The Social Security Administration (SSA) has revised its neurological listings, effective Sept. 29, 2016. The listing for Epilepsy has been significantly reorganized. The current listing distinguishes between convulsive epilepsy (grand mal or psychomotor) and nonconvulsive epilepsy (petit mal, psychomotor, or focal).
Under the current listing, if convulsive epileptic seizures occur monthly, in spite of three months prescribed medication, the listing is met. If nonconvulsive seizures occur as often as weekly, in spite of three months of prescribed treatment, the listing is met. To qualify as being “in treatment,” serum drug levels for the anticonvulsant medication must be in the therapeutic range.
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The revised listing distinguishes between generalized tonic-clonic seizures, dyscognitive seizures, and psychogenic nonepileptic seizures and pseudoseizures. Psychogenic nonepileptic seizures and pseudoseizures are not medically epileptic in nature, and are excluded from the neurological listing. They are assessed under the psychiatric listings.
A generalized tonic-clonic seizure is defined by a loss of consciousness accompanied by a tonic phase (sudden muscle tensing causing the person to lose postural control) followed by a clonic phase (rapid cycles of muscle contraction and relaxation, also called convulsions). If these seizures occur at least once a month for at least three consecutive months, despite adherence to prescribed treatment, the listing is met. There’s no longer a requirement that anticonvulsant medications be within the therapeutic range. This is merely one factor, among others, to consider in assessing medical treatment compliance.
A dyscognitive seizure produces alteration of consciousness without convulsions or loss of muscle control. During these seizures, blank staring, change of facial expression, and automatisms (such as lip smacking, chewing or swallowing; or repetitive simple actions, such as gestures or verbal utterances) may occur. If these occur weekly for at least three consecutive months, in spite of adherence to prescribed treatment, the listing is met.
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For both types of seizures, a new, alternative criteria, has been added. In cases of generalized tonic- clonic seizures, which occur at least once every two months for at least four consecutive months, the listing is met if there is additionally a marked limitation in one of the following: physical functioning; or understanding, remembering, or applying information; or interacting with others; or concentrating, persisting, or maintaining pace; or adapting or managing oneself. Marked simply means more than a moderate limitation, and less than extreme limitation. On a five point scale, it would be a four.
Similarly, if dyscognitive seizures occur at least once every two weeks for at least three consecutive months, and there is a marked limitation in one of those five domains, the listing is met.
This appears to be a substantial liberalization of the listing. Furthermore, logically, if the marked limitation in physical functioning; interacting; understanding information; concentrating; or managing oneself, arises from a different medical condition, it looks as if functional equivalence or medical equivalence could be easily established.
As always, at least somewhere in the medical file, there must be a very detailed description of the seizure phenomenon. That is, a description of the aura, length, and nature of the seizure. There’s no requirement for a positive EEG result, or objective abnormality on an MRI of the brain.
We advise all of our clients with seizure disorders to keep a detailed seizure diary. Use the calendar we give you, or whatever is handy, but the frequency and nature of the seizures is critical. Also, do comply with your medication regimen religiously. Even though therapeutic serum drug levels are no longer required, they are important to making your statement that the seizures cannot be controlled with medication believable.
If you need help proving your seizures qualify you for disability benefits, call our office today.