Search

Driving restriction is a well-known undesirable consequence of epilepsy and causes significant problems regarding independence and employment for epileptic patients. Many countries all over the world have provided comprehensive protocols in this regard with the aim of providing the possibility of less restricted, but safe driving for epileptic patients and also providing the opportunity for uniform decision-making for clinicians. However, the available fitness to drive protocol in Iran still lacks sufficient details and clinicians might encounter serious problems in terms of the driving issue in epileptic patients. In order to provide a uniform protocol containing adequate practical data, a systematic review of literature addressing guidelines about driving and epilepsy and driving laws of different countries for epileptic patients was performed and, after consideration of cultural issues, a practical protocol for Iranian neurologists was suggested. Introduction The negative impact of seizures on the quality of life (QOL) of epileptic patients has been acknowledged. Seizures particularly influence the social aspects of life including work, driving, interpersonal relations, and education.1-10 One of the most restricting factors of epilepsy is prohibition of driving that might have adverse effects on QOL, independence, and working capabilities.11-15 The main rationale behind limited rules for driving in epileptic patients is obviously the risk of occurrence of seizure during driving that might lead to significant injuries in patients and others. The first traffic accident due to a seizure has been reported in 1906,16 and for a few decades after that, a permanent driving ban law was enforced for all epileptic patients.17 Gradually, with the initiation of diagnostic advances and more common use of first antiepileptic drugs (AEDs), the conditional driving license in certain circumstances was allowed and some countries started to provide a comprehensive protocol to cover different types of seizures with the aim of providing the

Aim To implement and appraise a new model of care in terms of: patient experience, knowledge of epilepsy, readiness for transition and emotional and behavioural support in a new purpose-built facility for adolescents and young adults. Methods The new model of care included: upskilling of neurology staff in adolescent engagement and provision of group education sessions on epilepsy and mental health (MH), along with MH support, in a new purpose-built adolescent facility. Parameters examined pre- and post-attendance at the new clinic included: adolescent experience of service delivery, transition readiness, emotional and behavioural well-being, epilepsy knowledge and medication adherence. Results A total of 45 adolescents (mean age 15.7 years) attended the new epilepsy clinic between February 2017 and December 2017. Adolescents felt significantly better informed following education in relation to epilepsy and driving, alcohol/street drugs and birth control/pregnancy. There was no significant improvement in self-reported medication adherence, transition readiness or mental well-being at follow-up. While MH education was ranked highly in terms of importance by adolescents and parents at baseline, attendance at MH education and engagement with MH support was low. Conclusions This paper documents what is important to young people with epilepsy regarding service delivery. The new adolescent service was well received. Based on feedback from adolescents and parents relating to the service, and the suboptimal uptake of MH supports, the model of care has been revised to reduce attendance burden on families and improve patient experience.

This paper reviews a Coroner's inquest into the deaths of two people. The deaths were caused when a driver had a seizure, and lost control of his car, which then plowed into a café. The Coroner reviews the roles and responsibilities of primary and tertiary caregivers, with special focus on the question of who has the responsibility to inform the Drivers' Licensing Authority of a patient's unfitness to drive - the patient or the practitioner? The Coroner recommends the establishment of a multi-agency committee to advance work in this area. The paper notes a separate but parallel development - a review of AUSTROADS Assessing Fitness to Drive Guidelines, which may achieve the outcomes sought by the Coroner.

Introduction: Legal aspects of epilepsy are jurisdiction-dependent, and this analysis has focused on an Australian context; however, the reader can extrapolate to his/her local jurisdiction and/or legal system. Epilepsy and driving: The AUSTROADS Guidelines have codified the fitness to drive restrictions to be imposed for both private and commercial drivers. They set out the default positions and the considerations that can be applied to deviate from the default of at least 1 year seizure freedom for private license holders and 10 years seizure freedom for commercial drivers. Epilepsy and employment: People with epilepsy are broadly excluded from all employment requiring the wearing of a uniform. Only where preemployment medical examination mandates disclosure does the person with epilepsy have to disclose epilepsy to a prospective employer. There are specific laws that control workplace and employment standards that cover occupational health and safety, protection for the disabled, and antidiscrimination. Negligence: Negligence relies on establishing: duty of care; breach of that duty; and damage that is not too remote. Once ascertained, liability is established by the relative causation. The Civil Liability Acts served to redefine negligence, causation, and liability. Added consideration attaches to vicarious liability of the employer for the employee and nondelegable duty of care. Conclusions: This overview has examined three legal aspects of epilepsy, namely, driving, employment, and negligence. The concepts and interpretations should have relative applicability well beyond any narrow confines, limited to a single jurisdiction.

