She has seizures at work, but epilepsy hasn’t stopped her career from progressing

By Akshita Nanda

SINGAPORE – After multiple rounds of interviews, Mandy (not her real name) was offered a senior manager position at a multinational company. Only then did she reveal that she has epilepsy, a chronic neurological condition, and that she is on medication for recurrent seizures.

Her seizures may be as frequent as once or twice a week and last two or three minutes. After that, she recovers and can resume work.

“I stated my condition at the point of offer because I felt I wouldn’t have been given a chance if I had told them earlier,” the 39-year-old tells The Straits Times.

The job offer remained on the table after her disclosure and she accepted it. She declined to reveal more about her work as it could lead to her being identified.

There are an estimated 29,000 people with epilepsy in Singapore and many are able to work full time, including in professional and managerial roles. However, stigma and lack of knowledge about epilepsy can make it harder for people to be honest at the workplace.

Doctors treating people with epilepsy are often asked to write letters confirming the patient’s fitness to work. The issue is whether the employer accepts it.

Mandy has worked in several companies and found that people’s attitudes may change when they learn about her condition.

“At some companies, I have been treated like any normal member of staff. I have high performance ratings. My colleagues generally don’t treat me differently,” she says.

At another company, once her condition was made known, the human resources department did not accept a doctor’s letter stating that she was fit to work. Her boss also began criticising her work more.

Goh Keng Hwee, executive director of social service agency Epilepsy Care Group (Singapore), says he regularly counsels people who run into trouble finding or retaining jobs because of their epilepsy.

“Employment is a big issue,” he says. “I think that the professional ability of a person applying for a job should be separate from whatever medical conditions they have.”

His words echo a written reply from the Ministry of Manpower to a 2022 parliamentary question about barriers to employment for people with epilepsy. It said employers should assess candidates based on merit and their ability to do the job, and not their medical conditions.

Workers who feel they have been treated unfairly due to conditions such as epilepsy can approach the Tripartite Alliance for Fair and Progressive Employment Practices.

What is epilepsy?

Neurologist Rahul Rathakrishnan explains that brain cells, or neurons, normally transmit electrical and chemical signals to maintain the function of our nervous system.

A surge of abnormal electrical activity leads to a seizure. A person with epilepsy is predisposed to having recurrent seizures, he says.

Epilepsy may manifest in infants and children, often because of birth injuries or neurodevelopmental conditions, among other factors.

It may manifest in older adults because of structural changes caused by strokes, tumours or neurodegenerative illnesses.

“However, it should be emphasised that not all patients with structural brain changes or neurodegenerative illnesses will develop epilepsy,” adds the senior consultant at the National University Hospital’s division of neurology.

Genetic factors, immune dysfunction and infections of the central nervous system can also cause epilepsy.

“However, a significant number of patients have epilepsy with an unknown or unidentifiable cause,” Rathakrishnan adds.

Consultant Tan Zhibin from the National Neuroscience Institute says not everyone who has had a seizure has epilepsy.

Low blood sugar, low sodium, the effects of medication and alcohol withdrawal or, in a child, fever, can all lead a person without epilepsy to experience a seizure, he says.

“Epilepsy is a condition in which a person is prone to unprovoked seizures,” he says.

A seizure may be focal, or occur in only one part of the brain, or generalised, in the whole brain. Sometimes a focal seizure can spread to other parts of the brain.

The location of the abnormal electrical activity affects how the seizure manifests.

Tan says that a seizure in the occipital lobe, which processes visual stimuli, may affect what the person sees, while a focal seizure in the temporal lobe, which encodes memory, may produce a feeling of deja vu.

A focal seizure in the motor cortex of the brain may lead to jerking in the opposite side of the body.

What triggers a seizure?

Rathakrishnan notes that triggers lower a patient’s seizure threshold and contribute to a seizure occurring.

Common triggers are sleep deprivation, poor sleep quality, fatigue, illness, not taking anti-seizure medication, and emotional and psychological stress.

“Some specific forms of epilepsy are photosensitive, and flashing lights may also trigger seizures, although these are less commonly reported,” he says.

Isla (not her real name) developed seizures after a childhood car accident led to brain injury. She had seizures unpredictably soon after the accident.

As she grew older, the seizures disappeared for eight years while she was completing a bachelor’s degree and working part time.

When she started working full time, however, the seizures returned. She thinks the stress of taking on more responsibilities at work contributed.

Now 39, she manages a multinational team of 10 and has perhaps one seizure every one to two years.

Some people with epilepsy experience an “aura” that allows them to predict a seizure. It can feel like butterflies in the stomach, deja vu, or visual changes.

Isla feels a seizure approach through what she describes as “a wobbling feeling”.

“I feel like I’m going to faint,” she says. “There is time for me to react.”

One time, she had a seizure in the office when she was working late. This was before she had disclosed her condition. Not wanting to alert others, she went into a toilet cubicle.

When she returned to herself, she was in front of a colleague, talking. Without realising it, she had exited the cubicle and begun a conversation about the stress she was experiencing at work.

Later, her then boss offered to get Isla more help for the project she was working on. Isla is now better able to ask for help at work, which reduces her stress and thus reduces a potential trigger for seizures.

“This condition has not stopped my career,” she says. “I’m offered equal opportunities with my peers who are high performers.”

How is epilepsy treated?

Tan and Rathakrishnan both say epileptic seizures cannot be accurately predicted.

The condition is managed with anti-seizure medication, and two-thirds of patients achieve satisfactory seizure control.

In some cases, such as if the patient has tumours, surgery may be recommended.

Mandy’s epilepsy is managed with medication. Midway through her career with one company, her attacks got worse because she started a new medication that did not control the seizures as well.

This led to problems with her immediate boss and the human resources department.

“I was made to sign a letter of indemnity to indemnify the company from any harm that may occur to me because of the attacks,” she says.

Barriers to employment

Goh says that apart from a lack of understanding of epilepsy, employers are concerned about liability issues.

People with epilepsy are not allowed to drive, for example, and should not take jobs that involve them having to drive vehicles.

Jobs that require operating heavy machinery should also be avoided. “Be realistic,” he says.

People with epilepsy should also take their medication as directed and be careful about sleep quality so they can manage their condition.

He says it also helps to have a seizure action plan and communicate clearly to employers and colleagues what to do in the event of a seizure.

Mandy’s seizures tend to happen in the evenings or when she sleeps at night, but she has had seizures at work. Her colleagues know to leave her alone as she will recover within two or three minutes.

She has found a fulfilling career and built good relationships with colleagues who know about her epilepsy.

“You can work,” is her advice to others with the condition. “There are a lot of people who are very accepting. If your work is fine, you will be fine.”

What to do if someone has a seizure

Tan says the first step is to stay calm and act to protect the person having a seizure. Move them away from hot water, sharp instruments and other dangerous objects.

“If the person is on the floor, if possible, turn the person to the side,” he says. This helps to keep the airway clear.

Rathakrishnan says to place a soft object under the person’s head to prevent injury if possible.

Do not attempt to restrain the person or give them water or medication until they are fully alert.

Both doctors say not to put anything in the person’s mouth. Doing so increases the risk of injury.

Patients should be monitored during the seizure and not left unsupervised.

Tan says to note the duration of the seizure and what is happening.

“Call for an ambulance if the seizure does not self-terminate within five minutes,” he says. Most seizures end on their own within two minutes. A seizure that lasts for more than five minutes may put the person at risk of long-term cerebral damage. It should be treated as an emergency.

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