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.

Jacksonian Seizure


Related Terms

  • Focal Seizure
  • March Seizure
  • Partial Motor Seizure
  • Sensory-induced Epilepsy
  • Somatosensory Epilepsy

Specialists

  • Neurologist

Comorbid Conditions

Factors Influencing Duration

Disability may be influenced by the frequency of seizures, the response to treatment, and the side effects of medications, which may include dizziness, headache, nausea, altered gait (ataxia), speech disorders, impaired concentration, rash, nervousness, drowsiness (somnolence), tremor, and double vision.

Disability may also depend on the individual's work environment and duties.

Medical Codes

ICD-9-CM:
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
345.50 - Localization-Related (Focal) (Partial) Epilepsy and Epileptic Syndromes with Simple Partial Seizures, without Mention of Intractable Epilepsy
345.51 - Localization-related (focal) (partial) epilepsy and epileptic syndromes with simple partial seizures, with intractable epilepsy

Overview

A Jacksonian seizure was first described by the English neurologist Dr. John Hughlings Jackson in 1863 and is a type of simple partial seizure characterized by abnormal movements that begin in one group of muscles and progress to adjacent groups of muscles (motor seizure). These movements reflect the march of seizure activity arising from the prerolandic gyrus area of the brain through the brain's motor cortex.

The first seizures are usually seen in childhood or adolescence, although they may occur at any age. They can be a single episode or develop into a repeated, chronic condition (epilepsy).

The causes of seizures may include a lesion of the frontal lobe of the brain, lack of oxygen resulting in tissue damage, or tissue damage resulting from brain tumors or strokes.

Incidence and Prevalence: Simple partial seizures, such as Jacksonian seizures, affect approximately 20 out of 100,000 individuals up to age 65 (Boggs).

Source: Medical Disability Advisor



Causation and Known Risk Factors

The incidence of simple partial seizures rises slowly with age. Individuals over age 65 are much more likely to have them. Males and females are equally likely to have such seizures (Boggs).

Source: Medical Disability Advisor



Diagnosis

History: Jacksonian seizures are extremely varied. They may present with localized muscle twitching or contractions of the fingers of one hand, the face on one side, or one foot; and sometimes a series of these movements build up to a contraction. In some cases, the one-sided seizure is followed by a turning of the head and eyes to the side. In the classic Jacksonian form, the seizure spreads from the hand up the arm to the face and down the leg ("Jacksonian March"). If the first movement is in the foot, the seizure marches up the leg, down the arm, and to the face. Usually the seizure is fleeting and lasts 20 to 30 seconds. There is no loss of awareness, alertness, or consciousness if the motor symptoms remain confined to one side of the brain. Partial motor attacks usually involve the limbs, face, or head and can cause speech problems. Seizures are often followed by a period of weakness or paralysis.

Physical exam: The physical and neurologic exam may be normal. The neurological exam includes tests of motor, reflex, and sensory function. Testing the cranial nerves may point to specifically affected areas of the brain. Abnormalities in movement (motor function) and reflexes may be detected on examination.

Tests: Electroencephalogram (EEG) is the most useful test in diagnosing Jacksonian motor seizures because these seizures have characteristic findings not only during the seizure but also between seizure episodes (the interictal phase). The EEG will show an abnormal brain wave pattern that signifies seizure (epileptiform) activity. In partial (focal) seizures, the discharging neural focus is in some area of the cerebral cortex. Simple partial seizures most often arise from the sensori-motor cortex. Jacksonian seizures, however, arise from the prerolandic gyrus area of the brain. Routine imaging tests such as MRI, computer-aided x-rays (computed tomography or CT scan), and possibly x-ray visualization of the vessels of the brain after injecting contrast dye (cerebral angiogram), can be used to detect brain lesions that may be responsible for the seizures.

Source: Medical Disability Advisor



Treatment

If brain imaging studies detect an operable lesion such as a tumor or arteriovenous malformation (AVM), surgery to remove the tumor or malformation is indicated and will often eliminate or control seizures. Anti-epileptic drugs (AEDs) effective in treating seizures that arise from one area of the brain (focal or partial seizures) are used to treat Jacksonian motor seizures. They may also be used when convulsions occur. The AEDs can be used alone or in combination. The goal of anti-epileptic treatment is to reduce the frequency and severity of seizures while minimizing side effects. It is also suggested that firmly squeezing the muscles around those that are twitching can sometimes stop the attack from progressing. Because stress may increase seizure activity in some people, relaxation techniques, biofeedback, and yoga may be helpful when used along with medications. Depending on the cause of the seizures, if no seizures occur over 1 to 2 years, medication may be reduced and eventually stopped.

Source: Medical Disability Advisor



Prognosis

The outcome is difficult to predict, but seizure control is possible with appropriate AED selection. There is no cure for epilepsy, but some individuals with simple partial seizures may become seizure-free after a year of treatment with AEDs. The outcome also depends on whether the seizures evolve into generalized seizures, which are more difficult to treat and control. If the seizures are due to an operable brain lesion, surgical removal may eliminate the seizures or make them easier to control. If seizures are left uncontrolled, the seizures may worsen and develop into complex partial seizures resulting in loss of consciousness or become generalized and spread to other areas of the brain.

Source: Medical Disability Advisor



Complications

Jacksonian motor seizures may worsen and evolve into generalized seizures that are more difficult to treat and control.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

An individual with epilepsy may be unfit for jobs that require operating machinery, driving motor vehicles, working from heights, or swimming. The Jacksonian seizure involves the involuntary contraction and relaxation of muscles (clonic movements), which may lead to falls and necessitate work accommodations to prevent injury. Special precautions should be taken for those individuals who are at risk for recurring seizures. Tasks that expose an individual or others to the risk of seizures while driving are not acceptable for an individual whose seizures are not well-controlled. These rules may be gradually relaxed if an individual remains seizure-free for 1 year.

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:

  • Does individual have a history of a head injury, a lesion of the frontal lobe of the brain, lack of oxygen resulting in tissue damage, or tissue damage due to brain tumors or stroke?
  • Does individual report localized muscle twitching or contractions of the fingers of one hand, the face on one side, or one foot; or sometimes a series of these movements building up to a contraction?
  • Does individual have the classic Jacksonian form, with the seizure spreading from the hand up the arm to the face and down the leg?
  • How long does the seizure last?
  • Does individual remain alert, aware and conscious during the seizure?
  • Does individual have a period of weakness or paralysis after the seizure?
  • Does individual experience speech problems?
  • Has individual had a complete physical and neurological examination?
  • Were abnormalities in motor function or reflexes detected?
  • Has individual had an EEG, CT scan, MRI, or cerebral angiogram?

Regarding treatment:

  • Does individual have an underlying cause of the seizures such as a tumor or AVM?
  • Has it been corrected surgically?
  • Is individual being treated with anti-epileptic drugs?

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 the seizures worsening and evolving into generalized seizures or side effects from the anti-epileptic drugs such as dizziness, headache, nausea, ataxia, speech disorders, impaired concentration, rash, nervousness, drowsiness, tremor or double vision?

Source: Medical Disability Advisor



References

Cited

Boudi, F Brian . "Simple Partial Seizures." eMedicine. Eds. Joseph F. Hulihan, et al. 19 Feb. 2002. Medscape. 11 Oct. 2004 <http://emedicine.com/neuro/topic342.htm>.

Source: Medical Disability Advisor






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