The Swiss Guideline concerning epilepsy and driving has recently been revised. Recommendations have changed significantly in several respects. Some modifications arise indirectly from a change in the overall concept of epilepsy. As a consequence of the application of the new ILAE definition and diagnostic criteria for epilepsy, there are now cases in which the diagnosis of epilepsy is established even after one single seizure. Furthermore, a concept of imminent epilepsy was introduced to identify patients without seizures, but with a high risk of a first seizure within twelve months. On the other hand, the concept of a "resolved epilepsy" was established to loosen driving regulations for longterm seizure-free patients. In addition, the new guideline provides differential recommendations for provoked vs. unprovoked seizures in several clinical constellations.

BACKGROUND: Media have recently reported car accidents related to persons with epilepsy in Japan. We were afraid that sensational media coverage may worsen the attitude toward epilepsy among non-medical persons. We performed a questionnaire survey among non-medical students in order to evaluate the effects of media on attitude toward epilepsy and driving license in persons with epilepsy. METHODS: The survey was performed using a structured questionnaire. The students were divided into two groups according to knowledge on the recent serious car accidents related to persons with epilepsy. In order to clarify the effects of media coverage, we compared attitude toward epilepsy and driving license in persons with epilepsy between those who know the accidents and those who do not. RESULTS: The rate of students who are familiar with epilepsy was higher in those who know the accidents, whereas no significant difference was observed in the attitude toward epilepsy. The rate of students who oppose for persons with epilepsy to get a driving license was not different according to the knowledge on car accidents, whereas that of students who oppose severe punishment to epilepsy patients in case of a car accident was lower in those who know the accidents. CONCLUSIONS: Media coverage did not affect the attitude of the participants toward restriction of driving license in persons with epilepsy, whereas the rate of participants who objects severe punishment for car accidents in persons with epilepsy was decreased. Language: en

Driving is an important part of everyday life for most adults, and restrictions on driving can place a significant burden on individuals diagnosed with epilepsy. Although sensorimotor deficits during seizures may impair driving, decreased level of consciousness often has a more global effect on patients' ability to respond appropriately to the environment. Better understanding of the mechanisms underlying alteration of consciousness in epilepsy is important for decision-making by people with epilepsy, their physicians, and regulators in regard to the question of fitness to drive. Retrospective cohort and cross-sectional studies based on surveys or crash records can provide valuable information about driving in epilepsy. However, prospective objective testing of ictal driving ability during different types of seizures is needed to more fully understand the role of impaired consciousness and other deficits in disrupting driving. Driving simulators adapted for use in the epilepsy video-EEG monitoring unit may be well suited to provide both ictal and interictal data in patients with epilepsy. Objective information about impaired driving in specific types of epilepsy and seizures can provide better informed recommendations regarding fitness to drive, potentially improving the quality of life of people living with epilepsy.

Introduction The issue of epilepsy and driving has legal, social, and psychological implications. Many countries in the world restrict driving to people prone to epilepsy. There is no data from Saudi Arabia regarding the prevalence of driving among patients with epilepsy and their driving practices. In addition, to the best of our knowledge, there are no local laws or guidelines concerning driving for patients with epilepsy in Saudi Arabia. This study aimed to determine the prevalence of driving among male patients with epilepsy at King Abdulaziz Medical City in Jeddah, Saudi Arabia and determine the barriers and difficulties that they are suffering from especially when it comes to driving. Methods This is a cross-sectional study that was conducted between July 2017 and June 2018 at King Abdulaziz Medical City in Jeddah, Saudi Arabia. The inclusion criteria of this study were male patients with epilepsy 18 years of age or above. The exclusion criteria were female patients at any age (since they were not allowed to drive at the time of the study) and male patients less than 18 years of age. This study utilized a self-made self-administered 25-item questionnaire. Results A total of 182 surveys were distributed, and 164 individuals completed the survey (90.1% response rate). Most of the participants have a driving license (95.7%) and drive a car (98.8%). Almost all participants (99.4%) mentioned that nobody asked them whether they have epilepsy or not when issuing a driver's license. In addition, 94.5% were never told not to drive after the diagnosis of epilepsy. Regarding restrictions to driving, 98.7% reported that they drive at all times without any restrictions, and 92.7% reported that they drive both inside and outside the city. Conclusion This study showed that the number of male patients with epilepsy driving cars was extremely high, accounting for almost all the patients in this study, with most of them doing several wrong practices during driving. Other major issues include the lack of specific laws regulating driving for patients with epilepsy and no counseling from physicians about driving after the diagnosis of epilepsy. We recommend developing the Saudi driving regulations for patients with epilepsy, and this study is considered an urgent call for action for the formation of a local driving regulations taskforce. Health education about the risk of driving should be disseminated, especially for patients with uncontrolled epilepsy.

