Abstract
Driving restrictions in people with epilepsy (PWE) is a highly contentious topic. The fundamental difficulty lies in achieving a balance between safety and practicality. The aim of this review is to provide an overview, history, and rationale behind current laws regarding driving restriction in PWE. We also discuss recent findings that may be helpful to practitioners during individual discussions with PWE including seizure recurrence risk after first seizure, recurrent seizure, and anticonvulsant with drawl and driving restrictions in patients with psychogenic non-epileptic seizures (PNES).
Similar content being viewed by others
References
Papers of particular interest, published recently, have been highlighted as: •• Of major importance
Sandell C. Monica Chavez found Not Guilty in car crash that killed family of 5, caused by possible seizure. http://abcnews.go.com/US/monica-chavez-colorado-woman-seizure-killed-family-found/story?id=16584754. Accessed May 31, 2016
Classen S, Crizzle A, Winter S, et al. Evidence based review on epilepsy and driving. Epilepsy Behav. 2012;23:103–12. This is evidence based review of several key articles on PWE and driving literature. Each article was assigned a class of evidence according to AAN criteria and recommendations made to clinicians and policy makers. Seizure free interval (6-12 months) and fewer non-seizure related crashes are some factors that are protective against MVA.
Naik P, Fleming M, Bhatia P, et al. Do drivers with epilepsy have higher rates of motor vehicle accidents than those without epilepsy? Epilepsy Behav. 2015;47:111–4.
Elsharkawy A, May T, Thorbecke R, et al. Predictors of quality of life after resective extratemporal epilepsy surgery in adults in long-term follow up. Seizure. 2009;18:498–503.
Jacoby A, Gamble C, Doughty J, et al. Quality of life outcomes of immediate or delayed treatment of early epilepsy and single seizure. Neurology. 2007;68:1188–96.
Hansotia P, Broste SK. The effect of epilepsy or diabetes on the risk of automobile accidents. N Eng J Med. 1991;324:22–6.
Thalwitzer F. Epileptiker als Autofahrer. Münch Med Woschenschr. 1906;37:1818.
Krumholz A, Fisher R, Lesser R, et al. Driving and epilepsy a review and reappraisal. JAMA. 1991;265:622–6.
Krauss G, Ampaw L, Krumholz A, et al. Individual state driving restrictions for people with epilepsy in the US. Neurology. 2001;57:1780–5.
State Driving Laws Database. http://www.epilepsy.com/driving-laws. Accessed April 15, 2016.
Fisher R, Parsonage M, Beaussart M, et al. Epilepsy and driving: an international perspective. Epilepsia. 1994;35:675–84.
American Academy of Neurology. American Epilepsy Society, and Epilepsy Foundation of America. Consensus statements, sample statutory provisions, and model regulations regarding driver licensing and epilepsy. Epilepsia. 1994;35:696–705.
McLachlan R, Starreveld E, Lee M. Impact of mandatory physician reporting on accident risk in epilepsy. Epilepsia. 2007;48:1500–5.
Egli M, Hartmann H, Hess R. Driving licenses in epileptic patients. Schweiz Med Wochenschr. 1977;10/12:389–97.
Sillanpaa M, Shinnar S. Obtaining a driver’s license and seizure relapse in patients with childhood-onset epilepsy. Neurology. 2005;64:680–6.
Taylor J, Chadwick D, Johnson T. Risk of accidents in drivers with epilepsy. J Neurol Neurosurg Psychiatry. 1996;60:621–7.
Hansotia P, Broste S. The effect of epilepsy or diabetes mellitus on the risk of automobile accidents. N Eng J Med. 1991;324:22–6.
Berg A, Vickrey B, Sperling M, et al. Driving in adults with refractory localization-related epilepsy. Neurology. 2000;14:117–22.
Sheth S, Krauss G, Krumholz A, et al. Mortality in epilepsy driving fatalities vs other causes of death in patients with epilepsy. Neurology. 2004;63:1002–7.
