Introduction

During working hours, people with epilepsy can face risks similar to those faced by the general population, but particular attention should be paid to issues related to seizures and injuries resulting from sudden falls.

Risks to safety depend on what your epilepsy is like and what the job involves. When dealing with seizures, if possible, it is useful to develop a ‘Seizure Action Plan’ and share it with your employer and/or colleagues. Clear information and knowledge helps people to react appropriately to seizures and reduce the risk of serious injuries. This plan could include points such as:

• Stay calm, keep the person with epilepsy away from dangers and protect their head from injuries.
• Time the seizure, and call an ambulance if the seizure lasts more than 5 minutes.
• Do not put something in the mouth or try to restrain the person.
• Finally, after the seizure they should reassure you and help you to continue with the task in hand.

Trigger risks

Some hazards and risks are related to seizures triggering factors. Indeed, some seizures (such as reflex-seizures) are related to specific stimuli, common sounds, sudden movements and light. In the workplace, try to avoid such triggering factors and ask for the necessary accommodations. For example, your employer should allow you to work in an environment that minimises your exposure to disturbing sounds, flickering lights or sudden stimuli, if these can be triggers for your seizures. Together with your neurologist and your employer you should formulate a plan to adjust your work environment to work as safely as possible.

Photosensitivity is a particular feature of some generalized epilepsies: when a person suffers from photosensitivity, flickering lights must be avoided. To increase your safety in the workplace, your employer can aid you in making screens and lights safe. Some people with epilepsy can be specifically sensitive to visual patterns, such as checkered patterns, striped patterns and in general geometrical moving patterns (e.g. escalators, swirling figures in motion, etc), of which the employer can help minimise the associated risks for seizure triggers in the work environment.

If you have reflex epilepsy triggered by reading, it is advisable to avoid applying for jobs that require extensive reading.

A special consideration must be made for motor and sensory limitations related to seizures in the post-seizure period, such as Todd’s paralysis, which presents after some seizures. For motor limitations, consider jobs which focus on cognitive rather than manual skills. Some challenges may be permanent, such as if you have undergone surgery for epilepsy, which can potentially result in visual or motor impairments. If such impairments prevent you from working, you may be eligible for disability benefits. On the other hand, if you have only mild impairments, you can ask for adjustments at work: such as auditory support for visual problems, or the removal of barriers in the case of motor issues.

Epilepsy and  the effects on cognition, memory and IQ.

Certain types of epilepsy are associated with cognitive deficits. You can experience transient issues with memory, cognition and processing, especially during absence seizures or temporal lobe seizures. In these cases, it is advisable to avoid jobs which require high mental strain, and instead consider roles which are more manual in nature. If the lapses in cognition are mild or transient, you may need to simply rest and recover after seizures or ensure to ask for information to be repeated in order to work effectively.

Another key factor to consider is the effect of epilepsy medication on concentration and fatigue. You can discuss with your neurologist the possibility of adjusting your therapy to avoid drugs that significantly impair attention and concentration. Seizures are unpredictable and, even when all triggering factors are avoided, they can still happen unexpectedly, disturbing your normal functions. During seizures you may experience falls and injuries, and feel a bit dizzy, fatigued or confused.

Time shifts, such as changes in your sleep schedule or work hours, can affect your ability to work because some seizures are time-dependent and primarily occur at night or in the early morning. Sleep deprivation can be a triggering factor for seizures, especially if you suffer from generalized seizures. For a more suitable work environment, consider remote work for jobs that do not require in-person tasks, as this can help reduce fatigue and stress. Additionally, redistributing work hours and avoiding night shifts can be effective strategies for preventing seizures.

We will give you a scheme to evaluate environmental and personal limitations that you face.

Methods

We will provide information on the necessary accommodations we recommend taking and a simple tool to evaluate limitations to guide you in choosing the right job.

Checklist and resources

Before filling the table below to assess your personal risk in your workplace and to find the best strategies to cope with it, please be sure the points on the checklist are applicable to you.

Preliminary checklist

• I have received a specific and detailed epilepsy diagnosis from my neurologist (e.g. generalized epilepsy, childhood absence epilepsy.
• I recognize specific triggers for my seizures (intermittent fotostimulations, sleep deprivation, anxiety, etc; if you are in doubt please ask your neurologist)
• I am able to guarantee a full adherence to my medical treatment for epilepsy (if not please refer to your neurologist)
• I have a good quality of sleep (> 7 hours per night and I wake up rested; if not please refer to your neurologist).
• I have debated whether to communicate my illness to my employer and colleagues
  • if yes, please provide them a link to this project to increase their knowledge on this topic
  • if yes, provide them this link to teach them the help manoeuvres to be done in case of a seizure
  • if yes, please build an SAP procedure with your colleagues

Seizure Action Plan for Employers and Colleagues (Modified from https://www.epilepsy.com/sites/default/files/2023-08/SeizureActionPlan2023ACCE.pdf)

How to respond to a seizure (check all that apply)

First aid for any seizure – Stay. Safe. Side.

• STAY calm and begin timing seizure
• Keep me SAFE – remove harmful objects, don’t restrain, protect head
• SIDE – turn on side if not awake, keep airway clear, don’t put objects in mouth
• STAY until recovered from seizure

Other Actions

• Swipe magnet for VNS
• Write down what happens
• Give rescue therapy (benzodiazepine) if seizure lasts more than 3 minutes
• Call emergency number

When to call an emergency number

1. Seizure with loss of consciousness longer than 5 minutes
2. Not responding to rescue medication if available
3. Repeated seizures longer than 10 minutes, no recovery between them, not responding to rescue medication if available
4. Difficulty breathing after seizure
5. Serious injury occurs or suspected
6. Seizure in water
7. First time seizure

When to call your provider first

1. Change in seizure type, number or pattern
2. Person does not return to usual behavior (i.e. confused for a long period)
3. First time seizure that stops on its own
4. Other medical problems or pregnancy need to be checked