Disability with epilepsy

This is a long article on an important socio-medical topic. Let’s discuss common questions of patients with epilepsy: will they give disability due to epilepsy; causes of disability; criteria for disability; the establishment of disability at ITU; how many disability groups; what is the disability group for epilepsy; the first group of disability; second group of disability; third group of disability; what group of disabilities are given to children; indefinite disability; Let us give an example from the practice of registering a disability for a child with epilepsy.    

Whether disability will be given for epilepsy is determined by the presence of disability factors that ITU takes into account.  

Causes of disability

What does ITU take into account in epilepsy:

1. The main clinical sign of epilepsy is the presence of epileptic seizures. Repetition epipristupov limits the Life – the activity of the patient. During seizures, the patient cannot control himself. An epileptic seizure can start spontaneously, at any time, anywhere.     

Outside of seizures, a patient with epilepsy is usually indistinguishable from a healthy person. Most patients with epilepsy can work, study, and lead an active lifestyle. Often the people around them do not even know that a person is diagnosed with epilepsy. Such people with epilepsy are not considered disabled. Having epilepsy is not always a sign of disability.   

 Outside of epileptic seizures, the patient’s quality of life is reduced due to many factors: 

the need for daily, constant, long-term use of antiepileptic drugs; the need for regular monitoring by neurologists, epilepsy specialists;

sometimes the need for periodic monitoring by psychiatrists; 

the need for periodic examination (general blood test, general urine analysis, EEG, MRI of the brain and other additional methods).

Drugs for the treatment of epilepsy have undesirable side effects: depression of the nervous system, toxic effects on the liver and kidneys, and others. Epilepsy treatment is a significant financial problem: medications, examinations, consultations are expensive.

1.  Part of epilepsy accompanied by the presence of mental defect that manifests itself in the form of patoharakterologicheskih personality changes (pathological traits of character), behavioral disorders, intellectual – insufficiency, psychological disorders. The presence of mental disorders is also recognized as a limitation of human life , is the basis for the registration of disability, taking into account their degree of severity.  
2.  In some forms of epilepsy, movement disorders are possible in the form of paresis, paralysis, coordination disorders (ataxia). The presence of movement disorders, undoubtedly recognized as a limitation of human life , is the basis for the registration of disability, taking into account the degree of severity.  
3. Delayed motor development is not uncommon in children with epilepsy. In such cases, children, later than their peers, begin to hold their heads, roll over, sit down on their own, crawl, stand, walk. In severe cases, there is a pronounced delay in motor development: the child can neither hold his head, nor roll over, nor sit, nor walk. The presence of a delay in motor development for 3 age periods is the basis for registration of disability. As a rule, delayed motor development is combined with motor impairments.
4. Another option (or in combination with delayed motor development) in children with epilepsy is delayed speech development or regression of speech (loss of speech skills after the onset of epilepsy). The child has a late onset of humming , babbling, first words, phrasal speech. Speech therapists put their diagnoses in these cases: General speech underdevelopment (OHP), speech retardation (RRP), alalia, dysarthria.  
5. Perhaps a combination of epilepsy with impaired hearing, vision. 

Thus, the causes of disability in epilepsy are frequent epileptic seizures, movement disorders, mental disorders, severe retardation of psycho- motor development in children, hearing and vision impairments. ITU decides whether disability will be given to epilepsy .    

Establishing disability

Who is referred to MSU for epilepsy?

Indications for referral to medical and social expertise in epilepsy are:

• Contraindicated types and working conditions;
• The progressive course of the epileptic process (frequent cramps – stentnye therapy seizures, mental disturbances, changes in Lich – Nosta);
• Insufficiently effective surgical treatment.

Evaluation for ITU for epilepsy

What examinations for epilepsy need to be carried out for the ITU, in what time frame, what documents to provide for the ITU:

1. Electroencephalogram.

The EEG examination is less than 6 months old.  

Some forms of epilepsy require an EEG (background + sleep) or an EEG with sleep deprivation.   