Lings S. Increased driving accident frequency in Danish patients with epilepsy. Neurology. 2001;57:435–9.
Hansotia P, Broste S. Epilepsy and traffic safety. Epilepsia. 1993;34:852–8.
Krauss G, Krumholz A, Carger, et al. Risk factors for seizure related motor vehicle crashes in patients with epilepsy. Neurology. 1999;52:1324–9.
Krumholz A, Wiebe S, Gronseth G, et al. Evidence based guideline: management of an unprovoked first seizure in adults. Neurology. 2015;84:1705–13.
Bonnett L, Tudur-Smith C, Williamson P, et al. Risk of recurrence after a first seizure and implications for driving: further analysis of the multicentre study of early epilepsy and single seizure. BMJ. 2010;341:c6477.
Punia V, Farooque P, Chen W, et al. Epileptic auras and their role in driving safety in people with epilepsy. Epilepsia. 2015;56:182–5.
Cockerell OC, Eckle I, Goodridge DM, et al. Epilepsy in a population of 6000 re-examined: secular trends in first attendance rates, prevalence, and prognosis. J Neurol Neurosurg Psychiatry. 1995;58:570e6.
Mintzer S. Driven to tears: epilepsy specialists and the automobile. Epilepsy Curr. 2015;15:279–82. A recent Quantitative Practical Use-Driven Learning Survey demonstrating that the large majority of epilepsy specialists generally take a conservative approach regarding driving in patients with PNES and advise that patients stop driving or modify driving habits immediately following drug taper.
Kang J, Sperling M. Should physicians restrict driving in seizure free patients undergoing antiepileptic drug taper? American epilepsy society meeting December 2015, Philadelphia. Abstract 1.114.
Lossius MI, Hessen E, Mowinckel P, et al. Consequences of antiepileptic drug withdrawal: a randomized, double-blind study (Akershus Study). Epilepsia. 2008;49:455e63.
Bonnett L, Shukralla A, Tudur-Smith C. Seizure recurrence after antiepileptic drug withdrawal and the implications for driving: further results from the MRC antiepileptic drug withdrawal Study and a systemic review. J Neurol Neurosurg Psychiatry. 2011;82:1328–33.
Specchio LM, Tramacere L, La Neve A, et al. Discontinuing antiepileptic drugs in patients who are seizure free on monotherapy. J Neurol Neurosurg Psychiatry. 2002;72:22e5.
Mintzer S. License to ill: playing the odds after withdrawing and restarting antiepileptic drugs. Epilepsy Curr. 2011;11:177–8.
Callaghan N, Garrett A, Goggin T. Withdrawal of anticonvulsant drugs in patients free of seizures for two years. A prospective study. N Engl J Med. 1988;318:942–6.
Specht U, Thorbecke R. Should patients with psychogenic nonepileptic seizures be allowed to drive? Recomm German Experts. 2009;16:547–50.
Benbadis S, Blustein J, Sunstad L. Should patients with psychogenic nonepileptic seizures be allowed to drive? Epilepsia. 2000;41:895–7.
Greenough J. 10 million self driving cars will be on the road by 2020. http://www.businessinsider.com/report-10-million-self-driving-cars-will-be-on-the-road-by-2020-2015-5-6. Accessed May 20, 2016.
Haj-Assad S. When will self driving cars really arrive? http://www.autoguide.com/auto-news/2015/08/when-will-self-driving-cars-really-arrive-.html. Accessed May 20, 2016.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of Interest
Joon Y. Kang and Scott Mintzer declare that they have no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Additional information
This article is part of the Topical collection on Epilepsy
Rights and permissions
About this article
Cite this article
Kang, J.Y., Mintzer, S. Driving and Epilepsy: a Review of Important Issues. Curr Neurol Neurosci Rep 16, 80 (2016). https://doi.org/10.1007/s11910-016-0677-y
Published:
DOI: https://doi.org/10.1007/s11910-016-0677-y