by Robert S. Fisher, M.D., Ph.D.
Editor-in-Chief

In the United States, the automobile crash rate among people with epilepsy is about 50% higher than baseline, but still lower than is the crash rate for teenage male drivers. Automobile license restrictions are a form of discrimination against people with epilepsy. According to the San Jose Mercury News on 9/29/06, 15,126 California driver’s licenses were suspended for lapses of consciousness. The next most common category for suspension had less than 6,000 suspensions. Nevertheless, most reasonable members of the public agree that people with uncontrolled seizures should not drive. That opinion has been reinforced by an unfortunate series of horrific individual seizure-related crashes.

How do we come to a reasonable balance on determining when people with epilepsy can drive? Long ago, there was a lifelong ban on driving for anyone who had seizures. Then, the ban was relaxed for people whose seizures have been in control for five years; later two years, one year, six months and even three months. The three-month seizure-free interval was recommended in a consensus conference of the Epilepsy Foundation, American Epilepsy Society and the American Academy of Neurology, in which the current columnist participated. The rationale was that three months of freedom from seizures mostly separates those having frequent seizures from those having infrequent seizures. No time limit ever completely eliminates a risk for a crash. Different states in the United States and different countries utilize different seizure-free intervals. In the United States, various epilepsy specialists may recommend a driving pause of anything between three and twelve months, but the State agencies make the final determination. Most driving agencies have medical advisory boards to consider individual factors in the licensing determination. For example, people with prolonged and consistent warnings (auras), people whose seizures are too minor to affect driving, individuals with an established pattern of seizures only during sleep, or a seizure from a cause that is not likely to repeated, may be given a license by some states. The DMV is a state bureaucracy and moves slowly, which can add unintended time to a period of suspension.

How does the DMV know that someone has had a seizure? Because they are notified by a person with epilepsy, that person’s family or friends, the police or public safety officials at the scene of an accident or the patient’s doctor. In 44 states of the US, it is the patient's responsibility to report seizures. Six states: California, Nevada, Oregon, Pennsylvania, Delaware and New Jersey, mandate physician reporting of seizures. This misguided policy not only impairs the patient-physician relationship, but also has the counterproductive effect of causing people to conceal their seizures from their doctors. Twice recently in California, the State legislature voted to overturn this reporting requirement, but both times the change was vetoed by the governor. Independent of state regulations, it is a good idea for a physician to discuss driving and other safety risks with a patient who has seizures, and to document that discussion in the chart.

Some people drive more than others or drive more dangerous vehicles. Special rules apply to licensing for school buses, heavy trucking, transport of hazardous materials or interstate trucking. The interstate commercial drivers license, for example currently requires a minimum of 10 years seizure free off anti-seizure medications. People who drive professionally (cab driver, highway patrol, limousine drivers) should be seizure-free for longer than is the usual rule, even when driving with an ordinary license.

Some people with epilepsy recognize circumstances in which it is not safe to drive even when it is legal. Doing so is smart. The time after missing medications or lowering them on a doctor's recommendation is such a period of high risk. Times after missing sleep, consuming significant amounts of alcohol or being under extreme emotional stress may also be times to self-limit driving.

Here are some suggestions. 1. If your seizures are not in control and are of a type that might present a danger on the road, then do not drive. 2. Be honest with your medical care team about your seizures, even in the states that require doctors to report loss of consciousness episodes. Your doctor cannot help you to control your seizures without notification that you are having them. 3. Drive legally. The consequences of driving without a license or without a proper license can be severe. 4. Support the Epilepsy Foundation and other organizations to make driving laws and regulations fairer, clearer and more uniform. For more information on driving see our video on driving.