A driver's license is a passport to adulthood in the United States and many other countries. In both rural and suburban areas, driving a motor vehicle is often essential for independence and employment. Even in many urban areas, driving is needed for some jobs or to get to certain places for work or pleasure.

  • Driving is a privilege, and applicants must meet the criteria in their state to qualify for a driver's license.
  • Applicants in all states must be older than a minimum age (usually 16 or 17 years), must not have a medical disorder that would make driving dangerous, and must pass a written test, a vision test, and a driving test.

Licensing of people with epilepsy

The laws determining which medical conditions may prevent someone from driving varies from state to state.  Some states have become more liberal in recent years, basing laws on actual data about risks. This has resulted in fewer restrictions for people with epilepsy.

The laws are written to protect public safety and to grant the privilege of driving to people who are the least likely to have an accident. Even many absence or complex partial seizures while driving can be just as deadly as tonic-clonic seizures. The risk of injury or death is not restricted to the driver and passengers, but applies to pedestrians and people in other vehicles.

  • Studies have shown that the rate of motor vehicle accidents for people with epilepsy is higher than the average rate, but nowhere near the rate for those who drink and drive.
  • In some cases, accidents involving epilepsy are caused by people, especially men, who are driving without a license or who fail to report their epilepsy when applying for a license.

To get a driver's license in most U.S. states, a person with epilepsy must be free of seizures that affect consciousness for a certain period of time. The seizure-free period varies from state to state.

  • More recently, shorter intervals of seizure freedom are being required, for example 3 to 6 months.
  • While some states still require a period of at least 1year seizure free, most consider exceptions that would permit someone to drive after a shorter seizure-free interval.
  • Usually, the doctor who cares for the person with epilepsy must fill out a form stating the date of the last seizure, type and other relevant information. Some states ask for the doctor’s recommendation about the person’s ability to drive. Others feel that this decision should be left to the DMV, while the medical professional provides the epilepsy information.
  • In states that do not require a specific seizure-free period, the doctor's recommendation may carry considerable weight.

The review and decision process

In most states, the medical information and license application is reviewed by the state's department of motor vehicles (DMV). In complex cases or when the decision is not clear, the information is usually forwarded to a consulting doctor or the state's medical advisory board. A medical advisory board may also hear appeals about denying or revoking drivers' licenses.

  • Decisions made by the motor vehicle department can be appealed by requesting an administrative hearing with the medical advisory board or another designated body. If the administrative decision is not favorable, the applicant can request a review by a judge. These requests must be made within a certain time period.

Some states may allow someone with seizures to drive with certain restrictions. This may allow someone to drive under certain conditions, such as during the daytime only, to and from work or within a certain distance from the home, or only during an emergency. Situations that may be considered for restricted licenses may include: 

 

  • Seizures that do not affect consciousness, awareness or control of movement.
  • Seizures occur only during sleep.
  • Seizures that are consistently preceded by an aura.
  • Seizures are restricted to a certain time of the day (such as within an hour after awakening).
  • A change in seizures occurred only when seizure medicines have been reduced or stopped on the advice of a doctor.

Commercial driver's licenses

The US Department of Transportation (DOT) allows people with a history of epilepsy who have been seizure free off medication for 10 years to obtain a commercial driver’s license (CDL). People with epilepsy can not get a CDL if they have…

  • Ongoing seizures
  • Seizure free but taking seizure medication

There may be other restrictions, depending on a person’s risk and laws may vary state to state. Check your state DMV for up-to-date laws and how to apply for a CDL.

Maintaining a driver's license

  • If a person has been well-controlled (meaning no seizures) for more than 3 to 5 years, most states will no longer require periodic medical reports.
  • When a person has to renew their driver’s license, however, they may be asked for a letter from their doctor or treating health care professional stating the date of the last seizure or other information.
  • Check with your state DMV for information required at time of license renewal.
  • Please note that not reporting seizures at this time may leave you open to liability issues. Additionally, if you signed a form stating that you did not have seizures or epilepsy, when in fact you do, then you could have an invalid driver’s license.
  • Some states require periodic medical reports from people with epilepsy who have a driver’s license.  These reports may request information about the date of the last seizure or other factors that may affect driving.

Regardless of the reporting requirements, if seizures recur and impair consciousness or control of movement…

  • Stop driving and talk to your doctor.
  • Your health and ability to drive will need to be re-evaluated.
  • If a driver's license is revoked because of a breakthrough seizure under certain circumstances (reduction of medication on a doctor's advice or unusual stress such as the death of a loved one, for instance) the driver may appeal the decision. Evidence that the person takes the prescribed medications is often required.  

Potential liability and physician reporting

Personal Liability: A person with epilepsy may be civilly or criminally liable for a motor vehicle accident caused by seizures. Liability may occur when a person drives…

  • Against medical advice,
  • Without a valid license,
  • Without notifying the state department of motor vehicles of the medical condition, or with the knowledge that he or she is prohibited from driving.

Mandatory Physician Reporting:  Some states (California, Delaware, Nevada, New Jersey, Oregon, and Pennsylvania) have "mandatory reporting laws".

These laws require doctors and other treating health care providers to report persons with active epilepsy and other disorders that may make driving hazardous.  These laws generally order the doctor to notify the department of motor vehicles of the person's name, age, and address.

  • In these states, doctors may be liable for negligence if they fail to report a person with epilepsy who is later involved in a motor vehicle accident.
  • In states without such laws, however, the question of whether a doctor should report a patient who may be driving unsafely presents a difficult conflict between public safety and the doctor's need to respect the privacy of the patient. In theory, a physician who reports a patient's condition could be sued for disclosing confidential information.

There are some important situations regarding mandatory reporting:

  • When a doctor must report someone may be unclear and vary between states that require physician reporting. For example, do all patients with epilepsy have to be reported to the DMV, those with uncontrolled seizures, or those who may have specific risks or situations?
  • Mandatory reporting can destroy the doctor-patient relationship. In many cases, those who believe that they "must" drive will lie to the doctor about their condition in order to avoid mandatory reporting and potential loss of the driver's license. This is the worst of both worlds: the person is not receiving the best medical care and is driving. If the doctor and patient can work together, the seizures are likely to be better controlled, and the person can drive more safely.
  • If a physician fails to report a patient under mandatory reporting laws, they can be penalized with a monetary fine. However, an accident can lead to a lawsuit charging wrongful death or injury, with a large judgment against the doctor. In states that require mandatory reporting, compliance varies widely among doctors.
  • Doctors who state that it is safe for a person with epilepsy to drive and recommend licensure could also face some liability in case of an accident, although it appears to be minimal. Doctors should not be liable for recommendations made to the department of motor vehicles if their opinions are reasonable and consistent with good medical care. Some states grant immunity from liability to doctors who make recommendations about driving privileges.

 

Authored by: James W. Wheless, MD | Patricia O. Shafer, RN, MN | Joseph I. Sirven, MD on 9/2013
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