The laws concerning driving licences and epilepsy in different countries are very diverse with regard to the criteria for issuance or renewal of licences, and also the methods of evaluating fitness. In 2011, a law was issued in Italy implementing the European directives on driving licences, including provisions for mandatory notification that a driver is epileptic. This was established regardless of the European rules that require compulsory notification only of patients. The Federation of Italian Boards of Physicians has made recommendations against mandated physician reporting, resulting in a current confusion between legal and ethical recommendations to medical doctors. The mandatory notification enacted by Italian law raises ethical concerns about disparities in access to care and possible violations of the right to confidentiality of patient information. Moreover, the law discussed here fails to emphasise the importance of physicians ensuring compliance by the patient, by sharing the correct information about the risks associated with illegal driving and by obtaining information from the patient through regular check-ups. An urgent revision of the law is required to implement the duty of the physician to provide information and to ensure that the rule about mandatory notification should be erased in favour of optional self-reporting by epileptics as the preferred way to notify the licensing authority. The implementation of these measures could correct the dichotomy between the law and the ethical recommendations for medical doctors and protect the rights of people with epilepsy as well as those of any other patients whose pathology or impairment could imply a risk to the community.

In many parts of the world, licensing guidelines state that drivers with medical conditions such as epilepsy are restricted or prohibited from driving. These guidelines are sometimes subjective and not strongly evidence-based, rendering the task of assessing fitness to drive a complex one. Determining fitness to drive is not only essential for maintaining the safety of individual drivers but has implications for the community at large. It is therefore important to review the current state of knowledge regarding epilepsy and driving in order to aid health professionals required to assess fitness to drive and to guide future research directions. This review outlines the functional impairments related to epilepsy and driving, treatment and management issues, motor vehicle crash risk for drivers with epilepsy, estimates of predicted seizure occurrence and concludes with a discussion of the international licensing guidelines and relevant legal issues. More comprehensive research, including investigation into the effects of antiepileptic medication on driving, could aid in the development of policies and guidelines for assessing fitness to drive.

Although few neurologists are formally trained in traffic medicine, they are frequently asked to assess whether a patient is medically fit to drive. For patients with epilepsy, the physician must assess the risk of the patient having a seizure while driving, and decide what is an acceptable risk. The legislation on this subject is aiming at finding a reasonable balance between two important considerations: public safety and a patient's individual need to drive. For the neurologist to explain and put into practice the legislation may be a demanding task and a challenge to the doctor-patient alliance. The decision on driving capability should be tailored to the individual patient and based on careful evaluation and informed judgement. In Norway, to qualify for a driver's license, a seizure-free interval of at least 12 months is currently required for group 1 drivers (passenger cars), whereas group 2 drivers (heavy motor vehicles, commercial driving) must have been seizure-free for at least 10 years and not have experienced epileptic seizures from the age of 18 years. Norwegian physicians are obliged to report patients with seizures to driving authorities, although this is an unpopular rule. In reviewing the available literature, it is apparent that despite there being relatively few sound studies, the risks of car accidents among persons with epilepsy may previously have been overestimated.

Summary Purpose To compare medical evaluations of driving capability of drivers with epilepsy with the rules of Slovenian legislation. Methods Our research included all drivers in Slovenia that were evaluated as epileptic between 1993 and 2002. The results were processed using the standard descriptive statistical methods. Results During the 10-year period, the commission evaluated 541 cases and prospective drivers of motor vehicles with the primary diagnosis of epilepsy. On average, these individuals drove a third less than other drivers, moreover only 1.6% of the epileptic drivers caused traffic accidents, which is significantly lower than the percentage in general population. Medical evaluations resulted in 349 cases being recognized as capable of driving, while the legislation would issue a driver's license to only 140 of the cases. Conclusion Our research confirmed the supposition that drivers with epilepsy are safe drivers and mirror the general population in many of their driving capabilities, thus making it urgent that the obsolete Slovenian legislation is modified to conform to the recommendations of the International Bureau for Epilepsy as quickly as possible.

