Blog #53: New Studies: When Is It Safe to Drive With Epilepsy?

(This blog was originally posted on December 26, 2014)

 

 

 

 

 

            “I get an aura, a warning before my epileptic seizure, so that protects me and I can pull my car over and avoid an accident.” That’s what some people with epilepsy believe. Can these patients truly protect themselves and the driving public? There’s not enough information to make an accurate decision.

            An article in the December 4, 2014 issue of Neurology Today reviewed studies reported at the 2014 American Epilepsy Society Annual Meeting. The article concluded that neurologists and law-makers need to rethink current recommendations about driving with epilepsy. The American Academy of Neurology previously considered auras―“warnings”—that were consistent and prolonged to be a favorable feature in sanctioning a driving license. Recent studies question this belief: the aura did NOT protect the driver from an accident. Accident rates in people who have auras were similar to patients who did not have auras.

            In their study, patients underwent continuous video-EEG monitoring at the Yale Epilepsy Center while simulating “driving” on portable computer-based driving simulators, complete with brakes, gas, and a steering wheel. Researchers found that patients with longer seizures and seizures that led to a loss of consciousness were more likely to “crash” their vehicles in the simulated test compared to patients with other types of seizures without loss of consciousness (e.g., simple partial seizures). The research showed clearly that people who lose consciousness or have serious impairments in their movements during a seizure should not drive until treatment controls their seizures. Other patients whose EEG showed epileptiform discharges (these correlate with altered brain neuron-cell function) that did not alter consciousness or have other symptoms (subclinical EEG discharges) had vague, imprecise effects on driving. However, and very significantly, many patients who had lost consciousness did not know that their awareness was impaired during the “subclinical” EEG discharges when queried by the researchers.

            Some states leave the important decision of when to allow driving in people with epilepsy up to the neurologist. But in six states, California, Oregon, Nevada, Pennsylvania, New Jersey and Delaware, the state’s Department of Motor Vehicles makes the ultimate decision utilizing the physician’s—not necessarily a neurologist―input.

            With imprecise ability to determine if consciousness is preserved or not, neurologists need to be cautious in deciding whether a person who has epilepsy can drive safely. As noted above, there is still not enough information to make a highly accurate, sound decision about this important safety issue.

 

 

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.

 

Blog #45: Police Sued: They Failed to Recognize Epileptic Confusion and Tasered Man

(This blog was originally posted on April 24, 2014)

 

On January 26, 2014, a Connecticut newspaper, the New Haven Register, reported that a man sued the town of Hamden and the Police Department after he was tasered by two officers because he “refused” to cooperate with their orders to exit his crashed vehicle. He claims that at the time he was suffering an epileptic seizure and was unable to follow their directions. The victim said the police require better training to recognize and deal with people having epileptic seizures.

According to the news article the man experienced a seizure while driving on city streets. His car then picked up speed and hit a stone wall and a detached garage. The passenger, his sister, told the arriving emergency services that her brother had epilepsy and that he had just had a seizure; he was unresponsive and slumped over the wheel at that time. The police ordered the man to exit the car. When he failed to comply, they tasered his neck. The man “screamed in pain” and bit the officer’s arm. He was again tasered.

The police reported a different scenario. They claimed the driver was uncooperative and would not exit the vehicle. He became confused, and after “10 minutes” of discussion, the man finally exited the car but tried to manually remove the car from the wall. An officer intervened. The driver jumped back into the car and tried to start it. The officers claimed that they tried to restrain the driver’s arms and remove him from the car, but he resisted, bit the officer’s arm and violently lashed out. The police resorted to the taser. The driver still resisted. Police were able to gain control, remove him from the vehicle and then they applied handcuffs. Following the incident, the sister said her brother “becomes violent when he has epileptic episodes and can’t control himself…a similar incident occurred when he fought with medical staff attempting to assist him.” The police officers decided against pursuing criminal charges because of the man’s “state of mind” when he resisted them.

This incident describes classical post-ictal, confusion-associated violence that often follows a complex partial seizure, a very common form of epileptic seizure. If a person is experiencing a complex partial seizure and he is physically restrained, he may savagely resist any person attempting to restrain him. Furthermore, he will have no memory of it afterward.

Since one percent of the population has epilepsy, education and training of police to deal safely and properly with this common condition is essential.

 

 

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.