Considerations in Worksite Safety

General Considerations in Epilepsy and Workplace Safety
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 epilepsy/medical centers?
The physician should be involved in responding to requests for information and epilepsy or seizures in the workplace or other employment related concerns. If a vocational rehabilitation staff member or
liaison is available, their expertise would be very helpful in addressing employment specific questions. 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). Responses regarding a person’s seizures should address the functional aspects and impact on work and the need for accommodations (see recommendations and accommodation resources)

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 numbers 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:

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

  • Brochure on Working Effectively with Employees Who Have Epilepsy from Cornell University’s Industrial Relations Department. This brochure 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.
  • Factsheets regarding the workplace rights 
of persons with epilepsy available at www.epilepsylegal.org.