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.

Absence Seizures


Related Terms

  • Absence Spells
  • Generalized Nonconvulsive Epilepsy
  • Minor Epilepsy
  • Petit Mal Epilepsy
  • Petit Mal Seizures

Differential Diagnosis

Specialists

  • Internal Medicine Physician
  • Neurologist
  • Neurosurgeon
  • Pediatric Neurologist

Comorbid Conditions

  • Hepatic disease
  • Neurologic conditions
  • Renal disease

Factors Influencing Duration

The type, duration, and frequency of seizures, individual response to medications, and presence of complications may influence disability.

Medical Codes

ICD-9-CM:
345.00 - Generalized Nonconvulsive Epilepsy without Mention of Intractable Epilepsy
345.01 - Generalized Nonconvulsive Epilepsy with Intractable Epilepsy; pharmacoresistant (pharmacologically resistant); poorly controlled; refractory (medically); treatment resistant
345.11 - Generalized Convulsive Epilepsy with Intractable Epilepsy
345.2 - Petit Mal Status, Epileptic Absence Status

Overview

Typical absence seizures, a type of generalized seizures, are extremely short, lasting only a few seconds. Absence seizures appear as staring episodes or "absence spells." During one of these seizures, speech and activity cease. An individual experiencing an absence seizure may stop talking in mid-sentence, then complete the sentence one to several seconds later. There is no loss of postural control. The seizures may range from infrequent to quite frequent (many times per hour).

Atypical absence seizures start more slowly, are longer in duration, and may be associated with more noticeable muscle activity than typical absence seizures. Individuals usually have no memory of the seizure.

Incidence and Prevalence: Absence seizures have an incidence rate of 1.9 to 8 per 100,000 (Segan).

Source: Medical Disability Advisor



Causation and Known Risk Factors

Most studies conclude that females are more likely to have this disorder. Absence seizures are more common in children, and up to 66% of affected children are girls. Absence epilepsy with brief contraction of a muscle or muscle group (myoclonus) predominates in males.

A cause for typical absence seizures is usually not identified. Typical absence seizures are not associated with other neurologic disorders, while atypical absence seizures may or may not be associated with other neurologic disorders.

Source: Medical Disability Advisor



Diagnosis

History: Individuals report symptoms of typical absence seizures that include muscle activity changes (cessation of movement, minor facial twitches, fluttering of the eyelids, lip smacking, chewing motions, finger rubbing, and movements of the hands) and consciousness changes (staring, lack of awareness of surroundings, sudden halt in speech or movement). Symptoms of atypical absence seizures include longer lapse of consciousness, more obvious muscle activity changes, and less complete consciousness changes (less abrupt in onset and termination).

Physical exam: A complete physical and neurological examination usually reveals no abnormal findings, although individuals with atypical seizures may have some neurologic abnormalities.

Tests: A recording of the brain's abnormal electrical activity during seizures by electroencephalogram (EEG) may show changes typical of absence seizures. Atypical absence seizures have a different EEG pattern. Laboratory tests and imagining studies (x-rays, computed tomography [CT], or magnetic resonance imaging [MRI]) may be used to rule out other causes of seizure.

Source: Medical Disability Advisor



Treatment

Treatment goals include maximizing learning ability and preventing progression to more serious types of seizures. Treatment of any identifiable causes may decrease the number of seizures or eliminate seizures entirely.

Absence seizures may be eliminated or minimized by treatment with antiseizure (anticonvulsant) medications such as ethosuximide, valproic acid, or lamotrigine. Response to anticonvulsants varies widely with individuals. Changes in medication and dosage are made frequently in an effort to find a long-term medication and adjust the dose (titrate) of that medication to optimal blood levels.

Individuals who experience absence seizures should get proper rest every night (too little sleep is a major trigger for seizures) and should avoid smoking, alcohol, and caffeine. Driving should be prohibited in patients with poorly controlled absence seizures.

Source: Medical Disability Advisor



Prognosis

Medication usually effectively controls absence seizures. In some individuals, absence seizures may stop spontaneously, continue indefinitely (especially atypical absence seizures), or may progress to tonic-clonic (grand mal seizures). About 40% of children with childhood absence seizures progress to tonic-clonic seizures (Segan).

Individuals who go through typical absence seizures experience a full recovery with no associated confusion. Most individuals with absence seizures lead a reasonably normal life with minimal activity restrictions.

Source: Medical Disability Advisor



Complications

Complications arising from absence seizures may include learning disabilities, injury caused by a seizure while driving or operating machinery, a type of absence seizure that lasts for several hours (absence status epilepticus), and progression to generalized tonic-clonic seizures (grand mal seizures). Hyperventilation (rapid breathing) may trigger seizures in some individuals. Some drugs such as neuroleptics and large amounts of the antibiotic penicillin can lower the seizure threshold and cause uncontrollable seizures.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Individuals with recurrent absence seizures may be restricted from driving or operating potentially dangerous machinery. Individuals taking medications that cause drowsiness may face the same restrictions. Company policy on medication usage should be reviewed to determine if medication use is compatible with job safety and function. Special precautions (e.g., high railings or safety harnesses) should be taken for individuals working at heights.

Risk: Risk of recurrence may be reduced by getting a proper amount of sleep every night and avoiding smoking, alcohol, and caffeine. Medication compliance is important. Safety-sensitive jobs may be possible, depending on the individual seizure pattern.

Capacity: Between episodes, capacity in individuals with absence seizures is not affected, and as long as safety factors are adequately addressed, no work restrictions are necessary.

Tolerance: Tolerance is not a concern with this diagnosis as individuals typically have no memory of the absence seizures apart from awareness of muscle activity changes that may herald an oncoming seizure.

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:

  • Does individual have short periods where he or she seems "absent?" Were these episodes reported by the family or the individual?
  • How frequently do these episodes occur?
  • Is the neurologic examination normal?
  • Has an EEG demonstrated abnormal brain wave activity?
  • Has CT or MRI been done to rule out structural causes of seizures?
  • Has individual undergone a complete workup, including psychiatric evaluation, to rule out other conditions with similar symptoms (e.g.,., head injury, brain infections, brain tumor, stroke, drug intoxication, and withdrawal from alcohol, narcotics, cocaine, tranquilizers, and sleeping pills)?

Regarding treatment:

  • Has treatment with anticonvulsants lessened or stopped seizure activity?
  • Does individual rest properly at night?
  • Is individual avoiding use of alcohol, tobacco, and caffeine?
  • Has there been progression to generalized tonic-clonic seizures?
  • If so, has this condition been addressed in the treatment plan?
  • Have adjustments been made in the medication?

Regarding prognosis:

  • Has individual been restricted from driving or operating potentially dangerous machinery?
  • Is individual's employer able to accommodate these restrictions?
  • Does individual have any underlying conditions that contribute to seizures (e.g., congenital brain abnormalities, complications from kidney disease, liver disease, or brain injury)?
  • Have these conditions been addressed in the treatment plan?
  • Has individual experienced any associated complications that could impact recovery and prognosis (learning disabilities, seizure-related trauma, status epilepticus, or grand mal seizures)?

Source: Medical Disability Advisor



References

Cited

Segan, Scott. "Absence Seizures." eMedicine. Eds. SR Blenbadis, et al. 28 Mar. 2013. Medscape. 8 Jun. 2015 <http://reference.medscape.com/article/1183858-overview#showall>.

Source: Medical Disability Advisor






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