Blog #77: DRIVING PRIVILEGES, PAYING YOUR BILLS AND MORALITY: DRIVING AND THE EXPERIENCE OF A NEUROLOGIST

                 

WASHINGTON, Dec. 7, 2016 (UPI) -- The driver of a Baltimore school bus that hit a car and a transit bus last month, killing six people, including himself, had been involved in at least 12 other crashes in the last five years, the National Transportation Safety Board said Wednesday.

The investigative agency released a preliminary report on the Nov. 1 crash Wednesday, which detailed the incident and the medical history of the school bus driver. "The school bus driver had a history of hypertension, diabetes, and seizures. In the past 5 years, he had been involved in at least 12 crashes or incidents while operating a school bus or personal vehicle," the NTSB report said. "In addition, the week before the crash, paramedics were called ... because the school bus driver was experiencing what witnesses described as a seizure."

The report also says the school bus driver held a medical certificate denoting a medical condition but it had not been filed with the state motor vehicle administration.

I practiced clinical neurology in the state of California. California, Delaware, Nevada, New Jersey, Oregon and Pennsylvania are the only states that require physicians to report people who have been diagnosed with epilepsy to the local official health officer. Knowing that driving privileges are at risk often creates a barrier between the doctor and the patient. Doing the right thing, the moral thing, can be difficult for both parties. Patients often threatened me to not send in a report. “Are you going to pay my mortgage, Doc? If I have to quit my driving, I’ll be in the poor house. You better not send that in.” Many leave in anger.

Specifically, The California Health & Safety Code 103900(a) (2010) states: “Every physician and surgeon must immediately report to the local health officer individuals 14 years of age and older whom they have diagnosed as having a disorder characterized by lapses of consciousness.” Reports made because the physician acted reasonably and in good faith and believed will serve the public interest, the doctor shall not be civilly or criminally liable.

However, it is NOT the physician who decides if any particular patient should drive or not; it’s the official motor vehicle agency—with guidance by special medical panels. My experience has been that not all epilepsy patients have their driving restricted. If the patient and the doctor report that the seizures occur only during sleep (“nocturnal seizures”) the DMV often allows driving. But, periodic medical follow/up and reports to the DMV should show no seizures are occurring. The DMV decides how long a person must be seizure-free? Seizure-free 6 to 24 months is a routine observation period. 

Doing the right thing, the moral thing, can be difficult. I have followed patients whose licenses had been revoked for 6-24 months and then restored because they have been seizure-free. However, occasional follow-up visits have consisted of this scenario: “Are you taking your anticonvulsant medications as prescribed?” “Oh, yes, Doctor.” “Have you had any seizures?” Some have said, “Would you have to report to the DMV?” When I respond, “Yes,” patients have told me, “No, Doctor, I’ve been fine.” The doctor and patient are thus deprived of the opportunity to improve care by changing dosages or medications to give better seizure control. If the doctor fails to report to the health official, the physician is liable for damages by accident victims.

I have learned of news reports such as, “The driver lost control of his vehicle that jumped the curb and crashed into a group of people on the sidewalk.” As a neurologist dealing with epilepsy that affects one of every one hundred people, my response would be, “I hope it’s not one of my epilepsy patients.” What else would cause drivers to lose control? Alcohol? Drugs? An epileptic black out?     

In the other 44 states that don’t require doctors to report their epilepsy patients, it is hoped that patients will cease driving on their own and/or will report themselves to their DMVs. How many individuals report themselves? We can sympathize with their moral dilemmas. “Are you going to pay my mortgage if you stop me from driving, Doc? Will I kill myself or others?”

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 #14: Photosensitive Epilepsy

(This blog was originally posted on December 5, 2011)

 

          People can have seizures when exposed to certain stimuli. They are genetically predisposed to this phenomenon. There is a vivid scene in the recent movie release, Twilight Saga: Breaking Dawn, Part 1, in which bright lights in red, black, and white flash across the screen. Audience members in various cities across our country are reported to have suffered seizures while watching that scene. One man in Utah was said to be mumbling and blinking his eyes according to his wife. At least one person was taken by paramedics to an emergency room. In 2009 viewers suffered convulsions watching the movie Avatar. It is not known if any of these individuals ever had prior seizures.

Photosensitive epilepsy is a form of reflex epilepsy—seizures provoked by a specific stimulus, such as strobe or flickering lights. Some people find exposure to red-colored flickering lights, like the flashing red color in the Twilight film, induces seizures. Natural light—such as sunlight through leafy trees while driving, or waving a hand with spread fingers in front of a light source—can cause a seizure. Other examples include reading that induces certain eye movement patterns, or sound patterns heard in specific musical passages. Even anticipating, or thinking of eating food (this is rare), is known to cause reflex-type seizures.

Seizures while playing video games or watching TV is a recognized phenomenon. These events can consist of suspension of activity during which the mind is blank for several seconds to minutes followed by confusion or a genuine convulsion. Some people will jerk just one or more limbs, called myoclonic jerks. Electroencephalogram (EEG) laboratories routinely assess for this sensitivity to flickering lights. Patients are exposed to strobe lights during the EEG to test for abnormal paroxysmal patterns.

Those susceptible to reflex seizures should avoid exposure to that particular stimulus. If this fails to prevent seizures, then neurologists can prescribe anticonvulsant medications.

 

 

 

Lance Fogan, M.D. is Clinical Professor of Neurology at the David Geffen School of Medicine at UCLA. DINGS is his first novel.