Blog #92: Citizens Influence New York State Law: Driving With Epilepsy

      A few weeks ago I saw a TV report: a Brooklyn driver ran a red light and killed two children, ages four years and one year old and injuring others, including a pregnant woman — “It was something you see in a horror movie,” a witness said. The car dragged one kid’s stroller more than 350 feet at Ninth St. and Fifth Ave. in Park Slope, Brooklyn, N.Y.

      According to reports, this auto accident was caused by a driver afflicted with multiple sclerosis, seizures and a heart condition. After the accident she said she didn’t recall the red light or hitting anything. On-sight witnesses reported that she seemed oblivious to what had just happened. That strongly suggests that this person’s epilepsy caused a seizure.

      Neurologists evaluate and treat people who experience altered and loss of consciousness.  In contrast to the epilepsy type that causes falling to the ground with convulsive shaking, I had to include the non-convulsive type epilepsy as a possible cause of a person’s altered behavior. This form of epilepsy can be difficult to recognize. The non-convulsive forms include complex partial seizures and petit mal seizures. People suffering these common forms of blank-outs may walk about, converse in a confused manner, turn on water faucets and eat at a table with other people all the while they are in a mental fog—out of contact with their environment and without memory of their actions.

      Children may suffer these seizures but teachers, families and even medical workers may miss the correct diagnosis. These people may be considered to be “slow learners,” or have hearing problems, attention-deficit disorders (ADD) or autism. The prime diagnostic tool, the electroencephalogram (EEG), commonly is normal because the epileptiform abnormalities may not occur in the brain during the hour or so that the person is connected to the brain-wave-detecting equipment. Brain scans routinely are normal, too. The diagnosis can be made by speaking with observers who note these patients’ “foggy” mind-states. My novel, DINGS, is a medical mystery story of just such a bright third-grader who is failing school because of his unrecognized complex partial seizure-blank outs. He’s just not “keeping up.”

      Upon seeing this report on TV two weeks ago I recognized Brooklyn’s Park Slope as a neighborhood in which my cousins live. I sent them my opinion that the driver must have had a seizure causing the accident of which she had no memory. “It was murder,” they told me.

     Why was this woman with epilepsy driving?

      I related that my state, California, is only one of six states where state law requires physicians to report people with altered consciousness. New York is not one of those six states. The other 44 states hope that people with epilepsy will report themselves to the Department of Motor Vehicles (DMV). That’s a problem. Some of my California epilepsy patients would become understandably belligerent when I would caution them of their driving responsibilities and to stop driving until sanctioned by the DMV; they were endangering their families, passengers, the public and themselves. “No, Doc. Don’t send that report in. Are you going to pay my mortgage?” Personal insight, personal economics and ethics all swarm in their minds as they make decisions of giving up their driving privilege, i.e., their DMV license.

     Upon learning my information my Brooklyn cousin asked if he could share it with a New York State legislator’s office. That same week Brooklyn State legislators unveiled a bill to create a mandatory reporting system and to authorize the DMV to evaluate pe  I shall be following New York’s action.

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.

Blog #4: An Epileptic Driver Is Jailed In England for Causing A Death Crash

(This blog was originally posted on June 29, 2011)

                      

On June 23, 2011, the BBC News reported that a 33-year-old man had caused the death of a young woman in England. The perpetrator had suffered several epileptic episodes every month, and he had failed to tell the authorities about his condition. The victim was in the front passenger seat when her car was struck by the one driven by the person with epilepsy. It was criminal negligence.

            It is difficult to give up one’s driving privilege, but anyone who has uncontrolled seizures must admit he places himself and everyone else with whom he shares the road in danger.

            All but six states in the United States of America require anyone who experiences blank outs to report themselves to their Department of Motor Vehicles (DMV). These blank outs can be caused by epilepsy, poorly controlled diabetes, heart, blood pressure and other abnormalities. Please visit my website: LanceFogan.com, for further discussion of this in the “Epilepsy Information” tab.

            California is one of the six states where it is mandatory for physicians to report to the Health Department anyone aged fourteen years or over, who has suffered an episode of loss of conscious control on one or more occasions within the previous three years. The Health Department then notifies the DMV that this person may be in danger of harming himself and others while operating a motor vehicle. The DMV sends a questionnaire to be completed by the person and his physician. It is the DMV’s decision, not the physician’s decision, to allow, or to revoke, the driving privilege. The duration required for absence of any loss of conscious control for the revocation to be reversed, varies. It is usually six months to two years. Physicians in California and in the other five mandatory-reporting states who disregard reporting such a patient risk severe liability.

            In my experience, the DMV sometimes doesn’t restrict driving after one or more episodes of loss of conscious control. If the patient is just starting anticonvulsant medications—although this is no guarantee of seizure control—or if the seizures occur only during sleep, or if the patient lapsed in his medication intake and had a “breakthrough” seizure, then the DMV may not revoke the  license. But, usually it is revoked for a period of observation to gauge success or failure of treatment.

            Mandatory reporting by the physician can interfere with the patient-physician trust relationship. Patients who have finally regained their drivers’ licenses from the DMV will return to follow-up clinic. Some of these patients can be seizure-free for years; but then some have a recurrence. The scenarios I’ve been involved in went like this. Physician: “So, how are you? Have you had any seizures or spells?” Patient: “Doc, will you have to report anything to the DMV?” Physician: “Well, yes, if you had a seizure again.” Patient: “No, doc. I’m fine.” The consequence of this exchange is that I was hampered from adjusting the anticonvulsant medication regime. Adults with epilepsy usually require anticonvulsant medications for the rest of their lives. Even if the patient is hiding that he was having more seizures, the doctor’s hands are tied from trying to improve seizure control with the same or with different medications. Physicians can only abide by the patient’s own story and would record in the patient’s chart: “Mr. X reports no seizures.”

 

 

Lance Fogan, M.D. is Clinical Professor of Neurology at the David Geffen School of Medicine at UCLA. Conner’s Little “Dings” is his first novel.