Statement of Principles concerning seizure(Balance of Probabilities) (No. 38 of 2022) (Cth)

Statement of Principles concerning SEIZURE (Balance of Probabilities) (No. 38 of 2022) The Repatriation Medical Authority determines the following Statement of Principles under subsection 196B(3) of the Veterans' Entitlements Act 1986.

Dated 29 April 2022

The Common Seal of the Repatriation Medical Authority was affixed to this instrument at the direction of:

Professor Terence Campbell AM Chairperson

Contents 1 Name 2 Commencement 3 Authority 4 Repeal 5 Application 6 Schedules 7 Kind of injury, disease or death to which this Statement of Principles relates 8 Basis for determining the factors 9 Factors that must exist 10 Relationship to service 11 Factors referring to an injury or disease covered by another Statement of Principles Schedule 1 - Dictionary 1 Definitions Schedule 2 - Drugs 1 Specified drugs

1 Name This is the Statement of Principles concerning seizure(Balance of Probabilities) (No. 38 of 2022). 2 Commencement This instrument commences on 30 May 2022. 3 Authority This instrument is made under subsection 196B(3) of the Veterans' Entitlements Act 1986. 4 Repeal The Statement of Principles concerning epileptic seizure No. 78 of 2013 (Federal Register of Legislation No. F2013L01899) made under subsection 196B(3) of the VEA is repealed. 5 Application This instrument applies to a claim to which section 120B of the VEA or section 339 of the Military Rehabilitation and Compensation Act 2004 applies. 6 Schedules Any item in a Schedule to this Instrument has effect according to its terms. 7 Kind of injury, disease or death to which this Statement of Principles relates (1) This Statement of Principles is about seizure and death from seizure. Meaning of seizure (2) For the purposes of this Statement of Principles, seizure: (a) means an acute, nonrecurring episode of paroxysmal brain dysfunction due to sudden, abnormal, excessive neuronal discharge manifesting as seizure; and (b) includes status epilepticus; and (c) excludes: (i) movement disorders such as restless legs syndrome, periodic limb movement disorder, chorea and tics; (ii) muscle dystonia or spasms associated with tetanus, drugs or chemical poisons; (iii) psychogenic seizures; (iv) seizures occurring during electroconvulsive therapy; and (v) spontaneous movements occurring with syncope, vertigo or migraine. Death from seizure (3) For the purposes of this Statement of Principles, seizure, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's seizure. Note: terminal event is defined in the Schedule 1 – Dictionary. 8 Basis for determining the factors On the sound medical‑scientific evidence available, the Repatriation Medical Authority is of the view that it is more probable than not that seizure and death from seizure can be related to relevant service rendered by veterans or members of the Forces under the VEA, or members under the MRCA. Note: MRCA, relevant service and VEA are defined in the Schedule 1 – Dictionary. 9 Factors that must exist At least one of the following factors must exist before it can be said that, on the balance of probabilities, seizure or death from seizure is connected with the circumstances of a person's relevant service: (1) having a moderate to severe traumatic brain injury within the 10 years before the clinical onset of seizure; (2) having concussion within the 3 months before the clinical onset of seizure; (3) having an electrical injury of the brain before the clinical onset of seizure; Note: Electrical injury of the brain excludes transcranial magnetic stimulation and electroconvulsive therapy. (4) having a surgical procedure which involves a craniotomy or cranioplasty within the 10 years before the clinical onset of seizure; (5) having cardiac surgery or extracorporeal membrane oxygenation at the time of the clinical onset of seizure; (6) having brain radiotherapy to treat primary or secondary brain neoplasia or to treat brain arteriovenous malformation before the clinical onset of seizure; (7) having an hypoxic cerebral insult within the 30 days before the clinical onset of seizure; Note: hypoxic cerebral insult is defined in the Schedule 1 – Dictionary. (8) having a central nervous system vascular lesion from the specified list of central nervous system vascular lesions within the 10 years before the clinical onset of seizure; Note: specified list of central nervous system vascular lesions is defined in the Schedule 1 – Dictionary. (9) having autoimmune encephalitis at the time of the clinical onset of seizure; Note 1: Examples of diseases that can cause autoimmune encephalitis include granulomatosis with polyangiitis (Wegener granulomatosis), Hashimoto encephalopathy, multiple sclerosis, neuromyelitis optica, paraneoplastic neurological syndrome and systemic lupus erythematosus. Note 2: autoimmune encephalitis is defined in the Schedule 1 – Dictionary. (10) having an infection of the brain or meninges within the 6 months before the clinical onset of seizure; (11) having infection with human immunodeficiency virus at the time of the clinical onset of seizure; (12) having septicaemia at the time of clinical onset of seizure; (13) having an intracranial space-occupying lesion within the 10 years before the clinical onset of seizure; Note: intracranial space-occupying lesion is defined in the Schedule 1 – Dictionary. (14) having dementia as specified at the time of the clinical onset of seizure; Note: dementia as specified is defined in the Schedule 1 – Dictionary. (15) having a medical condition affecting the brain from the specified list of medical conditions at