Sometimes it may be necessary to record EEG monitoring video.

For ITU, examinations can be carried out both in a hospital setting and on an outpatient basis in a polyclinic at the place of residence or in medical centers. It is desirable to submit to the ITU both the EEG conclusion and the EEG itself (picture, graphs).

Both originals of EEG studies and photocopies of medical documents can be submitted.

The EEG conclusion can be presented both on a separate sheet and in hospital extracts.

It is preferable to provide previous (previously conducted) EEG in order to assess the dynamics of changes, that is, to determine whether there is an improvement or deterioration in the EEG.

A qualitative indicator confirming the presence of epilepsy on the EEG is the registered epileptiform activity. The quantitative indicator reflecting the dynamics of epilepsy on the EEG is the index of epileptiform activity. And also information on the description of the EEG with the clarification that the amount of epiactivity has become more or less in comparison with the previous year (or in comparison with the EEG of different ages).

It should be noted that not all forms of epilepsy can record epiactivity by EEG. In such cases, it is necessary to do an EEG with sleep deprivation or a long-term recording, for example, daily EEG monitoring. And even under these conditions, it is far from always possible to identify epiactivity by EEG.

1. Computed tomography or magnetic resonance imaging of the brain

CT or MRI of the brain shows the structure of the brain. This is a picture that visually reflects the presence or absence of a morphological defect in the brain.

1. With epilepsy, there may be changes on an MRI or CT scan of the brain (eg, cyst, tumor, abnormality of the brain). In such cases, we are talking more often about the diagnosis Symptomatic epilepsy, which developed secondarily against the background of the previous disease.
2. With epilepsy, there may not be any changes on an MRI or CT scan of the brain. In the description of MRI (or CT) of the brain, we read the conclusion: “Without structural disorders.” In such cases, we are talking more often about the diagnosis of idiopathic epilepsy, which developed initially, without a previous organic brain defect.
3. In epilepsy, changes may not be detected on an MRI or CT scan of the brain. In the description of MRI (or CT) of the brain, we read the conclusion: “No structural disorders.” But along the course of epilepsy, neurologists – epileptologists believe that there is some kind of structural defect in the brain. A defect in the brain is likely, but not proven, not identified. In such cases, we are talking more often about the diagnosis Probably symptomatic epilepsy, which developed secondarily against the background of the previous disease.

 Any duration of the MRI or CT scan of the brain can be taken into account.

Sometimes (for example, in idiopathic epilepsy), the MRI does not need to be repeated.

In some forms of epilepsy, when the current progressing process is detected by MRI, the attending physician (neurologist or neurosurgeon) recommends that the MRI be monitored after 1 year. The timing of a repeat MRI scan can be different: 3 months, 6 months, 1-2 years, 5 or 10 years. The timing of MRI monitoring depends on the rate of progression of the disease. For example , conditions such as a tumor, condition after brain surgery, or condition after severe TBI may require an MRI scan after 1 week.

For non-progressive diseases, a single MRI scan of the brain may be sufficient. In such cases, a conclusion and an MRI (CT) image of the brain are provided to the ITU.

With Probably symptomatic epilepsy, it may be recommended to perform MRI of the brain again, on another machine – a tomograph with a higher resolution, in the hope of revealing a morphological defect in the brain.

3. Extract for ITU from an epileptologist

In the discharge, the epileptologist freely describes the course of epilepsy:  

• when was the debut of epilepsy;
• describes the type of epileptic seizures in the patient;
•  describes the frequency of attacks;
•  what examinations were carried out over the past period, indicating the terms of hospitalization;
•  what kind of treatment the patient is receiving;
•  what results of treatment are observed in response to antiepileptic drugs;
• whether the patient follows a doctor’s recommendation or is not compliant ;
• whether the patient has mental and intellectual impairments;
•  makes a diagnosis of epilepsy according to the international classification of epilepsy;
•  notes the presence of concomitant pathology;
• can reflect the individual characteristics of the course of the disease.

