Blog #28: One Out of Every Twenty-Five American Drivers Has Epilepsy

(This blog was originally posted on November 9, 2012)

 

 

 

 

        There are 180 million drivers operating motor vehicles in the United States of America. Nearly one in twenty-five has epilepsy. These data appear in “Seize and Desist: The Ethics and Legality of Reporting Epileptic Drivers,” by Dr. Joseph S. Kass and medical student Jennifer Wax. Dr. Kass is also an attorney at law. The article appears in the November 1, 2012 edition of Neurology Today.

            The authors discuss a study: two-hundred-thirteen respondents with epilepsy completed a self-assessment driving questionnaire. It revealed that, in order to drive, nineteen percent were not candid with their physicians concerning their seizure-frequency. Nearly twenty-six percent of the drivers completing the questionnaire reported that they were in—and survived—a seizure-related motor vehicle accident (1).

            California is one of six states (Delaware, Nevada, New Jersey, Oregon and Pennsylvania are the others) that mandate by law that physicians report patients with epilepsy to the state health department. The health department then notifies the Department of Motor Vehicles (DMV). The DMV sends forms to be completed by the patients and their physicians with questions regarding the diagnosis and symptoms that could interfere with the safe operation of a motor vehicle. Once the DMV has the information, it’s the DMV—not the physician—that makes the decision to allow the driving privilege or not. After a variable duration of observation to determine if the seizures are controlled (usually 6 to 24 months) the DMV may, or may not, decide to return the driving privilege, i.e., the driving license.

            I have followed patients with epilepsy who have regained their driving privileges because the DMV considered them to now be safe to drive. In the course of my caring for them, I ask, “Have you had any seizures?” Knowing the implications of their answer, many patients said, “And, if I tell you, Doctor, will you have to report anything to the DMV?” When I respond, “Yes,” patients have told me, “No, I’m doing fine.” My hands were tied. I couldn’t make medication adjustments to try to gain better control for them since “no seizures have broken through” their current treatment. In those situations, my clinic notes indicated, “Patient reports: seizure free.” If I learned that seizures occurred and I didn’t report it, victims of any of their seizure-induced accident in California could successfully sue me. The other 44 states do not require physician-reports. In fact, Kass and Wax note in Neurology Today, physicians can be sued in Arkansas and Georgia because they reported epileptic patients; the physicians breached the patients’ rights to confidentiality.

            Studies have shown that mandatory reporting of epilepsy patients to DMVs does not necessarily contribute to reduced numbers of crashes (2). Krauss, et al. found that patients with epilepsy who have been seizure-free for a minimum of 12 months, and who have been in compliance with their anti-seizure medication regimen, have a very low risk for causing a motor vehicle accident due to seizures (3).

            Kass and Wax comment on patient autonomy, a key principal in medical ethics (“ethics” equates with “doing the right thing.”). Patients have the right to accept or refuse treatment and testing. The dilemma arises when other peoples’ well-being and safety are impacted by the patient’s choice, e.g., driving with uncontrolled epilepsy.

            The medical ethics and the legal responsibilities involved in the subject of driving with epilepsy is a complicated topic that Kass and Wax address in their article.

 

(1)   Elliott JO. Perceived risk, resources, and perceptions concerning driving and epilepsy: a patient perspective. Epilepsy Behav. Aug 1, 2008; vol 12 (2): 381-6.

(2)   Classen S, Crizzle AM, et al. Evidence-based review on epilepsy and driving. Epilepsy Behav. 2012; 23(2); 103-112.

(3)   Krauss A, Krumholz RC, et al. Risk factors for seizure-related motor vehicle crashes in patients with epilepsy. Neurology. April 1, 1999: 52; 1324-29.

 

 

Lance Fogan, M.D. is Clinical Professor of Neurology at the David Geffen School of Medicine at UCLA. DINGS is his first novel.