The following answers have been written by the Epilepsy Foundation of Metropolitan New York staff and members of its Professional Advisory Board.

1. Can I be fired for having epilepsy?
   You cannot be fired for having epilepsy. The Americans with Disabilities Act (ADA) protects the employment of a qualified individual with a disability who can perform the essential functions of the job with or without reasonable accommodations. In addition, many states and cities prohibit employment discrimination on the basis on an individual’s disability.

   To be afforded ADA protection, an individual must have a disability such as a physical or mental impairment, or must be regarded as having such an impairment. Most courts have determined that epilepsy is a disability under the ADA.

   If you are an individual with a disability, you must be able to perform the essential functions of your job, with or without reasonable accommodations, provided by your employer. If you cannot perform the essential functions of your job with or without reasonable accommodations, then your employment may not be protected under the ADA.

   State and local laws generally provide employment discrimination protection similar to that of the ADA, however, the definition of a disability varies by state and locally.

2. My child was diagnosed with epilepsy, will she outgrow it?
   Whether your child “outgrows” epilepsy will be dependent upon several factors. First, the diagnosis should be clarified. Epilepsy is defined as at least 2 seizures occurring more than 24 hours apart without acute provocation. Therefore, if your child had one seizure or had only febrile seizures, she does not have epilepsy. Epilepsy can be described by seizure type and also by syndrome. Prognosis, or whether your child outgrows epilepsy, will depend most on the epilepsy syndrome. Seizure syndrome is based on the age of onset of seizures, electroencephalographic (EEG) pattern, and seizure type.

   Some epilepsy syndromes are “benign,” meaning that the seizures will remit within a certain age range. There are also some epilepsy syndromes that rarely remit. If your child remains seizure-free for two years on medication, he or she should be given a trial off medication, regardless of the type of syndrome. Research shows that a percentage of children will remain seizure-free when medications are withdrawn. Some children have better outcomes than others including those with epilepsy of cryptogenic or unknown origin, and children with normal EEG’s.

   Ruth Shinnar RN MSN – Montefiore Comprehensive Epilepsy Management Center

3. Is there a connection between hormones and seizures?
   About 30% of women with epilepsy in their reproductive years note a connection between their menstrual cycle and the occurrence of seizures. Most often, these seizures occur in the few days just before, or on the first day of, the menstrual flow. In addition, the seizures may occur at the time of ovulation (the middle of the menstrual cycle). These times of increased seizure activity are thought to be related to the decline in blood levels of the reproductive hormone progesterone in the first case, and the peak of estrogen in the blood stream at ovulation, in the second case. Although a small proportion of women report an increase in seizure frequency after their menses, there is no clear-cut hormonal relationship to explain this phenomenon.

   The reproductive hormones, progesterone and estrogen, are active in the brain and can have some effect on seizures for some with epilepsy. Research has shown that estrogen may permit seizure occurrence while progesterone generally inhibits seizure occurrence. Therefore, right before menses begins and at ovulation, some women with epilepsy may be sensitive to their normal fluctuations in estrogen and progesterone levels.

   Natural progesterone has been reported to be helpful for women with seizures that occur during these times of the menstrual cycle. This treatment is currently being further evaluated at the Weill Cornell Epilepsy Center in order to determine if natural progesterone can be used effectively as an anti-seizure treatment in women.

   Some forms of epilepsy have their onset at puberty for both genders, suggesting a hormonal relationship between the emergence of epilepsy and hormonal status. Alternatively, childhood absence epilepsy tends to completely resolve at puberty. Many issues regarding hormones and seizures remain areas of active research and the relationships are yet to be more clearly determined.

4. I’m looking for a new job, but I’m afraid to tell my potential employer that I have epilepsy. What should I do?
   Deciding when to tell a potential or actual employer that you have epilepsy is a personal choice. Some people choose to disclose their epilepsy during the interview process, while others do so after they have been offered a job but before they begin work. Others choose to wait until they have begun working. It is important to take into consideration your personal safety and your comfort level. Although many people believe that it is better to not disclose their epilepsy until a later date, the pattern and severity of each individuals seizures must be taken into consideration to insure personal safety when deciding when to disclose. Employer and coworker education is key to their understanding and acceptance. Here are three possible scenarios:

   Scenario I:

   You are at an interview and wish to disclose your epilepsy immediately.

   Remember that your productive capacity is the major issue; not epilepsy. Defer your disclosure until your competence for the prospective job has been discussed and you have developed a good rapport with the potential employer. Once you feel comfortable that you’ve established yourself as a good candidate, introduce your epilepsy: “I want to be forthright and honest with you, since I’m not the kind of person to withhold information. I occasionally have seizures, but they do not interfere with my work routine.” If you have worked previously you can add that in prior jobs your seizures have not decreased your productivity. Encourage your employer to ask questions about epilepsy and even suggest that they and/or you contact an agency such as the Epilepsy Foundation of Metropolitan New York to find out more information. Conclude the disclosure by reiterating your high degree of motivation and commitment to work.

   Scenario II:

   You have decided not to disclose during the interview and have been offered a job, but wish to disclose before or upon starting work. It is possible that the employer may feel a sense of distrust since this issue was not discussed previously. In this case, you might say something like the following: “I have something to tell you which I was anxious about discussing with you at the time of my interview. Although I know epilepsy will not affect my ability to perform my job, there are so many misconceptions about this condition that I didn’t want to jeopardize my candidacy.” You can acknowledge the employers possible dilemma by saying words such as: “I hope this will not create difficulties. At the same time, I hope you understand my reluctance to reveal this condition.”

   Scenario III:

   Your seizure pattern is such that you feel confident about being able to work a substantial period of time and remain seizure-free. For this reason, you wish to postpone disclosure until you have established a pattern of productivity and positive relationships at work. In this case, you may want to introduce your condition in one of the following ways:

   “I really enjoy working with you, and I was reluctant to discuss my condition due to so many misconceptions.”

   “I have epilepsy and, although a seizure has not occurred yet on this job, at some point I may have one.”

   “When I have a seizure, the following things usually happen…” (explain your seizures in a factual manner)