What is the impact of seizures on employment? Most people with epilepsy can and do work, but having epilepsy doesn’t make it any easier, especially in the current economic climate. What do you need to disclose when you apply for a job? What are your rights if you are let go because of seizures or your employer’s fear of you having a seizure? Are there some jobs that you cannot do? Let’s take these questions one by one.

What to disclose? When you apply for a job, you do not need to reveal any medical conditions, medications or disabilities, unless the condition will make it impossible for you to fulfill the requirements of the job. Asking questions about a disability on an application form or in an interview is illegal. If you are asked, you can decline to answer or decide to seek work at a more informed and enlightened establishment. I recommend that you do not lie. If you do choose to disclose your epilepsy, it usually is best to do so in person at an interview, along with a discussion of how epilepsy will not limit your productivity.

What are your rights? Several federal and state laws pertain to rights of people with disabilities. The most relevant to people with epilepsy is the Federal 1990 Americans with Disabilities Act (ADA), authored by then Representative Tony Coelho, who is public about his own struggle with epilepsy. The ADA was amended in 2008 to clarify and extend who qualifies as being disabled. The ADA applies to businesses that employ 15 or more people, or who operate with Federal funding. Such businesses cannot discriminate on the basis of a disability. If a person with epilepsy cannot perform a job because of seizures or other limitations related to their disability, then the employer must attempt to make a “reasonable accommodation” for them within the framework of their employment. An accommodation might comprise a desk job instead of a driving job, or stable hourly shifts instead of changing shifts with sleep deprivation. An accommodation might include provisions for recovery breaks after a seizure. Before terminating an employee with epilepsy, an employer will need to be prepared to document attempts to arrange a reasonable accommodation.

If you believe that you have been discriminated against, you have three general options. The first is to talk to your supervisor or to the Human Resources office of the company, which generally is fairly sophisticated about disability and discrimination issues. Sometime, Human Resources can arrange an accomodation. The second is to contact the Equal Employment Opportunity Commission (http://eeoc.gov) in your region. The EEOC may, after hearing your story, decide to send a letter to or file an action against the company allegedly discriminating against you. Such actions typically are at no charge, but the EEOC may choose not to pursue your case. Your third option is to hire a disability attorney to advocate or sue on your behalf. This is a potentially expensive endeavor.

Can you do any job? The answer unfortunately is no, but well over 90% of jobs should not be limited by epilepsy. Absence of a driver’s license would prohibit employment requiring an on-the-road component. Some manufacturing or construction jobs - roofer, for example, might be unwise for someone with uncontrolled seizures. But the modern workplace has safety requirements to protect all workers, many of which will apply equally well to people at risk for having seizures. Such safety features might allow working around potentially dangerous machinery, chemicals, heat or on heights. Individualized judgment, and sometimes a three-way conversation among employee, employer and physician, is needed to decide whether the risks of the job are too high even with safety features. In a large study of working people with disabilities by Zwerling and colleagues, published in 1997 in the Journal of the American Medical Association (volume 278, page 2163), 3 of 209 workers with epilepsy experienced an on-the-job injury. This was 58% higher than the expected number, but not statistically different from the background risk rate. The message is that injuries can happen on (or off) the job in people with epilepsy, but the rate of injuries is not significantly increased.

Some work limitations may derive from side effects of seizure medicines that limit balance, energy, mood, memory, mental sharpness or ability to function under stress. A person with medication side effects should explore with his or her medical team whether a change in medications would make it easier to work. Epilepsy sometimes coexists with brain injuries that impose their own limits on potential for employment. In general, epilepsy does not mean unemployable; many people with epilepsy are outstanding employees. To read more about epilepsy and employment, take a look at two excellent articles on this subject in the epilepsy.com journal Epilepsy: Insights & Strategies by Jason Johnson (http://www.epilepsy.com/epilepsy/journal/issue1/ADAAA) and Jeanette Herting (http://www.epilepsy.com/epilepsy/journal/issue2/jobs).

Robert S. Fisher, M.D., Ph.D.
Editor-in-Chief, epilepsy.com