An epileptologist’s extract must be submitted to the ITU about 1 month ago. Although the ITU takes into account such an extract and is 6 months old.

Discharge from an epileptologist for MSE may also be required for patients without epilepsy if they have a history of symptoms associated with possible epilepsy. 

 Group of patients who need a discharge from an epileptologist for ITU:

• Active form of epilepsy,
• Epilepsy in remission,
•  Benign seizures of infancy
• Convulsive syndrome in the first days after childbirth,
• History of epilepsy
• Convulsive ( non-epileptic ) seizure against the background of acute conditions (for example, in the acute period of traumatic brain injury),
• Febrile seizures
• Paroxysms of non-epileptic genesis, similar in clinical presentation to epileptic seizures (hyperkinesis, tic disorders, flinching when falling asleep, conversion disorders, hysterical – neurotic reactions),
• The presence of epileptic activity by EEG in the absence of seizures,
• Mental disorders
• Autism Spectrum Disorders (Autism or Autosimilar Behavior Disorders)
• Reflex syncope
• Syncope (syncope)
• Panic attacks and other conditions.

4. Conclusion of the ophthalmologist

Ophthalmologist’s opinion for ITU, description of the fundus, visual acuity (data of ophthalmological examination).

5. Results of experimental psychological research

Psychologist’s conclusion

6. According to indications, additional survey methods may be required for ITU: 

Expert opinions for ITU:

• Neurosurgeon
• Psychiatrist
• Otolaryntologist
• Audiologist
• Speech therapist
• Orthopedist
• Surgeon
• Genetics
• Gastroenterologist
• Dentist
• Gynecologist
• Cardiologist (with ECG)
• Allergist-pulmonologist
• Hematologist

7. Laboratory diagnostics:

Complete blood count (with duration of bleeding, blood clotting time, platelet count)

General urine analysis,

 Biochemical blood test (ALT, AST, urea),

A blood test for antiepileptic drugs (for example, the concentration of valproate in the blood),

If indicated, individual diagnostic tests may be required. 

To summarize, mandatory examinations for ITU for epilepsy

 Essential examinations for ITU in epilepsy

• EEG
• CT or MRI of the brain
• Ocular fundus
• The conclusion of a psychologist (Results of an experimental psychological study).
• Epileptologist’s discharge for ITU

Medical and Social Expertise (ITU) 

The ITU is based on a medical and social assessment of the dysfunctions of organs and systems, leading to disabilities.     

Medical and social assessment is based on expert multilevel diagnostics. Diagnostics implies basic and additional research methods.

The main diagnostic methods of research for epilepsy on the MSU include:

1. Medical history, that is, information about the initial clinical manifestations of epilepsy; etiology (reasons); type of seizures, frequency of seizures. 
2. Objective assessment of neurological and somatic status.

At the commission itself, medical experts begin by interviewing the patient or the child’s parents about the complaints brought about by the ITU, collect anamnesis: how the disease began and developed, and dwell on the description of epileptic seizures, methods and stages of treatment. ITU is studying the provided medical documents. Further, the patient is examined by a commission and all the necessary neurological tests are carried out. The examination is carried out by a neurologist – a representative of the ITU. Based on the information received, ITU issues its opinion.

Additional methods of diagnosis are appointed for long – zaniyam to confirm the available functions – tional disorders of other body systems (detection of comorbidity).

