The United States codifies legal
restrictions regarding seizures and driving, but only six states have laws
requiring physicians to report patients with seizures to the state authorities:
California, Delaware, Nevada, New Jersey, Oregon and Pennsylvania. The other
states depend on the patients reporting their epilepsy diagnosis and status themselves
and/or ceasing to drive. A common restriction-determination used by some states
is the person should be free of seizures for three to twelve months but other
states may have different requirements. Researchers found it made little
difference if states used a three-month seizure-free period or a six-to twelve
month time frame.1
Seizure triggers such as missed medications
or sleep deprivation are more commonly associated with collisions. Crashes attributed
to generalized epilepsy are often preceded by the vehicle going out of control
from the onset, whereas those with focal epilepsy, e.g., complex partial
seizures, seventy-five percent of these crashes had a prior movement of driving
straight ahead and then veering off the road.2 This latter pattern
is suggestive of a brain focal aura followed by the spread of the epileptiform
activity throughout both cerebral hemispheres resulting in the generalized
convulsion.
Potential actions that could help
prevent driving-related seizures include optimizing morning antiseizure
medication blood levels, especially if seizures tend to occur then. Driving
with a passenger who is aware of the driver’s epilepsy and who could take
control of the wheel would help. Driverless cars offer hope, also.2
Only 1 percent of the population has
epilepsy, yet people with seizures had 2.3 times the rate of fatal driver
crashes as compared to people with heart or blood pressure problems and 4.6
times the rate for patients with diabetes.2
But, non-health problems cause most
fatal driving accidents. Between 1995-1997, an average of 86 drivers with
epilepsy died per year. Alcohol is the biggest problem accounting for 31 percent
of fatal driving accidents claiming 13,400/year on average. "The total number of deaths due to alcohol-related
fatal crashes is 6.6 times greater than the number of fatal crashes associated
with medical conditions and 156 times greater [than] those associated with
seizures." 2
Young
drivers aged 16-24 were at the wheel in 24 percent of all fatal crashes.
Fatal
driver crashes due to seizures are uncommon and this supports the current
public policy of permitting patients whose seizures are controlled to drive.3
- Drazkowski JF, Fisher RS, Sirven JI, et.al. Seizure-related motor vehicle crashes in Arizona before and after reducing the driving restriction from 12 to 3 months. Mayo Clin Proc 2003;78:819-825.
- Sirven JI, Payne ET. Seizure-related crashes. Neurology; 2018: 91: 543-544.
- Sheth, S. Neurology, September 2004; vol 63: pp 1002-1007.
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,
now available in eBook, audiobook and soft cover editions.
