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Mohamad Z. Koubeissi and Nabil J. Azar (eds.)Epilepsy Board Review10.1007/978-1-4939-6774-2_2727. Quality of Life in Epilepsy
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Department of Neurology, Vanderbilt University Medical Center, Nashville, TN 37212, USA
Keywords
EpilepsyRestrictionsSafetyTriggersDisabilityLiving with epilepsyMedicationsTreatmentAffordabilityAccommodationsSeizuresRestrictions: Patients at risk for seizures should be warned that all environments or situations that could cause harm to the patient or others, should a seizure occur, must be avoided. Specifically:
No working at “unprotected” heights, including roofs and ladders.
No working around heavy machinery with moving parts.
No construction equipment use.
No use of manufacturing equipment, including, among others, fork lifts, heavy presses, and conveyor belt systems.
Avoid known environmental triggers: heat, cold, humidity, dust, and fumes.
Shower or bathe in minimal amounts of water in order to avoid drowning in case of loss of consciousness.
Swim only when supervised by someone who is aware of seizure history and is capable of helping should a seizure occur.
No cooking or working around open flames.
NO DRIVING!
These restrictions stay in effect until released at the discretion of the provider or the stipulations of the state.
Driving: Without a doubt, the loss of driving privileges has the greatest overall impact on those with epilepsy. Each state has regulations and some leave the decision to the discretion of the provider. Driving restriction typically ranges between three and 12 months. Tennessee, for example, requires six months of seizure freedom, whereas Kentucky requires three months. The loss of driving means relying on others for transportation whether this is to school, work, shopping, or to go on a date! The loss of a license may mean the loss of employment for those that drive a truck or captain a boat for a living.
Commercial Truck Drivers: The restrictions are placed by the Federal Motor Carrier Safety Administration:
Current recommendations are that restrictions should be determined on an individualized basis. The nature of the seizure and risk of recurrence should be considered when determining fitness for specific job requirements.
Persons with diagnosed epilepsy who are seizure-free and off medication for 10 years may be considered for licensure to operate a commercial vehicle.
Onetime event thought to be nonepileptic and requiring no antiseizure medication will possibly allow for return to driving after six months of seizure freedom.
Single unprovoked seizure with no recurrence may be considered for reinstatement following a five-year period off medication. A waiver to this determination may be made if the individual has a normal EEG and has been evaluated by a neurologist that specializes in epilepsy.
Acute symptomatic seizures in the presence of acute structural insults to the central nervous system with low risk for recurrence; there should be no restriction after they have been seizure-free for two or more years off antiepileptic drugs.
Persons that have undergone any procedure that penetrates the dura should not be considered eligible for commercial licensure [1].
Merchant Mariners Including Riverboat Captains: According to the US Department of Homeland Security and the United States Coast Guard under COMDTMOTE 16700.4, NVIC 04-08, Enclosure (8) Mariners, including commercial ship captains and riverboat captains, are controlled by the Coast Guard.
Those mariners that have seizure(s) determined to be low risk of recurrence may be considered for a waiver to return to duty when they have been seizure-free and off medication for a minimum of one year.
Those with seizures considered as high risk of seizure recurrence must be seizure-free for a minimum of eight years [on or off medication]. If they continue on medication their dose regimen must be stable for two years. If they are off medication, they must be seizure-free for eight years from the time they stopped the medication [2].
Aircraft Pilots: Neurological disorders: epilepsy, seizures, stroke, paralysis, etc. The applicant should provide history and treatment, pertinent medical records, current status report, and medication. The Examiner should obtain details about such a history and report the results. An established diagnosis of epilepsy, a transient loss of control of nervous system function(s), or a disturbance of consciousness is a basis for denial no matter how remote the history. Like all other conditions of aeromedical concern, the history surrounding the event is crucial. Certification is possible if a satisfactory explanation can be established.
Guide for Aviation Medical Examiners:
A disturbance of consciousness without satisfactory medical explanation of the cause must submit all pertinent medical records, current neurological report, to include name and dosage of medication(s) and side effects.
This requires Federal Aviation Administration (FAA) decision.
Rolandic seizure must submit all pertinent medical records, current status report, to include name and dosage of medication(s) and side effect. Rolandic seizures may be eligible for certification if the applicant is seizure-free for 4 years and has a normal EEG.
This requires FAA decision.
Febrile seizure (single episode) must submit all pertinent medical records and a current status report if occurred prior to age 5, without recurrence and off medications for 3 years of issue.
Otherwise, this requires FAA decision.
Transient loss of nervous system function(s) without satisfactory medical explanation of the cause, e.g., transient global amnesia must submit all pertinent medical records, current status report, to include name and dosage of medication(s) and side effects.Related posts:
New-Generation Antiepileptic Drugs
Other Pharmacological Therapies: Investigational Antiepileptic Drugs, Animal Models of Epilepsy, Hormonal Therapy, Immunotherapy
Procedures and Outcomes in Epilepsy Surgery
Magnetoencephalography and Magnetic Source Modeling
Epilepsy Secondary to Specific Mechanisms
Epilepsy Surgery Assessment and Testing
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