INTRODUCTION: Austroads Guidelines for fitness to drive were promulgated in 2003. Epilepsy was one of the conditions included and this paper reports results of a survey of Australian neurologists regarding opinions and practices relevant to the guidelines. METHODS: The survey was developed, piloted and Human Research Ethics Committee approved. Members of the Australian Association of Neurologists received three mailings and results were analysed. RESULTS: Almost 70% of 236 surveyed indicated assessment of epilepsy and driving with

Epilepsy poses a risk for all participants in road traffic; therefore people with epilepsy do not meet the criteria for an unlimited driving license. Their driving is affected not only by epileptic seizures causing impaired consciousness and involuntary movements, but also by antiepileptic drugs with their many unwanted affects. The experts have not yet agreed on whether people with epilepsy have an increased risk of experiencing a road traffic accident. However, recent data suggests that the overall risk is lower compared to other medical conditions. Scientific evidence forms the basis of legislation, which by limiting people with epilepsy, enables all participants in road traffic to drive in the safest possible environment. The legislation that governs epilepsy and driving in Slovenia has been recently thoroughly reformed and thus allows a less discriminatory management of people with epilepsy. Although people with epilepsy experience many issues in their daily life, including their personal relationships and employment, they often list the need for driving as a top concern in surveys. General physicians play an important role in managing the issues of people with epilepsy.

Summary: Purpose: The driving regulations in Japan were amended in 2002, which lifted the absolute ban on driving by persons with epilepsy (PWE) and granted licenses to PWE after a 2-year seizure-free period. Methods: To survey the effect of the new driving regulations, we sent questionnaires both to the driving authorities (DAs) and to doctors of the Japan Epilepsy Society (JES). Results: Around 1,400 PWE legally obtained a driving license within 1 year after the amendment, licenses were rejected in 157, and 61 had the license withheld for

Objectives: To estimate the risk to public safety posed by drivers with epilepsy, the authors compared annual totals and disease-specific risk for fatal crashes associated with seizures and other medical conditions. They compared individual risks for fatal crashes due to seizures and other causes of mortality in patients with epilepsy.Methods: The authors analyzed Multiple-Cause of Mortality data files from death certificates provided by the National Center for Health Statistics (NCHS) for the years 1995–97. They analyzed International Classification of Diseases–9 codes for underlying causes of death and other major conditions and determined disease-specific rates of fatal crashes associated with seizures and other medical conditions.Results: An average of 44,027 US drivers died annually as a result of motor vehicle crashes during 1995–97; however, only 86 (0.2%, range 82 to 97) of these deaths were associated with seizures in mortality reports. The incidence rate of fatal crashes for patients with seizures was 2.3 times the rate for patients with cardiovascular and hypertensive diseases and 4.6 times the rate for patients with diabetes. The proportionate mortality ratio for motor vehicle crashes in patients with seizures was low (0.2); most patients with epilepsy died of common cardiovascular and systemic disorders.Conclusion: Fatal driver crashes due to seizures are uncommon. This finding supports the current public policy of permitting patients whose seizures are controlled to drive.

Operating a motor vehicle is important to people with epilepsy (PWE). Being allowed to legally drive, largely depends on being seizure free for a defined period of time and being physically capable. Each patient's driving situation should be considered individually with advice offered guided by the goals of maximizing safety for both PWE and the public. There are considerable risks associated with driving for PWE or other medical conditions. Unfortunately, laws that govern driving are not uniform from state to state or country to country, requiring individual practitioners to be familiar with the local regulations. Good medical care leading to improved seizure control may allow PWE to drive and improve their quality of life. The privilege of driving a motor vehicle is important for many people with and without epilepsy. Many factors impact the ability to drive and laws governing driving and epilepsy are quite variable around the USA and the world. Being restricted from driving due to seizures represents a significant event in one's life affecting independence, sometimes employment and quality of life. The privilege of operating a motorized vehicle is granted by some form of governmental agency in virtually every state and country.

Background:A seizure is the most common cause of loss of driving privileges for medical reasons but there is variability in how physicians and the authorities who regulate driving approach this issue.Methods:A questionnaire regarding epilepsy and driving was sent to all adult neurologists in Canada (n = 494).Results:Of 289 (59%) neurologists responding, 50% usually report patients with seizures to the department of motor vehicles compared to only 4% for stroke/TIA, 26% for dementia and 8% for other neurologic disorders (p < 0.0001). In the five provinces with mandatory reporting laws, seizures were reported most of the time by 84% compared to only 19% in the five provinces with discretionary reporting (p < 0.0001). Nationwide, 44% agreed with mandatory reporting but this also differed in provinces with and without mandatory reporting legislation (63% vs. 37%, p < 0.0001). Only 49% agreed with the current recommendation of at least one year seizure free interval before resuming driving.Conclusions:Seizures are disproportionately reported compared to other neurological conditions. Many neurologists disagree with the recommended Canadian standards for duration of driving restriction after seizures. Variability in the attitude and practice of neurologists in regard to reporting of seizures is confirmed.

