Blog #53: New Studies: When Is It Safe to Drive With Epilepsy?

(This blog was originally posted on December 26, 2014)

 

 

 

 

 

            “I get an aura, a warning before my epileptic seizure, so that protects me and I can pull my car over and avoid an accident.” That’s what some people with epilepsy believe. Can these patients truly protect themselves and the driving public? There’s not enough information to make an accurate decision.

            An article in the December 4, 2014 issue of Neurology Today reviewed studies reported at the 2014 American Epilepsy Society Annual Meeting. The article concluded that neurologists and law-makers need to rethink current recommendations about driving with epilepsy. The American Academy of Neurology previously considered auras―“warnings”—that were consistent and prolonged to be a favorable feature in sanctioning a driving license. Recent studies question this belief: the aura did NOT protect the driver from an accident. Accident rates in people who have auras were similar to patients who did not have auras.

            In their study, patients underwent continuous video-EEG monitoring at the Yale Epilepsy Center while simulating “driving” on portable computer-based driving simulators, complete with brakes, gas, and a steering wheel. Researchers found that patients with longer seizures and seizures that led to a loss of consciousness were more likely to “crash” their vehicles in the simulated test compared to patients with other types of seizures without loss of consciousness (e.g., simple partial seizures). The research showed clearly that people who lose consciousness or have serious impairments in their movements during a seizure should not drive until treatment controls their seizures. Other patients whose EEG showed epileptiform discharges (these correlate with altered brain neuron-cell function) that did not alter consciousness or have other symptoms (subclinical EEG discharges) had vague, imprecise effects on driving. However, and very significantly, many patients who had lost consciousness did not know that their awareness was impaired during the “subclinical” EEG discharges when queried by the researchers.

            Some states leave the important decision of when to allow driving in people with epilepsy up to the neurologist. But in six states, California, Oregon, Nevada, Pennsylvania, New Jersey and Delaware, the state’s Department of Motor Vehicles makes the ultimate decision utilizing the physician’s—not necessarily a neurologist―input.

            With imprecise ability to determine if consciousness is preserved or not, neurologists need to be cautious in deciding whether a person who has epilepsy can drive safely. As noted above, there is still not enough information to make a highly accurate, sound decision about this important safety issue.

 

 

Lance Fogan, M.D. is Clinical Professor of Neurology at the David Geffen School of Medicine at UCLA. DINGS is his first novel. It is a mother’s dramatic story that teaches epilepsy.