Labor market participation following onset of seizures and early epilepsy: Findings from a UK cohort *Paula Holland, ySteven Lane, *Margaret Whitehead, zAnthony G. Marson, and *Ann Jacoby *Division of Public Health, University of Liverpool, Liverpool, United Kingdom; yCentre for Medical Statistics and Health Evaluation, University of Liverpool, Liverpool, United Kingdom; and zDivision of Neurosciences, University of Liverpool, Liverpool, United Kingdom SUMMARY Purpose: Previous studies have reported a consid- erable employment disadvantage among people with epilepsy. In a cohort of men and women who had experienced a single seizure or had early epilepsy at study entry we explored employment status and social mobility over 4 years and inves- tigated whether employment outcomes were more disadvantageous for certain social groups. Methods: Analyses were based on 350 individuals of working age identified via the UK Multicentre Study of Early Epilepsy and Single Seizures. Employment rates were calculated for the cohort and general population. Employment trajectories over 4 years were explored according to occupa- tional social class. The relative risk of employment was calculated by clinical features of seizures and social class. Results: Individuals with single seizures or early epilepsy had significantly lower employment rates than the general population at study entry, and 2- and 4-year follow-up. Employment rates of men and women in the cohort did not differ significantly. Although little social class mobility occurred during follow-up, there was evidence of some downward mobility between first seizure(s) and study entry. In the fully adjusted model, non- employment was predicted at all time points by having fair/poor self-rated health and experiencing four or more seizures. We observed that some individuals continued to work in hazardous occu- pations or drive professionally within a year of experiencing seizure(s). Discussion: People who have recently experienced a single seizure or who have early epilepsy are exposed to substantial employment disadvantage. Greater efforts are necessary to help these people return to work and stay employed. KEY WORDS: New-onset epilepsy, Single seizures, Employment, Social mobility, Longitudinal. Epilepsy is a disorder associated with considerable stigma and discrimination (Jacoby et al., 2004, 2005a), and for which there are clear and often major impacts on quality of life (Jacoby, 1992, 1994; Jacoby et al., 1996; Baker et al., 1997). People with epilepsy may experience considerable employment disadvantage, in terms of both unemployment and underemployment (Hauser & Hesdorffer, 1990). Reasons for this are multiple, but include the self-imposed restrictions made by people with epilepsy because of fears about having seizures and the associated risks of injury; formal sanctions that limit driv- ing status and occupational possibilities; informal stigma and discrimination on the part of employers and cowork- ers; and decrements in cognitive function associated with having seizures and taking antiepileptic drugs (AEDs) (Jacoby et al., 2005b). Several studies have reported significantly higher unemployment rates among people with epilepsy com- pared with matched controls or the general population (Collings, 1990; Callaghan et al., 1992; Beghi et al., 2000; de Boer, 2005). Experiencing frequent seizures is associ- ated with employment disadvantage (Callaghan et al., 1992; Collings & Chappell, 1994; Rätsepp et al., 2000; de Boer, 2005), although the employment rates of people Accepted August 8, 2008; Early View publication October 24, 2008. Address correspondence to Dr Paula Holland, Division of Health Research, Lancaster University, Bowland Tower East, Lancaster LA1 4YK, U.K. E-mail: p.j.holland@lancaster.ac.uk Wiley Periodicals, Inc. ª 2008 International League Against Epilepsy Epilepsia, 50(5):1030–1039, 2009 doi: 10.1111/j.1528-1167.2008.01819.x FULL-LENGTH ORIGINAL RESEARCH 1030