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Epilepsy

Introduction

In this free educational guide on epilepsy, we provide you with a general discussion about this severe medical condition, and review what evidence or tests are needed to help prove that you are eligible for Social Security Disability Insurance (SSDI) and/or Supplemental Security Income (SSI).

For your general knowledge about this medical condition, we have included in this guide helpful information about what the disease is, symptoms, diagnosis, common treatment, and where you can find more help and information for this medical condition. This guide may also provide information about current legal issues that may be of value to you. This guide is not intended as legal advice or as a legal opinion.

After reading this guide, if you still have questions or would like to discuss your case with us, please call Chad Brown Law at (800) 556-9115. We are here to help you get the benefits you deserve.

1. What is Epilepsy?

Epilepsy is a disorder of the brain and is sometimes referred to as seizure disorder. This condition causes the clusters of nerves in your brain (neurons) to signal abnormally and periodically. Our thoughts, feelings, and actions are controlled by healthy functioning neurons. Patients with epilepsy experience a disturbed pattern of neuron activity, which can cause strange sensations, abnormal emotions and behaviors, and sometimes results in involuntary movements such as muscle spasms, convulsions, and loss of consciousness.

During a seizure, disturbances of nerve cell activity produce symptoms that vary depending on which part (and how much) of the brain is affected. Usually, a seizure lasts from a few seconds to a few minutes.

1a. Understanding Epilepsy

Epilepsy is usually broken down into two types:

  1. Convulsive – Convulsive epilepsy involves seizures that are accompanied with convulsions and/or loss of consciousness, such as grand mal seizures.
  2. Non-convulsive – Epilepsy that has milder symptoms that generally does not involve loss of consciousness. Examples of non-convulsive epilepsy are:
  • Absence seizure (petit mal seizures) – A seizure that causes a short loss of awareness. The patient may exhibit a blank stare while still being able to present subtle movements without control.
  • Tonic seizure – A sudden stiffening of the muscles, especially in the legs, arms, and back, that can cause the person to lose their balance and fall.
  • Clonic seizure – Rhythmic muscle contractions in the arms and legs. This type of seizure may be subtle or appear as more pronounced jerking motions.
  • Myoclonic seizure – Sporadic jerking movements that may feel like a sudden electrical shock. These movements may be more pronounced, causing involuntary jerking of the arms or legs.

Not all people who have seizures have epilepsy. Epilepsy involves seizures that occur more than once and periodically.

  • Non-epileptic seizures can occur as a result of stress or some psychological problem. They look like seizures but there is no abnormal electrical activity in the brain.
  • Provoked seizures can occur due to a temporary medical condition such as a high fever, low blood sugar, alcohol or drug withdrawal, or immediately following a brain concussion; this does not indicate epilepsy.

1b. Causes of Epilepsy and Complications

Known conditions and events that may cause epilepsy are:

  • Oxygen deprivation (e.g., during childbirth)
  • Brain infections (e.g., meningitis, encephalitis, or brain abscess)
  • Traumatic brain injury or head injury
  • Stroke (resulting from a block or rupture of a blood vessel in the brain)
  • Other neurologic diseases (e.g., Alzheimer’s disease)
  • Brain tumors
  • Abnormal blood vessels in the brain
  • Side-effects from medications such as tramadol and some antidepressants
  • Recreational drug use, especially cocaine and amphetamines

The occurrence of a seizure alone can cause several types of complications, but where you are and what you are doing can also cause complications that can further endanger yourself or others.

  • Seizure while driving – Experiencing a seizure that causes loss of consciousness or uncontrolled arm or leg movements can be a dangerous event if you are driving. Many states implement driving restrictions on adults who have a history of seizures, and may require that you remain seizure-free for a specific period before you are allowed to drive again.
  • Seizure while in the water – Studies have shown that people with epilepsy are 15 to 19 times more likely to drown while swimming or bathing than the general population.
  • Seizure while standing – Having a seizure while standing or walking can result in a fall, which often leads to broken bones or head injuries.
  • Emotional complications – Suffering from epilepsy can take its toll on your mental health. The stress of dealing with your condition can lead to depression, anxiety, and an increased risk of suicide. Side effects from some medications used to treat epilepsy can also increase these complications.
  • Pregnancy complications – The occurrence of seizures in pregnant women put them and their unborn child at risk of the previously mentioned complications. Additionally, some anti-epileptic medications may increase the risk of certain birth defects.

2. Common Medical Terms Associated with Epilepsy

Convulsions – When a person’s body shakes rapidly and uncontrollably. During convulsions, the person’s muscles contract and relax repeatedly and rapidly.

Epilepsy – A brain disorder in which a person has repeated seizures (convulsions) over time.

