Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labor's Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Epilepsy


Related Terms

  • Epileptic Convulsions
  • Epileptic Fits
  • Idiopathic Seizure Disorder
  • Recurrent Seizures
  • Seizure Disorder

Differential Diagnosis

Specialists

  • Neurologist
  • Neurosurgeon

Comorbid Conditions

  • Brain injury
  • Complications from kidney disease
  • Congenital brain abnormalities
  • Liver disease

Factors Influencing Duration

The frequency of seizures, response to treatment, and side effects of medications may influence disability. The work environment and duties of the individual may also affect duration. Tasks such as driving that expose the individual or others to injury in the event of a seizure would not be acceptable for an individual whose seizures are not under control.

Medical Codes

ICD-9-CM:
345.10 - Generalized Convulsive Epilepsy without Mention of Intractable Epilepsy
345.11 - Generalized Convulsive Epilepsy with Intractable Epilepsy
345.2 - Petit Mal Status, Epileptic Absence Status
345.40 - Localization-Related (Focal) (Partial) Epilepsy and Epileptic Seizures, Complex Partial Seizures, without Mention of Intractable Epilepsy
345.41 - Localization-Related (Focal) (Partial) Epilepsy and Epileptic Seizures, Complex Partial Seizures, with Intractable Epilepsy
345.70 - Epilepsia Partialis Continua without Mention of Intractable Epilepsy
345.71 - Epilepsia Partialis Continua with Intractable Epilepsy
345.90 - Epilepsy, Unspecified, without Mention of Intractable Epilepsy
345.91 - Epilepsy, Unspecified, with Intractable Epilepsy

Overview

Epilepsy is a group of chronic brain disorders (neurological disorders) characterized by a propensity for recurrent seizures. A seizure is a symptom of sudden and transient interruption of the brain function secondary to a chaotic disruption of the normal electrochemical process that transmits information from one nerve cell to another (electrical activity). The disruption occurs within the gray matter of the brain cortex and typically produces a brief period of impaired consciousness, unconsciousness, or focal neurological symptoms such as abnormal sensations, focal involuntary movements such as rapid blinking of the eyes, or widespread, intense, paroxysmal, and involuntary alternating contraction and relaxation of voluntary muscles (convulsions). The electrical activity of the brain is assessed by an electroencephalogram (EEG).

Epileptic seizures are generally classified into focal (partial) and generalized seizures. Focal seizures affect only a portion of the brain and may not result in loss of consciousness. Although focal seizures begin in a limited area of the brain, the electrical disturbance can spread and affect the whole brain, possibly evolving into a generalized seizure (secondary generalization). Generalized seizures involve all or most of the brain, affecting the whole body and causing loss of consciousness.

Seizures with no apparent cause account for about 60% of the cases in adults (Shafer). These seizures may actually result from microscopic brain lesions that occurred during birth or other trauma or from unexplained metabolic disturbances. A single seizure or episode of seizures does not necessarily mean that the individual has epilepsy.

Incidence and Prevalence: Approximately 2.5 million individuals in the US have been treated for epilepsy in the past five years. An estimated 1 in 26 individuals in the US will develop the condition during their lifetime (Shafer). There are approximately 65 million cases of epilepsy around the world and about 5% of the world's population will experience a seizure at some time during their lives (Shafer).

Source: Medical Disability Advisor



Causation and Known Risk Factors

The number of men who develop epilepsy is slightly higher than the number of women. Children, the elderly, blacks, and those who are economically disadvantaged are more likely to develop epilepsy. The condition can appear at any time in an individual's life, but especially during childhood and old age.

Epileptic seizures can result from various diseases or injuries. Seizures may be associated with birth trauma, head injury, central nervous system infections, brain tumor, stroke, ingestion of toxic substances, or metabolic imbalance. There may be an inherited tendency toward seizures.

Source: Medical Disability Advisor



Diagnosis

History: The type of symptoms and physical signs described by the individual or an observer depend on which part of the brain is affected and may include confusion, a staring spell, jerking contractions of the muscles of the arms and legs, loss of consciousness, or psychic symptoms. An individual with epilepsy have almost the same type of seizure in each episode. The history is very important in the diagnosis of epilepsy. A detailed description of the seizure from the individuals themselves or an observer is noted. Since individuals often do not remember the event, information obtained from someone who has witnessed the seizure is a valuable part of the history. If the individual is conscious throughout the seizure, he or she may be able to recall symptoms or other details. Many individuals with epilepsy have no symptoms between seizures (the inter-ictal phase). Others may have an aura characterized by restlessness, irritability, or an uncomfortable feeling that precedes a seizure (pre-ictal state).