Disability criteria

Criteria for assessing the patient’s condition during medical and social examination

The main clinical and functional criteria for MSE in epilepsy are:  

1. Epileptic seizure frequency
2. The state of the intellectually – mnestic sphere
3. The degree of movement disorders

At the ITU, the condition of patients with epilepsy is assessed according to the following criteria: 

• description of the type of epileptic seizures: generalized : tonic-clonic, myoclonic , atonic, absences ; partial: simple partial, complex partial, partial with secondary generalization (according to the statement of an epileptologist or neurologist);
• frequency of epileptic seizures during the defined – Nogo time period (the number of attacks per month, year);
• etiology of epilepsy (idiopathic, symptomatic, cryptogenic);
• the age of the onset of the first clinical manifestations of epilepsy (when epilepsy debuted);
• morphostructural state of brain tissue (presence of pathology on MRI or CT of the brain, established diagnosis);
• the state of bioelectric activity of the brain (presence of epileptiform activity by EEG);
• state of intellectual and mnestical sphere (the results of experimental psychological research)
• the severity of neurological symptoms, including movement disorders (based on the results of their own neurological examination on MSE and the conclusions of neurologists, hospital discharge);
• the effectiveness of anticonvulsant therapy (according to the discharge of an epileptologist or neurologist, discharge from the hospital). 

Determination of the frequency of epileptic seizures

The frequency of epileptic seizures – is the number of attacks over the last 6 – 12 months on the background of treatment with antiepileptic drugs. The frequency of seizures for all (both severe and light) seizures is calculated as the arithmetic average number of seizures per month. To confirm the frequency of seizures at the ITU , medical documents should be presented: an epileptologist ‘s discharge, an extract from the hospital, a certificate after calling an ambulance, a seizure diary.        

Quantifying the incidence of epileptic seizures

Type of seizures	Seizure recurrence rate
rare	average	frequent	very frequent
Simple partial	motor	2-3 per month	3-4 per week	3-4 per day	5 or more per day
somatosensory	1-2 per month	1-2 per week	1-2 per day	3 or more per day
with vegetative- visceral manifestations	2-3 for half a year	2-3 per month	2-3 per week	4 or more per week
with impaired mental functions	1-2 per quarter	1-2 per month	1-2 per week	3 or more per week
Complex partial	1-2 per quarter	1-2 per month	1-2 per week	3 or more per week
Partial with secondary generalization	3-4 per year	2-3 per quarter	3-4 per month	5 or more per month
Generalized	absences , myoclonic	3-4 per week	1-4 per day (day)	5-10 per day (day)	More than 10 per day (day)
tonic-clonic, atonic	3-4 per year	2-3 per quarter	3-4 per month	5 or more per month
atactic	1-2 per year	1-2 per quarter	1-2 per month	3 or more per month

 Risk factors for the development of medical and social consequences

Carrying out the MSE of patients with epilepsy involves the determination of risk factors for the development of medical and social consequences of the disease. Distinguish neurobiological, psychosocial and medical risk factors.  

Neurobiological risk factors for the consequences of the ITU include:

• early onset of epilepsy;
• the presence of a confirmed cause of epilepsy;
• seizure polymorphism (the presence of different types of seizures in a patient);
• high incidence of epileptic seizures;
• tendency to serial and status trends;
• the presence of highly traumatic seizures with an abrupt onset without an aura (precursors), for example, falling attacks; 
• the presence of pronounced structural changes in the brain;
• severe EEG disorders:

the presence of persistent, gross diffuse changes in the bioelectrical activity of the brain;

diffuse epileptic activity, characteristic of West syndrome, Lennox – Gastaut syndrome and other epileptiche – Sgiach encephalopathies ,;

signs of severe neurophysiological immaturity;

• the presence of pronounced focal neurological symptoms (paresis, muscle hypotension or hypertonicity , ataxia, strabismus and other disorders); 
• rapid regression of motor and intellectual capabilities (loss of previously existing motor skills, speech).

Psychosocial risk factors for consequences on the ITU include: 

• unfavorable social status;
• inadequate attitude of the patient to his condition.

Psychosocial factors are what motivates people to apply for a disability, demand and achieve it. The need for help, difficult family circumstances, the presence of other relatives who are dependent on the family, restrictions on the health of other family members – this and more makes people seek help from the state through the ITU. And, at the same time, the presence of only a difficult family and social situation without persistent deviations in health with limited life activity is not recognized as a basis for registering a disability. In such cases, you should contact social protection (in the territorial bodies of the ministry, in the departments of benefits and social payments). Social protection of the population is implemented under the state program “Development of the system of social support for the population for 2014 – 2019”.             

