in the opposite side of the body, as, through evolutionary events that are not entirely clear, one side of the brain controls the opposite side of the body. Cells in the motor cortex which supply the index finger and thumb, the corner of the mouth, or the big toe are most likely to be those in which a seizure discharge begins. There are more cells assigned to controlling these muscles, which are concerned with the fine tuning of manual skills and facial expression. Statistically, therefore, there is a greater chance of abnormal events occurring in these cells, but also experiments show that they are particularly easy to excite. The first evidence of such a partial seizure may be twitching of one corner of the mouth. As the seizure discharge spreads, the muscles around the eyes are next involved, as nerve cells supplying these muscles are next door to those supplying the mouth. Next involved are the hand muscles, and next the foot muscles. This march of events was described in the last century independently by Bravais, a French neurologist, and by Hughlings Jackson, an English neurologist whose wife had such attacks. This type of seizure is therefore often called a Jacksonian seizure. It may occur with no disturbance of consciousness whatsoever, as the discharge remains confined to the motor cortex. Partial seizures in which there is no disturbance of consciousness are said to be simple partial seizures.

Another type of partial seizure with movement is known as a versive (turning) seizure. In this the head and eyes turn to one side.

Usually the arm on the side to which they are turned is elevated and twitches. Sometimes the ‘version’ may continue so that the subject turns round several times on his own axis. Version is usually in the direction away from the discharging cerebral nerve cells—a left hemisphere focus causes turning to the right. Such seizures are therefore called adversive.

In the types of seizure described so far, there is an external manifestation-contraction of muscles driven by the discharging cerebral nerve cation-cells, so that this type of seizure is easily apparent to an observer.

Most people are right handed, the left hemisphere then being considered to be dominant. Language is very largely located in the dominant hemisphere. An aphasic partial seizure in which expression or comprehension of language is impaired may arise from a seizure discharge in the dominant temporal lobe.

Other groups of discharging cerebral nerve cells may not necessarily result in any external apparent event, only in a distorted internal perception. A focus in one parietal lobe (just behind the motor cortex) may only result in a transient disturbance of sensation, such as a perception of pins and needles in the opposite side of the face, arm, or leg. A seizure discharge in the anterior part of one temporal lobe may result only in the person perceiving a strange smell, unreal, often unpleasant, and yet often vaguely familiar. Similar hallucinations of distorted taste may also occur, which are usually perceived as unpleasant.

If the seizure discharge begins in a slightly different part of the temporal lobe, complex visual hallucinations may occur. A boy of 11 told one of us that he saw himself standing near a shower with another boy, whom he felt he knew yet could not name. This boy and he alternately put their feet under the running water, and this odd hallucination continued until the seizure ended.

Other seizures arising in the temporal lobe may cause a perception that events taking place have previously occurred in the person’s experience. This phenomenon is known as ‘deja vu’. Jamais vu is a phrase used to indicate that the person perceives familiar surroundings as unreal.

If such distorted perceptions occur they may disturb full consciousness—as defined by awareness of current events, interpretation of current events, and correct responsiveness to current events. All gradations of disturbance of consciousness may be seen. For example, the child or adult may respond appropriately to a question after a considerable delay, or he may respond inappropriately, or not at all. After the attack has terminated, people may say that they were dimly aware of ongoing real events, but this is not necessarily true, and the person may have no memory for all events during and for some time after the seizure. Partial seizures in which consciousness is disturbed are said to be complex partial seizures.

Sometimes seizures arising in the temporal lobe result in complex automatic behaviour — a so-called psychomotor seizure. The person may, for example, dress and undress repeatedly or drum his fingers on the table. Less complex, but more common manifestations, are repeated sucking or chewing or swallowing movements. The person will have no memory for these events after the attack.

Such automatic behaviour occurring during the seizure discharge must be distinguished from the common confusion following a grand mal attack, or following a prolonged temporal lobe seizure, for which the person will also be amnesic. This amnesia is, perhaps, analogous of the amnesia following a head injury, in which, for example, a young man will complete a game of rugby football after a collision resulting in a concussive head injury, yet afterwards he will be amnesic for this part of the game.

Emotional experiences are very frequent in partial seizures arising in the temporal lobe. These are often expressed just as ‘a horrible feeling’, but sometimes the sensation of fear is overpowering.

Sensations in the abdomen and chest often also occur. A common initial sensation is a vague feeling of discomfort in the upper abdomen, which rises rapidly into the chest and head. The abdominal sensation may be accompanied by contractions of the stomach and bowel resulting in audible rumbles.

Another frequent internal sensation is one of vertigo. People with seizures beginning in the temporal lobe may say that they are ‘dizzy.’ This word is used in different senses by various people, but some appear to perceive vertigo (a sense of dysequilibrium which may be rotational) as part of the seizure.

Any partial seizure may become secondarily generalized into a tonic-clonic seizure (grand mal seizure). Sometimes this happens so quickly that the partial (focal) onset is only apparent on careful analysis of an EEG recorded during a seizure.

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