The documented seizures must be recurrent and chronic in order to confirm a diagnosis of epilepsy. An isolated seizure episode of any type is not necessarily an epileptic seizure. In fact, if there is no history of seizures, a single seizure or repeated seizures in a short period may be a sign of a serious underlying disease, chemical imbalance, drug or alcohol use, stroke, or a tumor. Epilepsy diagnosis requires two or more unprovoked (no identifiable cause) seizures separated by at least 24 hours.

The International League Against Epilepsy (ILAE) classifies epileptic seizures as focal (partial)- onset or generalized-onset seizures, based on how the abnormal brain activity begins. Focal-onset seizures involve a focal portion of one side of the brain (cerebral hemisphere), and generalized-onset seizures occur simultaneously in both sides of the brain. Unclassified seizures do not fit precisely into either class.

Focal seizures are produced by abnormal activity in only one area of the brain. There are two types of focal seizures: simple focal seizures, and complex (dyscognitive) focal seizures. Simple focal seizures do not result in loss of consciousness. Individuals may have altered emotions or perceive a change in the appearance, smell, feel, taste or sound of things (visual, olfactory, and auditory hallucinations), involuntary jerking of an arm or leg, and sensory symptoms such as dizziness (vertigo), tingling or numbness in a part of the body (paresthesias), and flashing lights. Individuals with complex focal seizures have altered consciousness or awareness, and may have transient loss of awareness, staring, and purposeless movements such as hand rubbing, chewing, swallowing, or walking in circles.

Generalized seizures appear to involve all areas of the brain. There are 6 types of generalized seizures: absence or cognitive seizures (petit mal seizures), tonic seizures, clonic seizures, myoclonic seizures, atonic seizures (drop seizures), and tonic-clonic seizures (grand mal seizures). An Individual with absence or cognitive seizures does not respond in a normal manner to his or her surroundings (e.g., staring and subtle body movement) for a brief period; there is a brief loss of consciousness. Tonic seizures cause stiffening of muscles, usually in the back, arms and legs, and may cause a fall to the ground. Clonic seizures usually affect the neck, face, and arms, and are associated with rhythmic, jerking muscle movements. Individuals with myoclonic seizures have sudden brief jerks or twitches of the arms and legs. In atonic seizures, there is loss of muscle control, which may cause a sudden collapse or fall. Tonic-clonic seizures, the most recognized type of seizure, are characterized by loss of consciousness, abnormal and sometimes violent movements of the body (e.g., body stiffening and shaking), and sometimes loss of bladder control or tongue biting. These seizures can start as a focal (partial) seizure and show secondary generalization.

Physical exam: The exam may be entirely normal. If the individual is examined immediately after the seizure, a complete neurological exam may be postponed if the individual lost consciousness or is not alert. The period after the seizure is called the post-ictal phase. Some types of seizures leave the individual fatigued or confused and unable to follow directions. It is important to focus on findings that may indicate a brain lesion.

Tests: The approach to testing depends on whether the seizure was the individual's first seizure. If it was the first episode, extensive testing is necessary. Comprehensive blood tests look for a metabolic or chemical cause for the seizures. Routine tests include EEG, skull x-rays, magnetic resonance imaging (MRI), computed tomography (CT), and possibly a cerebral angiogram. The EEG is the most useful test in classifying seizures and can direct the best approach to therapy. Positron emission tomography (PET) imaging can be used to identify areas of the brain that are producing seizures. Occasionally a 24- to 72-hour sleep study or epilepsy laboratory observation may be necessary to help classify the type of seizure, or to rule out pseudo-seizures (the manifestation of malingering, factitious disorder, or hysteria).

If the individual was previously seen for seizures and the diagnosis of a recurrent seizure disorder or epilepsy was established, then the testing is more limited. If the individual is on medication for seizures, measurement of blood drug levels can determine whether the individual has been taking the medications as indicated or if the dosage should be changed.

Source: Medical Disability Advisor



Treatment

Treatment of the underlying cause, if identified, may stop the occurrence of seizures. Such treatments may include medication, surgery, a special diet, or implanted device, depending on the underlying cause.

Oral anticonvulsant medications help prevent or minimize the number and severity of future seizures. Response to treatment with oral anticonvulsants varies among individuals. The medication or combination of medications and their dosages may be changed frequently until the optimal treatment regimen is found. These medications may have unpleasant side effects, including drowsiness and impaired concentration that may lead to noncompliance. Follow-up visits should be scheduled anytime from monthly to annually, depending on response to treatment. Monitoring of plasma drug levels is important for seizure control.

In approximately 33% of individuals with epilepsy, seizures cannot be controlled with medication (Shafer). These individuals may be evaluated for epilepsy surgery. Tests must show that the seizures originate from a focal, resectable, brain region. The most common form of surgery involves the removal of the area of the temporal lobe where the seizures originate (partial temporal lobectomy). Resections of the frontal lobes can also be performed (extra-temporal resections).