Summary: Purpose: To study the effects of epilepsy from the patients’perspective and assist determination of content validity of health-related quality-of-life (HRQOL) measures. Methods: We asked 81 consecutive patients with moderately severe epilepsy to list in order of importance their concerns of living with recurrent seizures. To minimize investigator bias, patients completed the procedure in a private setting without staff involvement. Results: Twenty-four distinct domains were generated by the patients. Concerns about driving (64%), independence (54%), employment (51%), social embarrassment (36%), medication dependence (33%), mood/stress (32%), and safety (31%) each were listed by >30% of patients. Driving was listed as the most important concern by 28% of patients, followed by employment (21%), independence (9%), safety (6%), antiepileptic-drug side effects (5%), seizure unpredictability (5%), and seizure aversion (5%). Conclusions: The effect of epilepsy on HRQOL is not vague or obscure from the patients’perspective but is defined by a limited number of domains. Independence is an important concern that may not be evaluated adequately by currently available HRQOL instruments.

Individuals with a history of seizures may be granted driving privileges if the risks of future seizure while driving are relatively low. Different nations have defined these risks in a wide variety of ways. Some countries, e.g., Japan, Greece, Brazil, India, and Russia, preclude driving after a single seizure. Other countries, such as Canada and the United States, allow driving

Objective The aim of this study was to synopsize the evidence on predictors of crashes and driving status in people with epilepsy (PWE). Methods Evidence-based review of the published English literature was the method used. We searched various databases and extracted data from 16 (of 77) primary studies. On the basis of American Academy of Neurology criteria, we assigned each study a class of evidence (I–IV, where I indicates the highest level of evidence) and made recommendations (Level A: predictive or not; Level B: probably predictive or not; Level C: possibly predictive or not; Level U: no recommendations). Results For PWE, the following characteristics are considered useful: For identifying crash risk, epilepsy (level B) and short seizure-free intervals (≥ 3 months) (Level C) are not predictive of motor vehicle crash (MVC). For self/proxy-reported crash risk, epilepsy surgery (Level B), seizure-free intervals (6–12 months) (Level B), few prior non-seizure-related crashes (Level B), and regular antiepileptic drug adjustments (Level B) are protective against crashes; seizures contribute to MVCs (Level C); mandatory reporting does not contribute to reduced crashes (Level C). No recommendations for reliable auras, age, and gender (Level U), as data are inadequate to make determinations. For self-reported driving or licensure status, employment and epilepsy surgery are predictive of driving (Level C); there are no recommendations for antiepileptic drug use, self-reported driving, gender, age, receiving employment benefits, or having reduced seizure frequency (Level U). Conclusion Limitations, that is, heterogeneity among studies, examining the English literature from 1994 to 2010, must be considered. Yet, this is the first evidence-based review to synopsize the current PWE and driving literature and to provide recommendation(s) to clinicians and policy makers. Class I studies, matched for age and gender, yielding Level A recommendations are urgently needed to define the risks, benefits, and causal factors underlying driving performance issues in PWE.

In states that do not have mandatory physician reporting of seizures, clinicians face the ethical dilemma of whether or not to breach confidentiality of poorly controlled patients who continue to drive. In making this deliberation, one should consider both the probability and magnitude of harm posed by continued driving of an individual patient. When probability and harm are low or when probability is high but harm is low, there is generally no moral obligation to breach confidentiality, and it would be wrong to do so. The most difficult situation is when probability of harm is low but magnitude of harm is high. Judgments to breach confidentiality in these situations should also include assessment of risks and benefits to the patient and to society by taking such action. Ultimately, each patient must be judged individually.

People with epilepsy in Japan are prohibited by law from driving a motor vehicle regardless of whether their epilepsy is active or dormant. Nevertheless, some people with epilepsy illegally obtain driver's licenses. A total of 3,522 people with epilepsy throughout Japan, of whom 52.6% were men and 47.4% were women, were prospectively surveyed by a questionnaire regarding their automobile driving practices. Overall, 48.6% illegally held a driver's license and 38.9% actually drove. The automobile accident rate was 7.4%. The rate was 9.6% for patients with uncontrolled seizures, and 5.3% for those with controlled seizures. The incidence of accidents directly caused by seizures at the wheel was 1.6%. Complex partial seizures without auras were the most hazardous, and the risk became increasingly higher with increasing frequency of seizures. It was pointed out that the current law in Japan should be amended to conform with the more realistic regulations of Western countries.