Focal dyscognitive seizures – Seizures that affect consciousness or awareness and may cause you to lose awareness for a period of time. Focal seizures may result in the person staring blankly and performing purposeless, repetitive movements, such as rubbing their hands together, chewing on nothing, repetitive swallowing, or walking in circles.

Partial seizures—Seizures that involve a smaller, localized area of the brain. With some partial seizures, the disturbance can spread within seconds or minutes to involve widespread areas of the brain (secondary generalized seizure).

Primary generalized seizures—Seizures with widespread involvement of both sides of the brain.

Pseudo-seizures (non-epileptic seizures) – Do not involve changes in brain activity. These seizures are usually caused by stress or psychological disorder.

Seizures – Brief episodes of abnormal, excessive brain activity that causes loss of control of thoughts, sensations, or actions.

Simple focal seizures – Seizures that do not result in loss of consciousness. They may change your emotions or change the way things look, smell, feel, taste, or sound. They may also result in involuntary jerking of a body part, such as an arm or leg, and other symptoms such as tingling, dizziness, and flashing lights.

3. Epilepsy Symptoms

While many types of repetitive behavior may come from a neurological problem, a doctor needs to establish whether or not you are having seizures. The type of symptoms you may have depend on the type of seizure you are having.

Generalized seizures: All areas of the brain are involved in a generalized seizure. Sometimes these are referred to as grand mal seizures. The person may:

  • Cry out or make some sound, stiffen for several seconds to a minute and then have rhythmic movements of the arms and legs. Often these movements slow before stopping.
  • Appear to not be breathing and actually turn blue. This may be followed by a period of deep, noisy breaths.
  • Lose bladder control. Urination accidents are common.
  • Have a gradual return to consciousness with confusion for quite some time — minutes to hours. A person’s eyes are usually open.

Partial or focal seizures: Only part of the brain is involved, so only part of the body is affected. Depending on the part of the brain having abnormal activity, symptoms may vary.

  • If the part of the brain controlling movement of the hand is involved, then only the hand may show rhythmic or jerky movements.
  • Sometimes the person with a partial seizure appears dazed or confused.
  • If other areas of the brain are involved, symptoms might include strange sensations such a full feeling in the stomach or small repetitive movements such as picking at one’s clothes or smacking of the lips, or swallowing often.

Absence or petit mal seizures: Usually these seizures are brief, lasting only seconds. Some people may have many of these in a day. These are most common in childhood and include the following symptoms:

  • Loss of or impaired consciousness is present with the person often staring blankly.
  • Repetitive blinking or other small movements

4. How is Epilepsy Diagnosed?

A doctor evaluates a patient to determine what type of seizures are occurring (epileptic or non-epileptic) and their cause. This helps determine the specific course of treatment. The diagnosis of epilepsy is based on:

  • Your medical history – Including any family history of seizures, associated medical problems, and current medications.
  • A complete physical and neurological examination – Your doctor may test your behavior, motor abilities, mental function, and other areas to diagnose your condition and determine the type of epilepsy you may have.
  • Blood tests – Your doctor may take a blood sample to rule out other medical conditions that may be causing your seizures.

Your doctor may also suggest tests to detect brain abnormalities, such as an:

  • Electroencephalogram (EEG) – This is the most common test used to diagnose epilepsy. Doctors attach electrodes to your scalp that record the electrical activity of your brain. If you have epilepsy, it is common to have changes in your normal pattern of brain waves, even when you are not having a seizure. The EEG is useful not only to confirm a diagnosis of epilepsy, but also to determine the type of epilepsy.
  • Imaging test – A CT, PET, or MRI scan may be performed to rule out any other causes of your seizures, such as a brain tumor, cysts, or blood vessel malformation.
  • Neuropsychological test – Doctors assess your thinking, memory, and speech skills. The test results help doctors determine which areas of your brain are affected.

5. What is the Common Treatment for Epilepsy?

The majority of epileptic seizures (70 percent) are controlled by medication, particularly drugs that attempt to stop convulsions. The frequency and severity of the seizures and the person’s age, overall health, and medical history all help to determine the best treatment options. An accurate diagnosis of the type of epilepsy is therefore critical to choosing the best treatment.

Medication to treat epilepsy – Most people become seizure-free with just one anti-seizure medication. Others may affect the frequency and severity of the seizures. Your doctor is likely to first prescribe a single medication at a relatively low dosage, and then increase the dosage gradually until your seizures are well controlled. The choice of drug is most often based on factors like your tolerance to side effects caused by the medications, other illnesses you might have, and the medication’s delivery method. With some types of epilepsy, patients can be taken off treatment after a few years, while other types of epilepsy require lifelong treatment.

