Medical Underwriting Corner: Epilepsy

Epilepsy is a condition in which the brain’s electrical activity becomes abnormal, resulting in a seizure “episode”. During an “episode” unusual behavior such as body movements and loss of awareness may occur.

Seizures are classified by the description of the seizure activity and are divided into two general categories:  Focal onset and Generalized onset.

Focal seizures involve only a part of the brain, whereas generalized seizures involve all parts of the brain.

Some different types of seizures are listed below:

• Focal seizures with retained awareness (previously called Simple partial seizures).
• Focal seizures with impaired awareness (previously called Complex partial seizures)
  • Both types of focal seizures may progress over several seconds into generalized seizures; a subtype called Tonic-clonic seizures. This is called a secondarily generalized seizure.
• Generalized Tonic-clonic seizures (aka Grand mal seizures).
• Another subtype of Generalized seizures: Absence seizures (previously called Petit Mal).

In many cases, the cause of the seizures cannot be identified, but there are some factors that are known to increase the risk for seizures.

These factors can include: Head trauma, brain abnormalities (brain tumors, brain scars, vascular malformations, strokes), infections, and metabolic disturbances (very low blood glucose or other electrolyte abnormality, alcohol or drugs, certain medications).

Common diagnostic tests done to investigate seizures are:

• Electroencephalogram (EEG) with or without Video Monitoring
  • EEG monitors brain wave activity and is used to detect seizure activity
• Brain CT or MRI to investigate whether an abnormality in the brain, such as a brain tumor or a scar may be causing the seizures

The treatment of epilepsy focuses on controlling the seizures with medications appropriate for the type of seizure, monitoring for medication side effects, avoiding known triggers of the seizures, and maintaining or restoring quality of life.

Commonly used anti-seizure medications include:

• Phenytoin (Dilantin)
• Valproate (Depakote, Depakene)
• Carbamazepine (Tegretol)
• Lamotrigine (Lamictal)
• Topiramate (Topamax)
• Levetiracetam (Keppra)
• Phenobarbital

To underwrite epilepsy for life insurance, the underwriter will need to know the type of seizure, the cause (if known) and the frequency. Also taken into consideration are the control of the seizures, results of neurologic testing, and compliance with treatment.  The best offer is made according to underwriting guidelines.