A. Definition
Epilepsy is a group of related disorders of the central nervous system in which the nerve cell activity in your brain is disturbed, leading to a seizure causing abnormal behavior, sensations, and often, the loss of consciousness. It is characterized by a tendency for recurrent seizures. Epilepsy is defined by any of the following conditions: At least two unprovoked (or reflex) seizures occurring greater than 24 hours apart; one unprovoked seizure with the probability of further seizures similar to the general recurrence risk (at least 60%) after two unprovoked seizures — occurring over the next 10 years; or, the diagnosis of an epilepsy syndrome.
B. General information
An epilepsy diagnosis is generally made based on the description of the seizure and the underlying cause. Seizures may present in several ways, depending on the part of the brain involved, as well as your age. An electroencephalogram and neuroimaging usually are part of the workup. Video and EEG monitoring also may be useful in more difficult cases.
There are different types of epilepsy and seizures. Sixty percent of seizures are “convulsive.” Of these, two-thirds begin as focal seizures (which may then become generalized) while one-third begins as generalized seizures. The remaining 40% of seizures are non-convulsive. An example of this type is the ‘absence seizure,’ which presents as a decreased level of consciousness and usually lasts about 10 seconds. Focal seizures are often preceded by sensory or motor experiences, known as an aura. Jerking activity may start in a specific muscle group and spread to surrounding muscle groups.
There are six main types of generalized seizures: tonic-clonic, tonic, clonic, myoclonic, absence, and atonic seizures. They all involve loss of consciousness and typically happen without warning. About 6% of those with epilepsy have seizures that are often triggered by specific events and are known as reflex seizures. Those with reflex epilepsy have seizures that are only triggered by specific stimuli. Common triggers include flashing lights and sudden noises. In certain types of epilepsy, seizures happen more often, or only, during sleep.
About 1 in 100 people in the United States may have an unprovoked seizure once in life. However, a solitary seizure does not mean you have epilepsy. At least two unprovoked seizures are generally required for an epilepsy diagnosis.
Epilepsy can have adverse effects on social and psychological well-being. These effects may include social isolation, stigmatization, or disability. They may result in lower educational achievement and worse employment outcomes. Learning difficulties are common in those with the condition, and especially among children with epilepsy. More likely than not, recurrent seizures will negatively impact your ability to engage in substantial gainful activity for 12 months or longer.
C. Social Security Medical Listing 11.02 – Convulsive Epilepsy and 11.03 – Nonconvulsive Epilepsy
With epilepsy, Social Security will evaluate the degree of impairment, regardless of etiology, according to type, frequency, duration, and sequelae of seizures. At least one detailed description of a typical seizure is required. This description must include the presence or absence of aura, tongue bites, sphincter control, injuries associated with the attack, and postictal phenomena. Your reporting physician should indicate the extent to which description of seizures reflects his or her own observations and the source of ancillary information. Witness testimony is essential for description of type and frequency of seizures if professional observation is not available. Under Social Security Medical Listings 11.02 and 11.03, the criteria can be applied only if the impairment persists despite compliance to prescribed treatment.
Under Social Security Medical Listing 11.02, convulsive epilepsy (grand mal or psychomotor) must be documented by a detailed description of a typical seizure pattern with all associated phenomena. Seizures must be occurring more frequently than once a month, despite of at least 3 months of prescribed treatment.
Under Social Security Medical Listing 11.03, non-convulsive epilepsy (petit mal, psychomotor, or focal) documented by detailed description of a typical seizure pattern including all associated phenomena. Seizure must be occurring more frequently than once per week, despite at least 3 months of prescribed treatment.
Side effects of medication also will be considered in the overall assessment.
Your representative can help you determine whether your epilepsy is severe enough to qualify you for disability benefits under the Social Security Administration.