Previous studies of possible associations between chronic medical conditions and traffic safety have been inconsistent and subject to bias because of the incomplete identification of affected persons. Recent advances in the diagnosis and management of epilepsy and diabetes mellitus have improved the control of these disorders and suggest a need to reexamine the risk of traffic mishaps among patients with these conditions.We conducted a population-based retrospective cohort study of 30,420 subjects 16 to 90 years of age, with and without epilepsy or diabetes mellitus. Subjects included all the licensed drivers in seven contiguous ZIP Code areas in which the Marshfield Clinic and St. Joseph's Hospital, Marshfield, Wisconsin, are the primary sources of medical care. Standardized rates of moving violations and accidents over a four-year period (1985 through 1988) were compared in affected and unaffected cohorts.Standardized mishap ratios for subjects with diabetes were 1.14 for all moving violations (P = 0.23) and 1.32 for accidents (P = 0.01); for subjects with epilepsy the ratios were 1.13 for moving violations (P = 0.26) and 1.33 for accidents (P = 0.04).We conclude that drivers with epilepsy or diabetes mellitus have slightly increased risks of traffic accidents as compared with unaffected persons. The increases in risk observed in our study were generally smaller than those in previous studies, and we believe they are not great enough to warrant further restrictions on driving privileges.

Objective To evaluate whether changing the seizure-free interval in Arizona from 12 months to 3 months affected the number of seizure-related motor vehicle crashes. Methods We performed a time trend study with analysis of motor vehicle crash reports in the state of Arizona 3 years before (1991-1993) and 3 years after (1994-1996) the seizure-free interval was decreased from 12 to 3 months. The number of motor vehicle crashes related to seizures, other medical conditions, and other nonmedical crashes was compared before and after the law changed. Other population trends, including population growth, registered vehicles, and registered drivers, are also reported. Results Seizure-related crashes increased from 125 to 136 for the 3 years before and 3 years after the law changed, respectively. The total rate of seizure-related crashes did not increase on the basis of an incidence rate difference of −0.03/109 miles (95% confidence interval [CI], −0.30 to 0.24) and a relative risk of 0.98 (95% CI, 0.77 to 1.24). Over the same time interval, crashes related to other medical conditions increased from 288 to 310, respectively, for an incidence rate difference of −0.09/109 miles (95% CI, −0.51 to 0.33) and a relative risk of 0.97 (95% CI, 0.82 to 1.13). Fatalities due to seizure-related crashes decreased during the same period, whereas the number of multiple vehicle crashes increased. Conclusion The rate of seizure-related crashes did not significantly increase in the state of Arizona after the seizure-free interval was reduced from 12 to 3 months.

Author Tom Fothergill is Trainee Solicitor, Serious Injury Department, Irwin Mitchell Solicitors LLP Epilepsy sufferers number at least half a million in the UK. Along with the distress and disruption that any medical condition causes for its sufferer, epilepsy comes with additional challenges, such as the nuisance and confusion of memory loss and the dangers presented by unexpected seizures. A key manifestation of this danger takes place when the epileptic seizure occurs while the sufferer is driving, when the consequences can be fatal. In instances where the driver knew that they had epilepsy, the result can be highly publicised criminal charges and civil claims. Last year, Giles Furnival of Essex was sentenced to 3.5 years in prison for causing the death of Laura Williams following a seizure. The 33-year-old driver had known about his epilepsy since his teens but had failed to declare it to the DVLA. So what are the rules relating to drivers with epilepsy? Are these rules effective? And what part do medical practitioners play with regards to the epileptic driver in their care? This article sets about answering these questions.

Driving regulations in the state of Wisconsin have evolved. In 1987, changes in these regulations focused the problem on loss of consciousness and bodily control of drivers rather than on specific diagnostic entities such as epilepsy or diabetes mellitus. Current Wisconsin law encompasses loss of consciousness or events affecting bodily control, no matter what the cause. Current regulations balance individual needs with the needs of safety for society. Neurologists are encouraged to become involved to keep the process of regulation current with the dynamic changes in medical care and in transportation technology (e.g., air bags, roll bars, etc.).

Background:This report summarizes an invitational symposium on epilepsy and Canadian laws governing motor vehicle driving held in Québec City in November 1998.Methods:Invited neurological experts from Canada, the USA, and Europe; and representatives of provincial and territorial licensing bodies, the Canadian Council of Motor Transport Administrators, the Canadian Medical Protective Association, and the Canadian Medical Association participated. An edited version of transcribed audiotapes was prepared. Specific issues discussed were whether or not a physician should be required to report a patient with epilepsy to the licensing authority (mandatory reporting), the nature and quantification of the risks posed by epileptic drivers, and what would be a reasonable law regulating driving by people with epilepsy in Canada.Results:The consensus among medical experts was that mandatory reporting should be abolished in Canada and that a 6-12 month seizure-free period was appropriate before most patients could return to driving private cars. Experts also believed that these standards should be uniform across Canada. There was strong disagreement with the recommendation of the Canadian Medical Association that all such drivers be reported to provincial licensing authorities even in provinces without mandatory reporting rules.Conclusion:Physicians should be familiar with and follow the rules regarding epilepsy and driving in the provinces where they practice. Nevertheless, current evidence is against mandatory physician reporting of drivers with epilepsy and the neurologists recommended that this be abolished throughout Canada. Shorter seizure-free intervals should also be considered before resuming driving of private cars.