the time of the clinical onset of seizure; Note: specified list of medical conditions is defined in the Schedule 1 – Dictionary. (16) having alcohol intoxication, alcohol withdrawal or moderate to severe alcohol use disorder, at the time of the clinical onset of seizure; Note: alcohol intoxication, alcohol withdrawal and moderate to severe alcohol use disorder are defined in the Schedule 1 – Dictionary. (17) having malignant hypertension or hypertensive encephalopathy within the 4 weeks before the clinical onset of seizure; Note: malignant hypertension is defined in the Schedule 1 – Dictionary. (18) having eclampsia within the 4 weeks before the clinical onset of seizure; Note: eclampsia is defined in the Schedule 1 – Dictionary. (19) having acute liver failure at the time of the clinical onset of seizure; (20) having acute renal failure or chronic renal failure at the time of the clinical onset of seizure; Note: acute renal failure and chronic renal failure are defined in the Schedule 1 – Dictionary. (21) having an amniotic fluid embolism or fat embolism at the time of the clinical onset of seizure; (22) having hypoglycaemia at the time of the clinical onset of seizure; Note: hypoglycaemia is defined in the Schedule 1 – Dictionary. (23) having hyperglycaemia at the time of the clinical onset of seizure; Note: hyperglycaemia is defined in the Schedule 1 – Dictionary. (24) having diabetes mellitus at the time of the clinical onset of seizure; (25) having an electrolyte abnormality at the time of the clinical onset of seizure; Note: electrolyte abnormality is defined in the Schedule 1 – Dictionary. (26) having carbon monoxide poisoning within the 30 days before the clinical onset of seizure; (27) having sleep deprivation at the time of the clinical onset of seizure; Note: sleep deprivation is defined in the Schedule 1 – Dictionary. (28) having exertional heat stroke at the time of the clinical onset of seizure; (29) being dehydrated at the time of the clinical onset of seizure; (30) undergoing organ or tissue transplantation, excluding corneal transplant, within the 6 months before the clinical onset of seizure; Note: organ or tissue transplantation is defined in the Schedule 1 – Dictionary. (31) taking a drug specified in the Schedule 2 - Drugs of this Instrument, within the 24 hours before the clinical onset of seizure, and if multiple seizures occur, the first seizure occurred within 24 hours of taking the drug; (32) taking a drug which is associated in the individual with: (a) the development of a seizure within 24 hours of first taking the drug; and (b) the redevelopment of a seizure on rechallenge with the same drug; (33) being exposed to radiographic contrast media within the 24 hours before the clinical onset of seizure, and if multiple seizures occur, the first seizure occurred within 24 hours of exposure to the radiographic contrast media; Note: Examples of radiographic contrast media include meglumine carbamate, metrizamide and iohexol. (34) reducing the intake of, or withdrawing from, a chronically administered sedative drug within the 2 weeks before the clinical onset of seizure; Note: sedative drug is defined in the Schedule 1 – Dictionary. (35) being exposed to partial pressures of oxygen above 1.2 atmospheres absolute (120 kPa) from: (a) breathing oxygen enriched air during diving; (b) receiving hyperbaric oxygen therapy; (c) saturation diving; or (d) the use of closed or semi-closed rebreathing apparatus; within the 24 hours before the clinical onset of seizure; (36) being exposed to an abrupt reduction in the pressure of the air surrounding the person, resulting in the development of cerebral arterial gas embolism or decompression sickness, within the 24 hours before the clinical onset of seizure; (37) being poisoned with a metal from the specified list of metals, as demonstrated by clinical, haematological or biochemical evidence of such poisoning, at the time of the clinical onset of seizure; Note: specified list of metals is defined in the Schedule 1 – Dictionary. (38) inhaling, ingesting or having cutaneous contact with a neurotoxic substance, or a food or compound containing a neurotoxic substance, within the 24 hours before the clinical onset of seizure, and: (a) other signs and symptoms of poisoning are present; and (b) if multiple seizures occur, the first seizure occurred within 24 hours of exposure to the neurotoxic substance; Note: neurotoxic substance or a food or compound containing a neurotoxic substance and signs and symptoms of poisoning are defined in the Schedule 1 – Dictionary. (39) experiencing animal envenomation within the 24 hours before the clinical onset of seizure; (40) inability to obtain appropriate clinical management for seizure. 10 Relationship to service (1) The existence in a person of any factor referred to in section 9, must be related to the relevant service rendered by the person. (2) The factor set out in subsection 9(40) applies only to material contribution to, or aggravation of, seizure where the person's seizure was suffered or contracted before or during (but did not arise out of) the person's relevant service. 11 Factors referring to an injury or disease covered by another Statement of Principles In this Statement of Principles: (1) if a factor referred to in section 9 applies in relation to a person; and (2) that factor refers to an injury or disease in respect of which a Statement of Principles has been determined under subsection 196B(3) of the VEA; then the factors in that Statement of Principles apply in accordance with the terms of that Statement of Principles as in force from time to time.