Surgery to treat epilepsy – Medication can control seizures in most people with epilepsy, but for about 30 percent of patients, they are not effective or the side effects are not tolerated. In some cases, brain surgery may be an option. Although many people continue to need some medication to help prevent seizures after a successful surgery, you may be able to take fewer drugs or reduce your dosages.

Epilepsy surgery is an operation on the brain to control seizures and improve the person’s quality of life. There are three main types of epilepsy surgery:

  • Surgery to remove the area of the brain that is producing the seizures. This is only considered if the area of the brain where the seizures start can be clearly identified, and if the area to be removed is not responsible for any critical functions, such as speech, hearing, or movement.
  • Surgery to interrupt the nerve pathways through which seizure impulses spread within the brain. If your seizures originate in a part of your brain that does affect critical functions, your doctor may recommend a different type of surgery in which surgeons make several cuts in your brain. These cuts are designed to prevent seizures from spreading to other parts of your brain.
  • Surgery to implant a device used to treat epilepsy, such as a vagus nerve stimulator.

5a. Common Side Effects of Epilepsy Medication

Your healthcare provider will discuss with you the potential benefits, side effects, and risks before any epilepsy drug is prescribed for you.

Anti-seizure medications may have some side effects. Mild side effects include:

  • Dizziness
  • Fatigue
  • Loss of bone density
  • Loss of coordination
  • Memory and thinking problems
  • Skin rashes
  • Speech problems
  • Weight gain

More severe (but rare) side effects include:

  • Depression
  • Inflammation of certain organs, such as your liver
  • Severe rash
  • Suicidal thoughts and behaviors

6a. Social Security’s Rules for Epilepsy

Social Security maintains a list of medical conditions that are so severe they automatically merit a disability qualification. These conditions are expected to be permanent, expected to result in death, or have a certain length of time that it must last. Each medical condition on this list has a complete description of what symptoms or conditions have to be present with your medical condition for you to “meet the listing”. The complete medical listing for epilepsy, 11.02 (convulsive) and 11.03 (non-convulsive), is below.

Social Security’s rules for epilepsy:

“11.02 Epilepsy – convulsive epilepsy, (grand mal or psychomotor), documented by detailed description of a typical seizure pattern, including all associated phenomena; occurring more frequently than once a month, in spite of at least 3 months of prescribed treatment. With:

A. Daytime episodes (loss of consciousness and convulsive seizures) or

B. Nocturnal episodes manifesting residuals which interfere significantly with activity during the day.

11.03 Epilepsy – nonconvulsive epilepsy (petit mal, psychomotor, or focal), documented by detailed description of a typical seizure pattern including all associated phenomena, occurring more frequently than once weekly in spite of at least 3 months of prescribed treatment. With alteration of awareness or loss of consciousness and transient postictal manifestations of unconventional behavior or significant interference with activity during the day.”

(If you do not “meet” this listing, you may still be considered disabled if you are not able to do your past relevant work, or you are not able to do any other work that you may have the education or experience to do.)

6b. Chad Brown’s Explanation of Social Security’s Rules

The rules for a Social Security disability classification can be complicated, so we have written our explanations of the rules below.

(11.02 above) For you to qualify for Social Security disability benefits, you must have grand mal or psychomotor seizures (both are convulsive seizures), with medical records showing a typical seizure disorder occurring more frequently than once a month in spite of at least three months of medical treatment. These seizures must have:

  • Daytime occurrences where you lose consciousness or have convulsions or
  • Nighttime occurrences that leave you with symptoms that greatly affect your daytime activities.

(11.03 above) For you to qualify for Social Security disability benefits, you must have petit mal, psychomotor, or focal seizures that are documented and show a typical seizure disorder that occurs more than once weekly in spite of three months or more of medical treatment. The seizures must cause you to lose consciousness or lose awareness for a period of time, and you must have short-lived episodes where you have trouble responding or display unusual behavioral that greatly interferes with activities during the day.

7. Internet Resources for Epilepsy

For other general information about Social Security and Supplemental Security Income disability programs and how the law firm of Chad Brown Law can help you, visit:

http://chadbrownlaw.com/

For a complete listing of conditions that Social Security considers disabling, go to Social Security’s website at:

http://www.socialsecurity.gov/disability/professionals/bluebook/AdultListings.htm

For medical information on epilepsy, go to the Epilepsy Foundation’s website at:

http://www.epilepsy.com/

Or, WEBMD’s website on epilepsy at:

http://www.webmd.com/epilepsy/guide/epilepsy-overview-facts

8. Community Resources for Epilepsy

To find local help and information for North Carolina residents who have epilepsy, visit the NC Epilepsy Foundation at this website:

http://www.epilepsy.com/affiliates?field_affiliate_address_administrative_area=NC&field_affiliate_zips_value=

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Wilkesboro, NC 28697

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