Although the loss of freedom to drive is a serious consequence of the diagnosis of epilepsy, it is unclear how well current regulations are understood and adhered to by patients. Using questionnaires completed anonymously, we assessed attitudes and practices among 104 patients with epilepsy. Seventeen (16%) patients were driving, three illegally. In total, eight (8%) patients had at some stage driven illegally, even though seven admitted to having been warned not to do so. Even among the 14 patients currently driving and eligible to do so, only eight (57%) had informed the licensing authority and six (43%) their insurers. Only 34 (33%) patients showed satisfactory knowledge of current regulations, including seven (50%) of those currently driving and 21 (50%) of 42 patients who expressed a wish to drive in the future. Of these 34, only 14 (41%) expressed complete agreement with the regulations. Thus, a significant proportion of patients with epilepsy has driven illegally or has failed to inform the licensing authority or insurers. Understanding of regulations is poor. Less stringent restrictions have been shown to be safe in other countries and might improve compliance.

BACKGROUND: Many patients with epilepsy travel abroad and drive automobiles with the assumption that policies, rules, and regulations on epilepsy and driving are similar to those of their home countries. This paper investigates the driving restrictions and other pertinent information on this issue in foreign countries. METHODS: A questionnaire was sent to 231 neurologists (chosen from American neurological and epilepsy societies) from 84 countries and to 230 official (embassies and consulates) representatives of 134 countries asking for the local rules and regulations and their comments on driving and epilepsy. RESULTS: One hundred and sixty-six responses were received from 96 of 134 (72%) countries. One hundred and six neurologists (of 231 queried [46%]) responded. In 16 countries, persons with epilepsy are not permitted to drive. In the remaining countries, these patients must have a seizure-free period of 6 to 36 months. This period varies according to the type of seizure. In five countries, physicians must report the names of these patients to their local authorities. In many countries, the rules and regulations are being reevaluated and changed. CONCLUSIONS: Patients with epilepsy who plan to drive overseas are advised to contact local embassies and consulates, well before their trips (and keep records of the communications) to obtain the latest information on the rules and regulations governing the driving of automobiles in those countries. Language: en

The lack of driving privileges is one of the major concerns of people with epilepsy. Seizures undoubtedly represent a potential source of accidents and injuries, and this justifies limitations on driving for people liable to epileptic seizures. Convincing evidence shows that in the absence of seizures (with or without treatment), the risk of accidents and injuries is clearly decreased and tends to be close to that of the general population.1,2 Unfortunately, the variability of published reports on risk has led to differing regulations for a driving licence among the members of the European Union and elsewhere in the world,3 with each jurisdiction developing and enforcing its own regulations on epilepsy and driving. The European Council Directive 91/439/EEC on driving licences reports, “a licence may be issued or renewed subject to an examination by a competent medical authority and to regular medical check-ups. The authority shall decide on the state of the epilepsy or other disturbances of consciousness, its clinical form and progress (no seizure in the last two years, for example), the treatment received and the results thereof.”4 For commercial driving it states “driving licences shall not be issued for applicants or drivers suffering or liable to suffer from epileptic seizures or other sudden disturbances of the state of consciousness.”4

Worldwide, more than 50 million people are aff ected by epilepsy, and their management is often a challenge. During the past decade, the management of patients with epilepsy has evo lved substantially, with new data for the pathophysiology of seizures and epilepsy, increasingly complex and diverse neuroimaging and electrophysiological diagnostic methods, and new antiepileptic drugs and non-pharmacological treatments. To keep track of clinically relevant advances in the area has become more diffi cult—an issue emphasised by WHO and the Global Campain Against Epilepsy, which underscored that professionals who treat people with epilepsy often do not have suffi cient specialised knowledge about the disease. In this context, the provision of textbooks that bring together a synthesis of current data for epilepsy and its clinical management is welcome. This objective has been targeted by the Oxford Textbook of Epilepsy and Epileptic Seizures. Edited by four internationally renowned epileptologists, Simon Shorvon, Renzo Guerrini, Mark Cook, and Samden Lhatoo, this textbook provides high scientifi c quality, with 37 sections of the book covering the diff erent aspects of the disease and its management comprehensively. Every section is designed to provide up-to-date data in a concise manner, with the primary objective to inform daily practice. More specifi cally, the authors summarise present views about the pathophysiology of epilepsy, recent epidemiological data, state-of-the-art methods of investigation, general principles of the management of drug treatment or surgery, and treatment specifi cities for status epilepticus and specifi c populations, including children and patients with renal or hepatic dysfunction. The authors have added sections that are discussed rarely in such textbooks, although they are of substantial importance for the optimum management of patients with epilepsy, addressing social issues such as legal aspects of epilepsy and driving. Another section is entirely devoted to the issue of underemployment or unemployement in patients with epilepsy, and discusses epidemiological data, factors that might aff ect the employability of people with epilepsy, and the measures that could be proposed to improve the situation. Another original section adresses disorders of emotional behaviour in epilepsy, with specifi c emphasis on social cognition. Overall, this book is a well-designed textbook that supplies excellent educational material for both trainees and physicians who treat people with epilepsy but who are not highly specialised in the area.