Medical risk factors for the development of medical and social consequences of the disease in the MSU include:  

• inopportune diagnosis;
• insufficient diagnostics;
• inappropriate anticonvulsant treatment strategy;
• lack of the necessary drug;

An example is the situation with Suksilep’s defect ; 

• the occurrence of side effects on taking the drug, including individual intolerance;
• pharmacoresistance .

Medical risk factors are identified on the ITU on the basis of anamnesis; hospital extracts; extracts from an epileptologist ; a completed medical document by a neurologist, general practitioner or pediatrician: 

The assessment of risk factors is carried out by doctors of medical and preventive institutions, ITU specialists. This primarily helps to draw conclusions about the clinical prognosis.  

Clinical prognosis

Favorable prognosis for epilepsy: 

• does not depend on the frequency of seizures before treatment for benign forms of epilepsy and syndromes,  
• in the absence of pulmonary disorders or intellectual- mnestic functions;
• in the absence or mild movement disorders;
• without pronounced changes in the bioelectrical activity of the brain according to EEG, 
• without pronounced structural pathology of the brain according to MRI,
• in the presence of drug remission or spontaneous remission without therapy,   
• under favorable psychosocial environmental conditions. 

These favorable conditions determine the possibility of realizing the patient’s potential abilities in the framework of life in full. This means that in spite of the course of epilepsy, the patient is capable of compensation and his life activity is not recognized as limited. 

Questionable prognosis

It is determined in the presence of drug-resistant medium frequency and often recurring seizures polymorph – GOVERNMENTAL seizures (combination generalized and partial seizures), lightning, and suddenly occurring seizures (as drops attacks), moderate to severe disorders intellectual- mnestic and motor areas expressed morphostructural measurable – neny and dysgenesis brain expressed diffuse changes of bioelectric activity of the brain, it is impossible to Form – Vat adequate antiepileptic treatment strategy that pre – determines the possibility of partial realization of potential abilities – stey patient as part of life.

Doubtful prognosis determined in the presence of drug-resistant medium frequency and often recurring seizures polymorph – GOVERNMENTAL seizures (combination generalized and partial seizures), lightning, and suddenly occurring seizures (as drops attacks), moderate to severe disorders intellectual- mnestic and motor areas expressed morphostructural measurable – neny and dysgenesis of the brain expressed diffuse changes of bioelectric activity of the brain, it is impossible to Form – Vat adequate antiepileptic treatment strategy that pre – determines the possibility of partial realization of potential abilities – stey patient as part of life.

Poor prognosis is determined by the presence of generalizing – bathrooms (cryptogenic or symptomatic) epilepsies and syndromes and other epileptic encephalopathies, drug-resistant and often very repetitive seizures, propensity for serial and status – Nome flow, gross changes in intellectual and mnestical and moving – tion areas.

What disability group is given for epilepsy

 Criteria for assessing the degree of impairment of body functions and determination of the disability group

As a result of expert diagnostics, the quantitative division of functional disorders is determined:

• insignificant,
• moderately expressed
• expressed
• and significantly pronounced.

In this connection, the design of disability in epilepsy is shown

With epilepsy, mental and statodynamic functions of a person are more often affected.

Under mental function understands that perceptions – term, attention, memory, thinking, intellect, emotions, will, consciousness, behavior – denie.  

The statodynamic function is a person’s ability to move and coordinate. 

Disturbance of mental function and lead to statodynamic ogre – ness of all categories of activity. A person can not control their behavior, move, it loses the ability to self-service, learning and working Dey – faculty. 

Violation of mental and statodynamic function – this degree of limitation of life activity gives rise to the recognition of the patient as a disabled person.  

What disability group is given for epilepsy: for epilepsy, they give any disability group 1, or 2, or 3, or they do not give disability. It all depends on the severity of the disorders: how often do epileptic seizures occur , are there mental disorders, are there movement disorders. 

