In the United States of America, only the states of California, Delaware, Nevada, New Jersey, Oregon, and Pennsylvania require physicians by law to report persons with epilepsy. California mandates physicians report such patients to the state health authorities. The health department then reports such persons to the Department of Motor Vehicles (DMV). The DMV obtains information on the person’s medical condition from the patient and from the physician. The DMV decides if the license is revoked for a period of observation. If the person remains seizure-free due to effective medications or because the epilepsy has become inactive for 6-24 months the driving privilege can be reinstated. The DMV makes this decision―not the physician!
If the driving privilege is reinstated but then another seizure occurs it’s the responsibility of the patient AND of the physician to report this to the DMV for re-evaluation.
In the 44 American states that do not have a mandatory physician-reporting law, it’s up to the patient to voluntarily stop driving and to report to the DMV. Emotional constraints and ethical challenges are rife: who wants to stop driving if their livelihood depends on it and especially if there is a paucity of public transportation in their area? Some of my own patients challenged me: “Don’t send that report in, Doc. Are you going to pay my mortgage if I can’t work at my driving job?
EPILEPSY ACTION, a website in the United Kingdom (England, Scotland, Wales and Northern Ireland), advises people who have had a seizure of any kind to stop driving and report their seizure-condition to the driving agency. 1 In the UK, unlike in the United States, reporting is not necessary “on the understanding if the seizures are nocturnal, i.e., the seizures occur only during sleep. In nocturnal-type seizures in the United States physicians in those six mandatory-reporting states still must report. But, physicians may support driving for these people by stressing that their seizures occur only during sleep and not while driving―nocturnal epilepsy. Sleep lowers the resistance on seizures in people with epilepsy.
If one continues to drive in the UK they are breaking the law; significant financial fines can be levied. Car insurance is unlikely to cover the person.
Personal responsibility, ethical behavior and common sense are challenged; abiding by the law often is abandoned as a part of our common humanity.
My recent blog # 92 on this LanceFogan.com website (Citizens Influence New York State Law:Driving with Epilepsy, March 26, 2018) reviews how a deadly driving accident occurred during an apparent seizure in Brooklyn, NY in March, 2018. It led to a mandatory physician-reporting law being introduced in the New York State Legislature. If passed, New York would be the seventh American state making mandatory physician reporting of epilepsy. More lives then could be protected.
1. Epilepsy Action is a UK based charity providing information, advice and support for people with epilepsy. The organisation was founded in 1950 as the British Epilepsy Association and adopted Epilepsy Action as its working name in 2002. Epilepsyaction.org.