OBJECTIVE--To estimate the risks of road traffic accidents over a period of three years in drivers with a history of single seizures or epilepsy, and to compare them with a cohort of drivers followed up by the Transport Research Laboratory (TRL). DESIGN--A retrospective survey of driving and accident experience by self-completion questionnaire. SUBJECTS--16,958 drivers with a previous history of epilepsy responding to the survey and 8888 non-epileptic drivers responding to a TRL survey. MAIN OUTCOME MEASURES--The risk of any accident, any accident producing an injury, and any accident producing a serious injury, over a three year period. RESULTS--After adjustment for differences in age, sex, driving experience, and mileage between the two populations there was no evidence of any overall increase in risk of accidents in the population of drivers with a history of epilepsy. However, there was evidence of an increased risk of more severe accidents in the population with epilepsy. The risk was increased by about 40% for serious injuries and there was evidence of a twofold risk of increase in non-driver fatalities. These increases seem largely explicable by the occurrence of seizures in this population during the three years of driving that the survey covered. CONCLUSIONS--The acceptability of driving for people with a history of epilepsy should be determined by an acceptable risk of accidents resulting in injury or serious injury rather than overall accident rates. As people with epilepsy can now drive after a 12 month seizure free period rather than the required two year period when this survey was undertaken, it is important to ascertain whether there is any increased risk of injury associated accidents with this policy.

Many countries restrict the issue of driving licences to people prone to epileptic seizures. Regulations are deemed necessary because research has repeatedly shown an increased rate of road traffic accidents (and accidental deaths) in drivers with epilepsy.1 2 3 4 5 6 7 8 Ideally legislation should balance the excess risks of driving against the social and psychological disadvantage to people of prohibiting driving, but achieving this balance is difficult, and regulations vary widely among countries.8 In Britain the lifelong prohibition against driving enacted in the 1920s was changed in 1969 to permit those who had been free of seizures for at least three years to drive. In 1982 the seizure free period was reduced to two years (but remained at three years for people whose attacks occurred only during sleep). The law was later changed again, in January 1993 for vocational licences and in August 1994 for ordinary licences. To be eligible for a group 1 licence (an ordinary licence—that for motorcars and motorcycles) an applicant with epilepsy must have been free of epileptic attacks during the year before the date when the licence is granted (or, if epileptic attacks occur only during sleep, must have had a sleep only pattern for three years or more). In addition, his or her driving must …

Historically, persons with seizures or epilepsy have been prohibited from driving automobiles or motor vehicles because of concern for public safety. Seizures have a tendency to recur and pose risks of traffic accidents, property damage, and personal injury. In our modern world, however, driving an automobile is such an economic and social necessity that a conflict results between our need to protect public safety and our responsibility to provide reasonable opportunities to drive for persons handicapped by seizures and epilepsy. Currently, there is a trend toward liberalization of driving standards for persons with epilepsy, but there is still considerable controversy regarding the specific driving restrictions necessary for persons with seizures, the way in which such policies should be administered, and the role physicians should have in the process. Language: en

From results of a survey of 72 epileptic car drivers who had a mean driving history of 8.6 years, 18 (25%) had experienced one or more automobile accidents ascribed to a seizure while driving, with the total number of accidents of the surveyed group amounting to 35. All the drivers were known to have partial epilepsy, 13 of them having temporal lobe epilepsy. The main characteristics of these 35 accidents were as follows: (1) Fifty-seven percent were caused by complex partial seizure without an aura in which consciousness was immediately impaired at onset, while about 10% were attributed to simple partial seizure in which the conscious state was not altered. No accident was caused by a first seizure; (2) Fifty-one percent occurred on an empty road with little pedestrian and/or vehicular traffic; (3) In about half the accidents, the driver's vehicle collided against an immovable object, and only 20% involved crashing into another car; (4) Most accidents caused damage to only the driver's car and/or mild physical injury; and (5) Fifty-four percent of the accidents were not reported to the police, and many that were reported were ascribed to driving while asleep, to careless driving or to similar behavior.