Blog #101: EPILEPSY—FIT TO DRIVE?

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

1.   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.
2. Sirven JI, Payne ET. Seizure-related crashes. Neurology; 2018: 91: 543-544.
3. 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.