How many disability groups:

There are 3 disability groups in total: III group of disability (the lightest), II group of disability ( medium-severe ), I group of disability (the most severe patients).   

Mental dysfunctions

Minor mental disorders:

Minor subjective symptoms (complaints): increased fatigue, sleep disturbance, infrequent headaches, irritability, emotional lability. 

Strengthening of complaints (decompensation) after severe physical and neuropsychic stress. Experimental psychological research methods reveal normal indicators of attention and memory. 

Rare (not more than 1 time per month) seizures primary and secondary – were generalized – en : individual – 1-2 times a year; rare – once a month or less; 

Rare (1-2 times a day) focal seizures without impairment of consciousness: single – 1-2 times a month; rare – 1-2 times a day.  

Rare (no more than 1 time in 3 months) psychomotor attacks: single – 1-2 times a year; rare -1 every 3 months.

Rare status epilepticus: rare once a year.

Minor violations do not lead to limitation of the categories of life activity. For minor mental disorders, no disability group is established. 

3 group of disabilities

Moderately severe mental disorders: 

Complaints (subjective symptoms) are more pronounced, stable: 

Frequent or almost constant headaches, pain tension , unsteadiness when walking, fatigue, general weakly – Bost, poor sleep, irritability. 

Vegeta – tive disorders: sweating, palpitations, “interruptions” in the heart, shortness of breath, feeling short of breath, sensitivity to cold, abdominal discomfort, and others. Patients can not tolerate fiziogennye stimuli (noise, vibration, optical-kinetic and ve – stibulyarnye load), there is poor tolerance of alcohol, lack of air, heat and cold, meteozavisimost.  

The deterioration (decompensation) comes at moderate INDIVIDUALS – Sgiach and neuropsychiatric loads.

Experimental psychological research methods reveal a moderate decrease in attention and memory, decreased performance, pace of work, loss of productivity activities. 

The frequency of seizures in group III disability: 

Epileptic seizures primary and secondary generalizing – Bathrooms : medium frequency – 2-3 times a month. 

Focal seizures without impairment of consciousness: the unit – expectation values of frequency – 3-4 times a day. 

Psychomotor attacks: medium frequency – 1 time in 1.5-3 months;

Status epilepticus : average frequency – 1 time in 4-6 months. 

Moderately expressed disturbances of mental functions: moderately expressed complaints epipristupy average frequency lead to the restriction of capacity is controlled – Vat his behavior, 1 st degree, to the orientation of the 1st degree, samoobsluzhi – vaniyu 1st degree, work 1 st degree, teaching 1 th degree – no. The III group of disability is established.   

2 group of disabilities 

Severe mental disorders

Complaints (subjective symptoms) expressed and stable:  

Sharp weakly – Bost and fatigue with minor physical and neuro-psychological stress, chronic headaches, sleep disorders marked (insomnia, daytime drowsiness).

Asthenic syndrome combined with hypochondriacal, anxious, de – compressively disorders.

Experimental psychological research methods reveal a significant deterioration of – exponents of attention (concentration, stability, switching), mind – rennoe memory loss.

The frequency of seizures in group II disability:

Frequent seizures primary and secondary generalizing – Bathrooms : frequent – 4 times a month or more. 

Frequent focal seizures without impairment of consciousness: frequent -5 or more times a day.

Psychomotor attacks: medium frequency – 1 time per month or more;

Status epilepticus : 1 or more times every 2-3 months. 

The expressed disturbances of mental functions: expressed complaints, frequent epipristupy lead to restriction of the ability to control the behavior of 2nd degree, to the orientation of the 2nd degree, self-service, 2 nd degree, work 2nd degree ; teaching of the 2nd degree. The II group of disability is established.  

