Epilepsy refers to a recurrent paroxysmal disorder of cerebral function. Diencephalic epilepsy arises from the midbrain area or the diencephalon. This area contains the thalamus and hypothalamus. Diencephalic seizures may be classified as partial seizures, either simple or complex.

Partial seizures are often associated with structural abnormalities of the brain. There may be other conditions that influence the threshold for seizure occurrence, such as genetic factors or maturational brain development. Many cases are idiopathic.

Simple-partial seizures cause symptoms in motor, sensory, autonomic, or psychic areas. Patients with a simple-partial seizure may experience sensations for minutes to hours after the episode. There may be changes in somatic sensation such as: seeing flashing lights, vertigo, flushing, or sweating. There may also be alterations in smelling, or hearing. Odd feelings of fear, of detachment, and of things appearing smaller or larger may also occur. If these feelings precede a generalized seizure, they are called an aura. Persons experiencing a complex-partial seizure often start with an aura, a fixed stare, and automatic behaviors, such as swallowing, chewing, and hand-picking movements. There is no verbal response during this period and no recollection of the event. Partial seizures can spread to a generalized seizure (see Diagnostic Code: 8910 Epilepsy, grand mal).

A history is among the first diagnostic measures done to determine if the patient had a seizure. Physical examination; blood laboratory studies of electrolytes, glucose, calcium, and magnesium; and liver and renal tests are usually done. A lumbar puncture may be indicated. An electroencephalogram (EEG) is usually done as soon as possible. Magnetic resonance imaging (MRI), and computed tomography (CT) scan are also used in evaluation of seizure activity.

Because there are many different types of epilepsy, therapy is aimed at the underlying condition that may be causing the seizure. Antiepileptic drug therapy is the basic treatment. Patients should be encouraged to avoid factors that lower the threshold for seizures and produce seizures (alcohol, sleep deprivation, or specific stimuli such as video games).

Long-term use of antiepileptic drugs may produce side effects that are unwanted such as hirsutism, gum hypertrophy, coarsening of facial features, liver problems, leukopenia, or aplastic anemia. Studies also suggest that persons who have been partial seizure-free for three to five years on medication may discontinue therapy with supervision. If seizure activity is going to recur, it usually happens in the first three months after discontinuing therapy.

• This disease shall be granted service connection although not otherwise established as incurred in or aggravated by service if manifested to a compensable degree within the applicable time limits under 38 CFR 3.307 following service in a period of war or following peacetime service on or after January 1, 1947, provided the rebuttable presumption provisions of 38 CFR 3.307 are also satisfied. [38 CFR 3.309]

• Rating Specialists must bear in mind that the epileptic, although his or her seizures are controlled, may find employment and rehabilitation difficult to attain due to employer reluctance to the hiring of the epileptic.

• Where a case is encountered with a definite history of unemployment, full and complete development should be undertaken to ascertain whether the epilepsy is the determining factor in his or her inability to obtain employment.
• When rating grand mal epilepsy, the primary factor for rating severity is the frequency of seizures and not the severity of the seizures.
• A diagnosis of epilepsy must be confirmed/verified by a medical doctor. This does not mean that the MD has to personally witness a seizure but that he has to have enough medical evidence to make, confirm, or verify the diagnosis.
• Psychiatric disorders secondary to epilepsy should be rated separately.
• May be entitled to special monthly compensation where the Veteran has a single service-connected disability rated as 100% with additional service-connected disability or disabilities independently ratable at 60% or more, which are separate and distinct from the 100% service-connected disability and involves different anatomical segments or bodily systems. See 38 CFR 3.350(i)(1) – Total plus 60% – Special Monthly Compensation (SMC).

• A major seizure is characterized by the generalized tonic-clonic convulsion with unconsciousness.

• A minor seizure consists of a brief interruption in consciousness or conscious control associated with staring or rhythmic blinking of the eyes or nodding of the head (“pure” petit mal), or sudden jerking movements of the arms, trunk, or head (myoclonic type) or sudden loss of postural control (akinetic type).

• When continuous medication is shown necessary for the control of epilepsy, the minimum evaluation will be 10%. This rating will not be combined with any other rating for epilepsy.

• In the presence of major and minor seizures, rate the predominating type.

• There will be no distinction between diurnal and nocturnal major seizures.

• A thorough study of all material in 38 CFR 4.121 and 38 CFR 4.122 of the preface and under the ratings for epilepsy is necessary prior to any rating action.