Another treatment used when medications fail is vagus nerve stimulation (VNS). In this procedure, a generator is surgically implanted in the left chest wall. An electrode lead that is attached to the left vagus nerve is tunneled under the skin and connected to the generator. After implantation, the generator is programmed to deliver intermittent bursts of electricity to the vagus nerve.

Source: Medical Disability Advisor



Prognosis

Epilepsy (idiopathic seizure disorder) is a chronic, usually lifelong condition. Anticonvulsant therapies prevent or minimize the number of seizures. Surgical removal of brain lesions may stop or lessen seizure activity. For some individuals, the need for medication may be reduced or eliminated over time (the milestone for this change in treatment is a seizure-free period of 2 years).

Death or permanent brain damage from epilepsy is rare but can occur with prolonged seizures (status epilepticus).

Source: Medical Disability Advisor



Complications

Complications of epilepsy include prolonged seizures (status epilepticus), injury from falls, tongue biting (during a seizure), injuries sustained while driving or operating machinery during a seizure, pneumonia secondary to foreign matter such as food particles in the lungs (aspiration pneumonia), stroke, brain damage, and learning disabilities.

Age-related physiologic changes may affect the pharmacokinetics of anticonvulsant therapies; therefore, careful, routine monitoring of anticonvulsant levels in older individuals is imperative.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

An individual with epilepsy may be unable to perform jobs that require operating machinery, driving motor vehicles, or working from heights. Special precautions should be taken for those individuals at risk of recurrent seizures. These rules may be gradually relaxed if an individual remains seizure-free for a period of at least 1 year.

Individuals with epilepsy should wear a medical identification bracelet or carry an informational card to aid in obtaining proper medical treatment if a seizure occurs.

Risk: Typical work restrictions for individuals with epilepsy involve removal from safety-sensitive work tasks and conditions in which significant injury to the self or others could occur during a seizure. Drowsiness from medications may be an additional issue of risk. Generally no work at unprotected heights.

Capacity: Between seizures, capacity in individuals with seizure disorders is not affected. As long as risk is adequately addressed, individuals with epilepsy may work without limitations.

Tolerance: Some individuals with epilepsy may dislike working, fearing that a potentially embarrassing seizure may occur in the workplace. In this case, tolerance becomes an issue of choice (to work or not to work) and is not a reason for reduced capacity or disability.

Source: Medical Disability Advisor



Maximum Medical Improvement

180 days.

Source: Medical Disability Advisor



Failure to Recover

If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case.

Regarding diagnosis:

  • What type of seizure does individual have—focal (partial) seizures (simple focal seizures, or complex [dyscognitive] focal seizures) or generalized seizures (absence or cognitive seizures [petit mal seizures], tonic seizures, clonic seizures, myoclonic seizures, atonic seizures [drop seizures], or tonic-clonic seizures [grand mal seizures])?
  • Does individual have idiopathic seizures?
  • Does individual have an aura?
  • Has individual had birth trauma, head injury, central nervous system infections, brain tumor, stroke, ingestion of toxic substances, or metabolic imbalance?
  • Does individual have a family history of seizures?
  • Has individual had a witnessed seizure?
  • Are individual's documented seizures recurrent and chronic?
  • Has individual had a single seizure or repeated seizures in a short period?
  • Is the seizure related to a known serious underlying condition?
  • Has individual had comprehensive blood tests, EEG, skull x-rays, MRI, CT, and possibly a cerebral angiogram?
  • Has individual had sleep study or epilepsy laboratory observation?
  • If individual has a diagnosis of epilepsy, were drug levels done?
  • Have conditions with similar symptoms been ruled out?

Regarding treatment:

  • Has an underlying cause been identified?
  • Is individual on oral anticonvulsant drugs?
  • Does individual see physician regularly for monitoring plasma drug levels?
  • Is individual a candidate for surgery?
  • Has vagus nerve stimulation been considered?

Regarding prognosis:

  • Is individual's employer able to accommodate any necessary restrictions?
  • Does individual have any conditions that may affect the ability to recover?
  • Does individual have any complications, such as status epilepticus, injury from falls, tongue biting (during a seizure), injuries sustained while driving or operating machinery during a seizure, aspiration pneumonia, stroke, brain damage, and learning disabilities?

Source: Medical Disability Advisor



References

Cited

Shafer, Patricia O. "About Epilepsy: The Basics." Epilepsy Foundation. Mar. 2014. 22 Apr. 2015 <http://www.epilepsy.com/learn/about-epilepsy-basics>.

Source: Medical Disability Advisor






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