1 group of disabilities

Significantly pronounced disorders of mental functions

At significantly expressed violations observed the presence of gross focal neurologic symptoms, a sharp decline in memory, attention, loss of previous knowledge and skills sharp affective violated – Nia, weakness, lethargy, akinesia , hallucinatory-delusional experiences and others.  

Lack of criticism to his condition, reaction or improper behavior – denie the usual situation, failure to comply with personal security, difficulty of contact with people in everyday life.

The presence of seizures of any frequency.

Significantly expressed disturbances of psychic functions lead to the restriction of the ability to control his conduct third degree, to the orientation of the third degree, self-service third degree, work third degree ; training of the 3rd degree. The I group of disability is established.  

Violation of static-dynamic function

Slightly pronounced disorders stato-dynamic functions – tion

Slightly pronounced disorders stato-dynamic functions – tion are shown:

easy paraparesis , tetraparesis , hemiparesis, monoparesis lower extremity with malnutrition and thigh muscles of – laziness 1.5-2.0 cm (flaccid paresis), decreased muscle strength (up to 4 points); mild paresis of one or both upper limbs with hypotrophy of the muscles of the shoulder, forearm by 1.5-2.0 cm (flaccid paresis), a decrease in muscle strength in all parts of one or both upper limbs up to 4 points.

Slightly pronounced disorders stato-dynamic functions – tion (as a light reducing power in one or in all four limbs to 4 points out of 5 required) to restrict the categories do not cause life activity, disability is not established.   

The design of disability is not shown with a slight decrease in strength to 4 points.

3 group of disabilities

Moderate disorders stato-dynamic functions – tion

With moderately severe violations, the following are observed:

mild paresis of both lower extremities, tetraparesis , hemiparesis, monoparesis ghee – potrofiey thigh 5-7 cm lower leg – 4-5 cm, increasing myshech – Foot tone of spastic type or hypotonia of muscles, moderate CNI – zheniem muscle strength (up to 3 points ), spastic, paretic, peroneal gait with slight or moderate drooping of the feet; movement sometimes using additional support (cane); moderate paresis of the upper limb with a decrease in muscle strength in all parts of one or both upper limbs up to 3 points.

Moderate disorders stato-dynamic functions – tion (in a moderate reduction in power in one or in all four limbs to 3 points out of 5 required) leads to a restriction capable – STI mobility 1st degree, self-service 1st degree, work 1st degree, teaching 1st degree. The III group of disability is established.      

2 group of disabilities 

Marked disorders stato-dynamic functions – tion

With pronounced violations of the statodynamic function, the following are observed:

expressed paresis of both lower extremities, tetraparesis , triparez , hemiparesis with a marked increase in muscle tone by rescue – Ceska type or hypotension muscles with reduced muscle strength (up to 2 points) lower limbs, spastic, paretic gait with pronounced overhang stop movement with an additional support (co – froze); severe paresis of the upper limb with a decrease in muscle strength in all parts of one or both upper limbs up to 2 points.

Marked disorders stato-dynamic functions – tion (in the form of significant reduction in power in one or in all four limbs to 2 points of 5 necessary) leads to the limitation of ability to Move, – zheniyu 2nd degree, self-service 2nd degree, work – STI 2nd degree, teaching 2nd degree. Set group II disabled – Nosta.  

1 group of disabilities

Significantly expressed disturbances stato-dynamic functions – tion

Significantly expressed violations are manifested:

lower pair – plegia, pronounced tetraparesis , paraparesis with increased muscle tone or spastic type of hypotonia with muscle strength decline (1 points) to the inability of self-re – motion; pronounced paresis of the upper limb with a decrease in muscle strength in all parts of one or both upper limbs up to 1 point.

Significantly expressed motor disorders (immobility) result in a limited way – Nosta mobility third degree, self-service third degree, Trudy – howling activity 3rd degree, teaching third degree. The I group of disability is established.  

