L’emploi figure parmi les premières préoccupations des personnes épileptiques ; or, celles-ci se heurtent à un taux de chômage particulièrement élevé en cas de pharmaco-résistance. Toutefois, la persistance des crises ne résume pas à elle seule les obstacles à l’insertion socio-professionnelle, qui peuvent aussi comprendre des perturbations des fonctions cognitives, des difficultés psycho-comportementales, ou encore un déficit des acquisitions scolaires et de qualification professionnelle lorsque l’épilepsie pharmaco-résistante a débuté dès l’enfance. La chirurgie de l’épilepsie, dont la mission est de faire disparaître les crises, peut ne pas contribuer de façon déterminante, tout du moins à court ou moyen terme, à l’insertion socio-professionnelle qui reste dépendante de la conjugaison de l’ensemble de ces facteurs. La prise en charge médico-sociale se doit de prendre en compte ces éléments propres au patient, mais aussi des éléments extérieurs : famille, neurologue et/ou médecin traitant, milieu scolaire, employeur, médecin du travail. Les principales mesures et procédures d’accompagnement médico-scolaire et médico-social sont évoquées. Notre expérience de travail coopératif « de terrain », dans la durée, entre neurologue, médecin du travail, et structures d’insertion, illustre l’utilité d’un accompagnement personnalisé de la personne épileptique depuis son élaboration d’un projet jusqu’à son insertion.

While employment appears to be among major concerns for epileptic patients, these are confronted with a very high rate of unemployment, especially when epilepsy is pharmacoresistant. However, the persistence of seizures is not the only factor bearing on vocational training or employment; other factors may intervene as well: cognitive dysfunctions, psychological/behavioral disturbances, impact of AEDs, education, vocational training, family members and relatives’ attitude, school teams’ attitude, employers’ attitude, occupational physicians’ attitude. Educational level is lower when epilepsy started at school-age; persisting seizures together with other problems may lead the epileptic child or teenager to attend specialized schools. In France, there are few institutions dedicated to children or teenagers with severe epilepsy, and these are very unevenly distributed over the French territory. The main social measures regarding children with epilepsy in France are mentioned. Besides being seizure-free and able to drive, work is one major expectation of patients from epilepsy surgery. The results of epilepsy surgery regarding employment are somewhat controversial; in some studies, temporal lobe surgery may not raise the employment rate; other studies point out that operated-on patients need a long time (up to 6 years) to find a job after surgery. The vocational level or the previous work experiences appear to be as important factors for further employment as being seizure-free, a condition which may not be met in all favourable work outcomes. The medico-social support to patients with pharmacoresistant partial epilepsies has to deal with all the factors mentioned previously; the opportunity for epilepsy surgery may have to be considered early in order to try and prevent the detrimental impact of pharmacoresistant epilepsy on school achievement and vocational training; adult patients with pharmacoresistant epilepsy often cumulate a low qualification level, an absence of a solid work experience, a lack of motivation and a social deprivation… Neurologists may have an insufficient knowledge of social and work regulations: in this paper we describe the main possibilities for epileptic patients to obtain social supports in France. Likewise, occupational physicians seldom know much about epilepsies… We have a positive experience of a multidisciplinary approach combining neurologists, occupational physicians and insertion teams. We are convinced that a personalized follow-up of the epileptic person is useful and often.