Occupational Definition of Epilepsy
For occupational purposes, epilepsy is defined as recurrent unprovoked seizures, with the International League Against Epilepsy (ILAE) requiring either: (1) at least two unprovoked seizures occurring more than 24 hours apart, (2) one unprovoked seizure with ≥60% probability of recurrence over the next 10 years, or (3) diagnosis of an epilepsy syndrome. 1, 2, 3
Core Occupational Definition Components
The occupational definition differs from the general medical definition by focusing on workplace safety implications rather than purely clinical criteria:
Epilepsy is considered "active" for occupational purposes when an individual has doctor-diagnosed epilepsy or seizure disorder AND is currently taking medication for control OR has had one or more seizures in the past year 1, 2
A single seizure does not constitute epilepsy in the occupational context unless there is high recurrence risk (≥60% over 10 years), which distinguishes it from isolated provoked seizures due to acute metabolic, toxic, or systemic insults 1, 3
Epilepsy is considered "resolved" occupationally when individuals have remained seizure-free for the last 10 years AND off antiseizure medicines for at least the last 5 years 3
Occupational Safety Considerations
The occupational definition emphasizes functional capacity rather than diagnosis alone:
Safety-sensitive positions (operating dangerous machinery, carrying firearms) require evaluation of whether the employee could become suddenly disoriented or incapacitated, which typically occurs only with severe hypoglycemia-like episodes or uncontrolled seizures 1
Most employment settings (office, retail, food service) pose no inherent safety risk from epilepsy itself 1
Recurrent unprovoked seizures are the key occupational concern, as they indicate ongoing risk of sudden incapacitation that could endanger the employee or public 1
Key Distinction: Provoked vs. Unprovoked Seizures
This distinction is critical for occupational determinations:
Provoked (acute symptomatic) seizures occur at the time of or within 7 days of an acute neurologic, systemic, metabolic, or toxic insult (electrolyte abnormalities, hypoglycemia, drug toxicity) and do NOT constitute epilepsy for occupational purposes 4
Unprovoked seizures occur without acute precipitating factors and define epilepsy occupationally, as they indicate an enduring predisposition to generate seizures 1, 3, 5
Practical Occupational Application
A single episode should not automatically disqualify an individual from employment—rather, evaluation should determine the cause, circumstances, whether it was isolated, and likelihood of recurrence 1
Workplace accommodations can be minimal yet effective in managing epilepsy on the job, including medication compliance support and monitoring strategies 1