Considerations in Work Site Safety and Epilepsy

General Considerations in Epilepsy and Workplace Safety

Coordinator:  Robert T. Fraser, Ph.D., CRC, University of Washington Epilepsy Center,
Director of Vocational Services)

There are a number of perspectives on epilepsy as a disability within the context of workplace safety.

How prominent are requests for seizure-related information specific to
workplace concerns?

Requests to national epilepsy centers for this type of information are very frequent – approximately
2/3 of the centers had six or more requests monthly. An additional 30% of the centers had 3-5
requests monthly. This would be a range of 48 to more than 70 requests annually being received at
these centers.

Who handles the employment-related information requests at different
epilepsy/medical centers?

The physician is involved in 85% of the requests for information. It is actually important that the
physician be involved in all of these responses. Ideally, a vocational rehabilitation staff member or
liaison could also be involved in all of these responses. In other cases, a social worker or senior
nurse could collaborate with the physician in framing the response (see this Web site section on
The Physician’s Guide), but it shouldbe a very functional response on seizure status as per
the Web site guidelines and note that accommodation resources (see Accommodations section of
this Web site) should be reviewed.

What about general physical risk for those with epilepsy? Do they have more
injuries in general activities of daily living?

After review of multiple studies (Beghi & Cornaggia, 1997; Neufeld et al., 1999; Neufeld et al., 2000;
Wiebe et al., 1999), it appears that people with epilepsy fare quite well in relation to accident risk or
physical injury. In fact, there is considerable support for fewer injuries and fewer accidents outside
the home as compared to healthy and other disability control groups.

What about risk in the actual workplace? How do workers with epilepsy fare?

There is considerable "good news" here for the employer and the qualified worker with epilepsy.
Limitations of these studies are that most are not prospective or involve randomized controls. Work-
related accidents are also generally by self-report from workers who may have less active seizures.
Nevertheless, let’s review the positive news:

  • Over a 13-year period in New York State, twice the number of workers' compensation accidents
    were due to coughing and sneezing rather than to epilepsy (Sands, 1961).
  • Lowered industrial insurance rates for the national Epi-Hab sheltered work facilities serving those
    with active seizure conditions (Risch, 1968). This involves not only attention to safety by these sites,
    but life hygiene efforts (e.g., lack of substance abuse) on the part of workers with epilepsy.
  • No increase in accident rates for 860 new Italian patients diagnosed with epilepsy over a 20-year
    follow-up after work return (Quattrini, 1999).
  • With control groups or comparison groups, the concern for workplace accidents, absenteeism, or
    hospitalization for people with epilepsy is an insignificant issue (Lassouw et al., 1997: Van Den
    Brock & Beghi, 2004; Zwerling et al., 1997).

  • In one recent prospective study with 631 adults having epilepsy and 592 matched controls
    (Téllez- Zenteno, Hunter, & Wiebe, 2008) although 22 people with epilepsy on the job had
    accidents vs. nine controls (p<.05), injuries were mild, only one requiring hospitalization in each
    group. Absence from work was basically unaffected.

What is the role and challenge for the physician when asked to respond to workplace
safety requests?

Again, see The Physician’s Response section, but consider:

  • Keeping the information "functional" relative to seizure status.
  • Don't put yourself in the position as the ability-to-work "decision maker."
  • Reference the need for accommodation consideration and the need to utilize a vocational
    rehabilitation counselor or the Epilepsy Foundation of America (EF) employment coordinator
    (1.301.459.3700).

Other accommodation resource sites regionally include the Disability and Business Technical Assistance
Centers (DBTACs) at 1.807.949.4232, www.adata.org/centers.aspx and nationally at the Job
Accommodation Network (JAN), 1.800.ADA.WORK, jan@wvu.edu, or ABLE-DATA, www.abledata.com.
JAN often provides accommodation examples as specifically used by different companies.

Is there some quality resource material that is directly applicable to the concerns
of employers?

Cornell University’s Industrial Relations Department has developed a specific brochure on "Working Effectively with
Employees Who Have Epilepsy." This brochure can be easily downloaded at their web site,
http://digitalcommons.ilr.cornell.edu/edicollect/15/ and is a great tool for employers, supervisors, and human
resources specialists. It is written in "user friendly" language and provides good information on workplace risk
issues and examples of jobsite accommodations. Also, there is a series of factsheets regarding the workplace rights
of persons with epilepsy available at: www.epilepsylegal.org.

REFERENCES

Beghi, E., & Cornaggia, C. Epilepsy and everyday life risks. Neuropidemiology, 1997; 16:207-216.

Benbadis, S.R., Blustein, J.N., & Nunstaad, L. Should patients with pseudoseizures be allowed to drive? Epilepsia,
2000: 41:895-897.

Benbadis, S.R. The problem of psychogenic symptoms: Is the psychiatric community in denial? Epilepsy & Behavior, in press.

Cornaggia, C.M., Beghi, M., Moltrasio, L., Beghi, E.; RESt:-1 Group (2006). Accidents at work among people with epilepsy.
Results of a European prospective cohort study. Seizure, 15(5):313-9.

Devinsky, O. Epilepsy: Patient and Family Guide. Philadelphia: F.A. Davis Co., 2002.

Floyd, M., Chaplin, J., Espir, M., & Kirtz, Z. The management of epilepsy at work. Int J Rehabil Res, 1988; 11(1):3-10.

Fraser, R.T., & Bruyere, S.M. Working effectively with employees who have epilepsy. Ithaca, N.Y.; Employment and Disability
Institute, Cornell University, 2000.

Hauser, W.A., & Hesdorffer, D.C. Epilepsy: Frequency, Causes, and Consequences. New York:
Demos, 1990.

Lassouw, G., Leffers, P., de Krom, M., & Troost, J. Epilepsy in a Dutch working population. Are employees diagnosed
with epilepsy disadvantaged? Seizure, 1997; 6:95-96.

Lindsten, H., Stenlund, H., Edlund, C. et al. Socioeconomic prognosis after a newly diagnosed unprovoked epileptic
seizure. Epilepsia, 2002; 43:1239-1250.

Neufeld, M.Y., Vishne, T., Christik, V., & Korezyn, A.D. Lifelong history of injuries related to seizures. Epilepsy Research,
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Quattrini, A. et al. Working activities and entailing risks in a large population of epileptic subjects. Epilepsia, 1999;
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RESt-1 Group. Social aspects of epilepsy in the adult in seven European countries. Epilepsia,
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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;
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Téllez-Zenteno, J.F., Hunter, G., & Wiebe, S. (2008). Injuries in people with self-reported epilepsy: A population-based
study. Epilepsia, 49(6):954-961.

Van den Brock, M., & Beghi, E. (RESt-1 Group). Accidents in patients with epilepsy: Types, circumstances, and complications:
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Wiebe, S., Bellhouse, D.R., Fallahy, C., & Eliasziw. M. Burden of epilepsy: The Ontario Health Survey. Can J Neurol Sci,
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Zwerling, C.Z., Whitten, P.S., Davis, C.S., & Sprince, N.L. Occupational injuries among workers with disabilities: The
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