Specific conditions to help orient experts to characterize work disability caused by epilepsy

Abstract

BACKGROUND: Epilepsy is a public health problem and an important cause of work disability in Brazil and worldwide and is a condition of interest for medical assessment. OBJECTIVE: To describe what conditions should be considered to help orient experts to characterize work disability caused by epilepsy. METHODS: Literature review. RESULTS AND DISCUSSION: The term diagnosis of epilepsy in itself is not synonymous with work disability. Most cases have a good prognosis with control, in which there is continued work capability. However, work disability can result from this condition and, in general, is related to somatic or psychological implications, psychiatric comorbidities, side effects of antiepileptic drugs and whenever there is risk to workers’ health and/or other people. Factors related to disability are the following: frequent seizures, seizures with loss of consciousness, seizures of sudden onset without triggering factors, seizures in wakefulness, non-adherence to treatment, alcoholism or drug abuse, structural, metabolic or unknown causes of epilepsy, epilepsy resistant to treatment. Other aspects may indicate disease severity, but they should be considered in medical assessment in relation to the following: monitoring referral service, inclusion in programs for special drugs dispensation, complementary tests indication, indication of neuropsychological assessment, polytherapy in high doses, frequent interactions, persistently altered EEG, surgical treatment. All medications analyzed in this review may trigger potential side effects, especially those relating to cognitive and behavioral functions. The results of additional tests should be analyzed in association with symptoms and there are no findings or specific outcomes that are synonymous with work incapacity. Authors tend to characterize the incompatibility of certain occupations or labor situations with epilepsy, even when the disease is controlled. They are as follows: occupations involving activities with risks individuals themselves and others: airline pilots, train conductors, firemen, police officers, operators of hazardous machinery and instruments, solitary guards, swimming instructors and lifeguards, babysitters, nurses, surgeons, professional drivers, military, people responsible for providing care to disabled people, people working at heights or using stairs, near water, with exposure to high voltage electrical circuits, moving vehicles, underground or in contact with fire, furnaces and stoves. CONCLUSIONS: There are specific conditions that should be considered to help orient experts in characterizing work disability caused by epilepsy. Technical training, individualized evaluation, careful and detailed assessment all serve to guide expert judgment that is strongly supported by scientific knowledge, thereby achieving the goal of medical assessment: to see that justice is done.