Epilepsy and social security: general aspects of the insured claimants and medical decisions.

BACKGROUND: Epilepsy affects adults at productive age and interferes with their ability to work. However, the granting of social security benefits to these patients has not received sufficient attention. This article aims to provide a profile of individuals with a previous diagnosis of epilepsy that file claims for social security benefits and a profile of the medical advisory decisions that support the concession of these benefits. PARTICIPANTS: A sample of thirty individuals with illness-related problems due to epilepsy was selected from the claimants that receive Social Security Incapacity/Sickness benefits. METHODS: An exploratory data analysis of the 188 Social Security medical files of the thirty claimants was performed using the clinical and epidemiological information and the medical advisory criteria. RESULTS: The mean age of the claimants was 39 years and most of them were males in jobs that do not require a lot of schooling. The first claim was filed within an average of four years of employment. On average, each worker files a claim every three months, which entitles him/her to receive incapacity/sickness benefits for seventeen months. The frequency of seizures and the medications used by the claimants were registered in 60% of the medical files. In addition, the description of the physical and neurological exam was incomplete in 50% of the files. Furthermore, 60% of the files did not include the argument or the clinical evidence that was used to justify the concession of a benefit. CONCLUSION: The medical advisory decisions on epileptic workers tend to be inconsistent, overly lenient and generally lacking in clinical evidence. The disparities among the granted benefits indicate the need for the National Social Security System to review and draft specific guidelines for epilepsy.

Epilepsia e Previdência Social: a decisão médico-pericial / Epilepsy and Social Security: the medical decision making on disability compensation

A maior dificuldade encontrada no manejo de pacientes com epilepsia frente aos seguros saúde é que, apesar de todo o aparato tecnológico de que se dispõe atualmente, o diagnóstico continua sendo predominantemente clínico, não havendo critérios objetivos na definição da incapacidade laborativa. Este ensaio tem como propósito discutir necessidades e parâmetros e apresentar uma proposta de aperfeiçoamento de relatório a ser preenchido pelo médico assistente a fim de traçar estratégias para que o perito médico defina, com maior segurança, a incapacidade laborativa em segurados portadores de epilepsia. A proposta discute aspectos relacionados a diagnóstico, tratamento e prognóstico, assim como fatores que interferem na capacidade de trabalho, visando auxiliar a decisão médico-pericial acerca da concessão ou não de benefícios.

Regarding health insurances, the major difficulty in handling patients with epilepsy is that the diagnosis is basically clinical, and there is not a totally objective criteria to define work incapacity, even with all the existing modern technology. In this essay we discuss needs and parameters, propose guidelines for the report filled up by assistant physicians, and formulate strategies to help medical experts defining work incapacity for workers with epilepsy, with a greater margin of accuracy. We discuss aspects related to diagnosis, treatment, prognosis, and list facts that can eventually interfere in the ability to work, contributing for medical experts to decide whether they should or not grant disability benefits.

ACUTE LESION OF THE MOTOR BRANCH OF THE ULNAR NERVE IN THE WRIST AFTER TUG-OF-WAR TRAINING.

Papers correlating clinical and electrophysiological findings relating to ulnar nerve lesions in the wrist are uncommon in the literature, if compared with elbow injuries. We present the case of a patient with atrophy of the intrinsic musculature of the hand, secondary to injury only of the motor branch of the ulnar nerve, which is located in Guyon's canal close to the hamate hook. We review the anatomical, clinical and neurophysiological aspects of distal ulnar nerve injuries and we emphasize the importance of multidisciplinary approaches. Specifically in relation to the mechanism of injury of this patient (tug-of-war), we did not find any similar cases in the literature. We issue an alert regarding the risks during military physical training.

Lesão aguda do ramo motor do nervo ulnar no punho após treinamento com cabo de guerra / Acute lesion of the motor branch of the ulnar nerve in the wrist after tug-of-war training

Artigos que correlacionam achados clínicos e eletrofisiológicos da lesão do nervo ulnar no punho são incomuns na literatura, se comparados com lesões no cotovelo. Apresentamos o caso de um paciente com atrofia da musculatura intrínseca da mão, secundária à lesão exclusiva do ramo motor do nervo ulnar, localizada no canal de Guyon, próxima ao gancho do hamato. Revisamos aspectos anatômicos, clínicos, neurofisiológicos da lesão do nervo ulnar, de localização distal e enfatizamos a importância da abordagem multidisciplinar. Especificamente relacionado ao mecanismo de lesão do paciente (cabo de guerra), não encontramos casos semelhantes na literatura e alertamos quanto aos riscos durante o treinamento físico militar.

Papers correlating clinical and electrophysiological findings relating to ulnar nerve lesions in the wrist are uncommon in the literature, if compared with elbow injuries. We present the case of a patient with atrophy of the intrinsic musculature of the hand, secondary to injury only of the motor branch of the ulnar nerve, which is located in Guyon's canal close to the hamate hook. We review the anatomical, clinical and neurophysiological aspects of distal ulnar nerve injuries and we emphasize the importance of multidisciplinary approaches. Specifically in relation to the mechanism of injury of this patient (tug-of-war), we did not find any similar cases in the literature. We issue an alert regarding the risks during military physical training.