Disability criteria for epilepsy

III group of disability (in 35-40% of patients): moderate limitation of life activity, absolute and sometimes relative contraindications in work due to the limitation of the ability to work in the first degree or to study in the first degree (in combination with the limitation of the ability to work) – with seizures not less than the average frequency. The grounds for determining the III group of disability with seizures of medium frequency, moderate personality changes occur more often in workers than in employees, due to contraindications at work, difficulties in finding a job. 

II group of disability (in 55-60% of patients): severe limitation of life activity due to frequent (documented) seizures, pronounced personality changes (in the absence of the effect of treatment), and as a result of this limitation of the ability to work in the second, sometimes third degree, control behind their behavior of the second degree. Most patients can continue to work in specially created conditions (in special workshops , at home).  

I group of disability (in 2-4% of patients): a pronounced limitation of life activity, for example, due to very frequent epileptic seizures against the background of pronounced personality changes, frequent seizures with repeated statuses during the year, dementia (according to the criteria of limiting the ability to self-service of the third degree, control for his behavior of the third degree). In case of persistent disability (I or II disability group), the hopelessness of rehabilitation measures after 5 years of observation, the disability group is established indefinitely. 

Perpetual disability

In case of persistent disability (I or II disability group), the hopelessness of rehabilitation measures after 5 years of observation, the disability group is established indefinitely.

Practical example. Is disability due to epilepsy in this case?  

Child 1.5 years old. The debut of epileptic seizures at 6 months. Seizures in the form of focal motor seizures with secondary generalization – clones in the hand, then falls, clonic- tonic convulsions, lasting 1-2 minutes. The frequency of attacks is 1 time per week. Then epipristupy in 1 month to daily participation (1-2 times a day). Against the background of therapy in a hospital setting, attacks became less frequent ( 1-4 times a week), shorter (3-15 seconds each), less severe – only clones in the hand. Receives two antiepileptic drugs. The selection of outpatient therapy continues.      

Neurological status – mild spastic tetraparesis up to 4 points. The rate of delay in motor development: holds the head from 1 month, sits from 10 months, walks from 1 year 5 months unstable. In speech by 1.6 years – 3 words (slight lag in speech development).

On MRI of the brain, an anomaly of the development of the brain ( dysgenesis of the frontal lobe).

Diagnosis: Symptomatic focal epilepsy , focal motor seizures with secondary generalization. Organic damage to the central nervous system, against the background of anomalies in the development of the brain ( dysgenesis of the frontal lobe), mild spastic tetraparesis , delayed motor and speech development.  

So, will disability for epilepsy be given in this case?  

On the background of therapy, simple focal motor epileptic seizures of medium frequency persist – 1-4 times a week. There are mild movement disorders (spastic tetraparesis up to 4 points), a slight tempo delay in psychomotor development (the child walks unstably, speaks only 3 words), there are persistent pronounced changes in the MRI of the brain ( dysgenesis of the frontal lobe).  

Considering the combination of these factors, especially the persistence of medium-frequency seizures , despite the ongoing treatment, there is currently a basis for referral to the MSE and the solution of the issue of registration of disability for this patient.

What disability group is issued for children?

In children, disability is not divided into groups; the category of disabled child is assigned . 

From the article we learned:

• That takes into account the ITU in epilepsy: only frequent repetition epipristupov limits the Life – the activity of the patient, as in epilepsy patients can not control myself.   
• The presence of epilepsy is not always the basis for disability .   
• Who is referred to MSU for epilepsy.
•  What examinations are required for MSU in case of epilepsy: EEG, CT or MRI of the brain, fundus of the eye, a psychologist’s opinion, an epileptologist’s discharge for MSU. What is an epileptologist’s discharge for ITU.    
• Criteria for disability in epilepsy: the frequency of epileptic seizures, the state of the intellectually – mnestic sphere, the degree of movement disorders.  
•  What are the frequency of seizures according to ITU – a table of the frequency of epilepsy seizures.
•  Criteria were determined for each of the three groups of disability in epilepsy. 
• What disability group is assigned to children: a disabled child. 
• They gave a clinical example to the question of whether disability is formalized in epilepsy.