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Epilepsy in the Workplace

Other articles: What is Epilepsy   
Multiple Sclerosis 

Is Epilepsy Really a Concern at the Work Place For Those With an Active Condition?

Many individuals experiencing seizures will present absolutely no job-relevant concerns. These are individuals who have seizures only nocturnally, have a consistent warning aura and simply seat themselves taking safety precautions, or have a partial seizure in which they do not lose consciousness and have only a limb tremor, as an example. For those with active epilepsy, seizure conditions can vary widely and need to be considered on an individual basis.

Implications of the Americans with Disabilities Act (ADA) for Individuals with Epilepsy

The ADA defines experiencing disability under the act as having a physical or mental impairment. The ADA defines physical impairment as including a physiological disorder or condition. Epilepsy is an example of a physiological disorder affecting the neurological system. Persons with seizure disorders therefore have a physical impairment.

As an employer, you will have identified the essential functions of a job that an individual is required to do at your work place with or without reasonable accommodation. Many individuals with epilepsy will simply not discuss their disability because of their freedom from seizures, a high level of seizure control, or the fact that it doesn’t interact with performance of the essential functions of the job (e.g., a person with nocturnal seizures only). Individuals with epilepsy will often prefer to discuss their disability at the end of the interview as a matter of personal comfort or courtesy to the employer even if it may not be required. They, however, may need to discuss the disability if drug testing is a standard part of the employment screening process once a job offer is extended. Their anticonvulsant use can be misinterpreted.

A General Perspective on Employer Concerns in the Work Place for Employees with Epilepsy

Employers can often have a number of unfounded concerns about the work performance of individuals with epilepsy; some of the information below may be helpful:

• ·    Attendance and performance - Most studies suggest attendance and performance records for those with epilepsy are equal or better than the general working population (McLellan, 1987).

• ·    Accident rates - Risch (1968) demonstrated that actual time lost due to seizures was approximately one hour for every thousand hours worked for individuals with active seizure conditions. Sands (1961) reviewed workers’ compensation cases over a 13 year period in the state of New York and established that accidents caused by sneezing or coughing on the job were twice as frequent than those related to seizure occurrences. Quattrini et al. (1999) indicate no change in job accident rate after the onset of epilepsy for 860 workers.

• ·    Working around machinery - In consideration of today’s safety standards, it is rare that machinery would require any special modification for individuals with a seizure condition. Plastic guards, cut-off mechanisms, etc. on machinery and other safety modifications are becoming standard.

• ·    Insurance rates - Hiring individuals with epilepsy does not increase a company’s industrial insurance rates. These rates are linked to the hazards of specific occupational classifications. Health insurance providers generally link rates to age and sex in larger companies, while among smaller companies, the providers usually pool claim experiences and no one employer is penalized. EPI-HAB, a sheltered work system for those seizure disorders, reported receiving significant insurance premium reductions due to outstanding safety records.

• ·    It should be noted that people with epilepsy generally refrain from drinking alcohol or recreational drug activity, and otherwise lead a relatively healthy lifestyle in order not to aggravate their condition. Consequently, they are often safer on the job than the average employee and are highly stable employees.

Accommodations Issues for the Individual with Epilepsy

In the actual application completion and interview process, accommodation concerns are generally not necessary for an individual with epilepsy. In the interview, however, some individuals will respond to the need for a specific type of accommodation in order to perform the essential functions of a job or to perform those functions more safely.

Although a number of companies routinely require a driver’s license, this is often not linked to an essential function of a job. A company may need to examine whether the capacity for driving is actually a requirement for their jobs or whether a job could be slightly modified or restructured in order that, as an example, the 9% of a job that relates to driving is performed by another worker or shared by other workers. Many individuals with epilepsy, however, are very capable of driving due to their level of seizure control, type of seizure warning, and other considerations. To drive, people with this disability are generally required to have a seizure free period of three months to a year. In some states, this is at the discretion of the physician and his or her assessment of an individual’s seizure condition. In sum, driving can be an essential job function in some positions such as a traveling sales representative or courier, but in any number of other cases driving is often a marginal and non‑essential job function.

In addition to restructuring job tasks, other examples of accommodation for individuals with epilepsy would include:

• ·    Installing a fiberglass safety guard on a piece of machinery.

• ·    Installing some industrial rubber matting or carpeting in order to cover a concrete floor in a work area.

• ·    Scheduling consistent day work shifts for individuals whose seizures are exacerbated by inconsistent sleep patterns caused by rotating shifts and, in some cases, night shifts.

• ·    Allowing individuals to have an extended break or some time off after they have incurred a seizure while on the job.

• ·    Providing flame retardant clothing for individuals working in an area in which a burn could be incurred during a seizure event and period of disorientation.

• ·    Provision of some type of safety helmeting while on the job

In general, accommodations for individuals with epilepsy are minimal, not costly, and generally not necessary. It should be noted that the Job Accommodation Network (JAN) at West Virginia University indicates that 70% of the accommodations made result in a cost of no more than $500 to an employer with about 20% involving no cost whatsoever. Accommodations for individuals with epilepsy will generally involve a type of procedural consideration. This type of consideration routinely does not require any real cost or undue hardship to the employer. Employees with epilepsy, particularly with a reasonable accommodation having been made, will rarely cause any direct threat of harm to him- or herself or any co-worker.

Selecting an Accommodation

The selecting of a reasonable accommodation can often be established through direct dialogue between the employee and the employer. Accommodations can involve procedural changes, physical modifications or safeguards to a work station, or low tech or high tech assistive equipment. Again, most of the considerations for those with epilepsy will involve a procedural change or perhaps some safeguarding of a work station.

If the employer and employee cannot establish a reasonable accommodation approach, a state vocational rehabilitation agency, a local Epilepsy Foundation affiliate, the national Epilepsy Foundation, or resources such as the Job Accommodation Network (JAN) can be contacted for purposes of assistance. State vocational rehabilitation agencies will often send a vocational rehabilitation counselor or assistive technologist to the job site in order to help with establishing accommodation needs. Again, it must be underscored that accommodation concerns for employees with epilepsy, when helpful, are very low cost. Individual companies can also receive tax credits or deductions for physical modification or equipment purchase efforts at the work site if this cost is not borne by a local or state vocational rehabilitation agency.

References

Devinsky, Orrin. A Guide to Understanding and Living With Epilepsy. Philadelphia: FA Davis, 1994.

Epilepsy Foundation of America. Americans with Disabilities Act: A Guide to Provisions Affecting Persons with Seizure Disorders. Washington, DC: author, 1992.

Fraser, RT, Glaser, E., Simcoe, B. Epilepsy. In Brodwin, M, Tellez, F, and Brodwin, SK (editors). Medical, Psychosocial, and Vocational Aspects of Epilepsy. Athens, GA: Elliott & Fitzpatrick, 2001.

McLellan, DL. Epilepsy and employment. Journal of Social and Occupational Medicine. 1987, 3:94‑99.

Pfafflin, M, Specht, U, Thorbecke, R, Fraser, RT, Wolf, P., editors. Comprehensive Care for People With Epilepsy. London: J. Libbey, 2001.

Quattrini, A, et al. Working activities and entailing risks in a large population of epileptic subjects. Epilepsia, 1999, 40 (Sp 2):199.

Risch, F. We lost every game...but. Rehabilitation Record, 1968, 9:16-18. 

Sands, H. Report of a study undertaken for the committee on neurological disorders in industry. Epilepsy News, 1961 7(Abstract), 1