Epilepsy and Driving
Epilepsy News From: Wednesday, August 26, 2015
Driving a car is so critical to employment, socialization, and self-esteem that people with epilepsy list it as one of he main concerns. Physicians, patients, and regulators share the responsibility of protecting the public, while still providing reasonable opportunity for individuals with seizures to drive a car.
Do people with epilepsy have more accidents than the general population?
A study estimated that people with epilepsy have an accident rate of between 1.13 and 2.16 times that of normal subjects. However, the rate of fatal accidents in people with epilepsy is lower than the highest-risk groups, such as young drivers and those who abuse alcohol.
What type of seizures are more risky?
Seizures with motor and visual impairment, and of course those with loss of consciousness, may pose greater risk than others.
Could auras be a protective factor?
In theory, having a warning should allow a person with epilepsy to pull off the road before an impending seizure, but it is not completely clear that reliable auras make driving safer.
Should psychogenic non-epilepsy seizures (PNES) have the same restrictions?
People with PNES may experience events while driving, although these events are less likely than epilepsy seizures to result in a crash. Strictly speaking, the laws for epilepsy do not apply here, but since PNES can be just as disabling as epilepsy seizures, physicians usually make individual decisions depending on their preferences and the particular person.
What are the restrictions for people with epilepsy to get 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. In some states, this period can be shorter if under doctor´s supervision. The need for reporting to the state Department of Motor Vehicles (DMV) also varies. Only very few states have mandatory reporting, which has pros and cons. Driving regulations change, so it is best to verify them on updated sources, such as the epilepsy.com State Driving Laws Database. For example, Florida recently changed the seizure-free period from 6 months to 12 months.
What are the restrictions in other countries?
In Germany, in heavy cases the period of time is 2 years seizure free. People with seizures that do not involve motor activity are not disqualified from driving. In France, the required seizure-free period is 2 years, but this may be reduced at the advice of a physician. In Australia, people must be seizure-free for 3 to 6 months for recently diagnosed seizures, and 2 years for chronic epilepsy (exact laws vary by state). In other countries like China and India, anyone who has ever had a seizure is prohibited from driving.
What is coming?
Driving simulators have been used to capture driving performance data in populations with risk factors such as epilepsy, and in the future this may play a role.
Nowadays, driving safety in epilepsy relies on regulations and medical advice. Better evidence strengthens the ability of physicians and regulators to provide appropriate advice and may help remove driving restrictions for those who pose little risk to themselves and others.
Chen, William C. et al.Epilepsy and driving: Potential impact of transient impaired consciousness. Epilepsy & Behavior 2014; 30: 50 – 57.
Epilepsy and Driving Regulations Explored in Three Studies at American Epilepsy Society Annual Meeting. December 7, 2014.
Odie WW, et al International Regulations for automobile driving and epilepsy. J Travel Med 2000; 7:1-4
Benbadis SR, et al. Should patients with psychogenic nonepileptic seizures be allowed to drive? Epilepsia. 2000 Jul;41(7):895-7.
Authored by Carolina Cuello Oderiz MD of Servicio de Neurología de Adultos, Hospital Italiano de Buenos Aires
Carolina Cuello Oderiz MD
Selim Benbadis MD
Wednesday, August 26, 2015