drivers need to be able to identiy changesin the trac and conditions around them,interpret these changes, and respondquickly and appropriately.
Seizures that occur during driving can adversely aect these abilities and requently cause seriousaccidents.
It is estimated that between50% and 60% o seizures that occur whiledriving result in accidents and approximately30% o all medical-related crashes havebeen attributed to seizures.
The needs o people with epilepsy withregard to driving need to be balanced withthe potential risks to public saety. There-ore, a variety o state regulations havebeen designed to allow people with epilepsyto drive only i their seizures are controlled.In these patients, the risks associated withdriving are lower and more comparable withthose o individuals with other medicalconditions
Because seizure control iscentral to driving privileges, physicians playa pivotal role in determining driving rightsor patients with epilepsy.
The ollowing sections o this article briefy review thisimportant aspect o clinical practice andprovide basic inormation relevant tocounseling patients regarding their driving privileges.
Legal Issues and Driving With Epilepsy
For people with epilepsy, maintaining adriver’s license is surrounded by a number o legal issues. Individual state laws restrict drivers’ licenses or persons with activeuncontrolled seizures as well as providerules regarding how a license to drive maybe acquired in that state.
The principalocus o these regulations is to restrict driving or those at greatest risk o having aseizure while driving, most oten by requiring a seizure-ree interval prior to obtaining driving privileges.In most states, people with epilepsy must be ree o seizures or a set period o time,ranging rom 3 to 12 months beore theycan legally operate a car.
Although somedata have indicated that longer seizure-reeintervals may have the least risk or seizure-related accidents, states are trending towards requiring shorter seizure-ree intervalso 3 or 6 months.
One recent study oundthat seizure-related accidents did not increase signicantly when the requiredseizure-ree interval was decreased rom12 to 3 months.
Regulations and the degree o restrictionvary or each state and some states haveadopted regulations that assess individualclinical actors in determining whether aperson with epilepsy may drive.
Somestate regulations require periodic physicianreports led with the department o trans-portation or a medical review board. Whenand how these are led also varies by state.Further, some states mandate physicianreporting o epilepsy.
Another variationin laws isthat somestates allow patients with epilepsy to drivewhen their seizures are limited to certaincircumstances, such as or those who haveprolonged and/or consistent auras, purelynocturnal seizures, or seizures that arecaused by transient events.
This myriad o laws makes physicianknowledge and understanding o the statelaws that apply specically to their patientscritical, which in some cases may alsoinclude knowledge o laws o neighboring states. Physicians need to know the localregulations regarding driving privileges or persons with epilepsy, as well as their ownobligations with regard to reporting. Unor-tunately, physician knowledge o applicabledriving laws may be decient.
In a recent survey o 209 physicians treating patientswith epilepsy, a large number were unableto correctly identiy the reporting require-ments or their state, suggesting that their understanding o the complexities relatedto individual state driving requirements or people with epilepsy may be inaccurate.Among respondents in this investigation,only 12% o amily practitioners, 14% o internal medicine physicians, and 27% o neurologists considered themselves to bevery knowledgeable o their state’s driving laws.
All physicians caring or patientswith epilepsy should review their state lawsor the specics that apply to their practice.In addition to knowing and adhering to thereporting laws in their state, physiciansneed to be aware o their own liabilities andthe impacts o privacy codes.
Immunityrom civil and/or criminal prosecution or ling epilepsy or seizure reports also variesbetween states, as does physician liabilityi a person with epilepsy drives and causesan accident.
I a physician knows that a person with epilepsy is driving contraryto medical advice, the physician has anobligation to the patient and the communityto report that patient to the driving authorities.In the event that a physician is ound tohave ailed in his/her responsibilities tothe wider community, the physician maybe personally liable to litigation by injuredthird parties.
In clinical practice,physicians may need to adequatelydocument in patient charts their having advised patients not to drive.
Similarly, patients may be ound guilty o dangerous driving i they ail to report their epilepsy as required by local authorities andsubsequently have an accident.
Patientswho mislead authorities or drive ater being told not to may experience civil and legalrepercussions, and insurance may not cover the patients i they are driving illegally.
Driving Privileges: Protecting Your Patients and Yourself
by Laura Hershkowitz, DO
Physicians need to know the local regulations regarding driving privileges for persons with epilepsy, as well astheir own obligations with regard to reporting.
ing Issues in Epilepsy:
What You Need to Know About Epilepsy and Driving