Page 483 - ILAE_Lectures_2015

Chapter 53

Employment

GUS A. BAKER

University Department of Neurosciences, Walton Centre for Neurology and Neurosurgery,
Lower Lane, Liverpool

People with epilepsy have been shown to be up to twice as likely as people without it to be
at risk of unemployment1; and as being also subject to underemployment, relative to the level
of their skills and qualifications2; with related impacts for their financial status and
psychological well-being. Factors contributing to the likelihood of under- and unemployment
in people with epilepsy are both internal and external. In the former category, a range of
clinical factors have been demonstrated as predictive of employment status, including seizure
frequency and type, age of onset of epilepsy and duration, and the adverse cognitive effects
of antiepileptic drugs (AEDs); and the effects of these clinical factors may be further
compounded by internal psychological factors, for example, reduced self-esteem and
achievement expectations3. External mechanisms, in the form of stigma and discrimination4,
which may be either formal or informal, overt or covert, intentional or unintentional, also
contribute to the compromised employment position of people with epilepsy; and their effects
may be felt particularly hard in areas or times of high unemployment. For many people with
epilepsy, employment is the major quality of life issue facing them5,6.

The question of employment is crucial when considering the needs of people with epilepsy.
Working, being an employee and earning a living, is an outward indication of integration and
acceptance by others in society. The advent of seizures can have serious effects on work
prospects and as a consequence can adversely influence psychosocial functioning of the
person with epilepsy, and his or her family. In most surveys of people with epilepsy,
employment problems are frequently highlighted7,8. From a societal viewpoint the economic
cost of epilepsy in the workplace is also a concern. A recent study suggested that of the
estimated 200,000 people with epilepsy of working age in the UK as many as half are
experiencing moderate or severe problems with employment9. Employment was the third
major concern cited by people with epilepsy after driving and medication in a survey
conducted by Epilepsy Action, with a third of respondents describing the problem as serious.

Employment problems

Restrictions
There are a number of ways in which epilepsy can have an impact on employment. In the
first instance certain occupations are barred by law to the person with epilepsy because of the
potential hazards to him or her or others if a seizure occurs in the workplace. These include
working as an aircraft pilot, ambulance driver, merchant seaman, taxi driver, train driver, and
in the armed services. Secondly, the stigma attached to epilepsy and the resulting prejudice
on the part of the employers and co-workers limits employment opportunities for individuals
with epilepsy. Thirdly, there are also some occupations in which difficulties may be
experienced, although there are no statutory barriers concerning them, such as teaching posts
involving physical education, science and technology in state schools, some nursing posts,
work with young children and jobs in the prison service involving close contact with inmates.
Certain positions also involve substantial risks if seizures are not fully controlled and
therefore should not be recommended. These include working at heights and working alone
near open water or around unguarded machinery or fires. To hold a Large Goods Vehicle