Epilepsy and driving

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Epilepsy and driving is a personal and public safety issue. A person with a seizure disorder that causes lapses in consciousness may put themselves and the public at risk if a seizure occurs while they are operating a motor vehicle. Not only can a seizure itself cause a car wreck, but anticonvulsants often have side effects that include drowsiness. People with epilepsy are more likely to be involved in a traffic collision than people who do not have the condition, although reports range from minimally more likely up to seven times more likely. [1] [2] [3]

Contents

It is for this reason that most people diagnosed with epilepsy are prohibited or restricted by their local laws from operating vehicles. However, some places have exceptions built into their laws for those who can prove that they have stabilized their condition. Individuals who may be exempt from such restrictions or may have fewer restrictions include those who had seizures as a result of a medical condition that has been cured, from a physician's experimental medication change that failed, as an isolated incident, whose seizures occur only while asleep, or who may be able to predict their seizures in order to ensure that they do not lose consciousness behind the wheel of a moving vehicle.

The first seizure-related automobile crash occurred at the turn of the 19th century. [4] Since then, laws have been enacted all over the world regarding driving for people with epilepsy. There is an ongoing debate in bioethics over who should bear the burden of ensuring that a person with epilepsy does not drive a car or fly an aircraft.

Laws

Some countries prohibit people who have ever had a seizure from driving. In these countries, it is common for people with epilepsy to hide their condition from authorities in order not to be denied a driver's license. [5] Other places allow those who have had seizures to drive after a seizure-free period, which ranges from six months to a year. EU (European Union) harmonisation of periods of freedom from seizure means the periods shown below for EU states is wrong - now 6 months for an isolated seizure, 12 months for a second or more seizures within 5 years, whether or not antiepileptic drugs are taken. For drivers of heavy lorries and buses the seizure-free period is five years without drugs.

Epilepsy driving laws by country

United States

In the U.S., people with epilepsy can drive if their seizures are controlled with medication or other treatment and they meet the licensing requirements in their state. How long they have to be free of seizures varies in different states, but it is most likely to be between six months to a year. [22] [23] In 44 of the 50 states, the burden is placed on patients to report their condition to appropriate licensing authorities so that their privileges can be revoked where appropriate. Six states place the burden of reporting on the patient's physician. [24] After reporting is carried out, it is usually the driver's licensing agency that decides to revoke or restrict a driver's license.

Restrictions on operating a commercial vehicle are often stricter than those for a private automobile. Federal law in the United States prohibits people with epilepsy from operating a commercial vehicle across state lines, even if seizures are controlled. [25]

Studies have shown that in states where drivers are required to report their own condition, about 1/3 of licensed drivers comply with this law. The most recent trend adopted by many states allows those who have been seizure-free for 90 days to drive. This leniency has been passed with the hope that drivers will be more willing to report their health conditions.

Laws by state

Canada

The following are the driving laws for people with epilepsy in each province/territory of Canada:

Laws by province

ProvinceLawPhysician required to reportSeizure-free period
Alberta Those who have daytime seizures are barred from driving for 3 months. Driving is then permitted if seizures are prevented by medication and/or there are no reoccurrences.yes3 months
British Columbia No law specified for non-commercial driver's on site. Commercial drivers may be prohibited.No6 months
Manitoba Yes6 months
New Brunswick Yes
Newfoundland and Labrador Yes
Northwest Territories Yes
Nova Scotia
Nunavut
Ontario Persons with a Seizure Disorder May Drive in Ontario, if [26]
  • Febrile convulsions were limited to early childhood
  • seizures were a result of a toxic illness which is now completely cured
  • seizures are prevented by medication, the person has been free of seizures for 6 months, and medication does not cause drowsiness or poor co-ordination
  • the person has had a solitary seizure which cannot be related to a toxic illness and has provided a full neurologic examination revealing no epileptiform activity
  • the person has had seizures only during sleep or immediately upon awakening (nocturnal seizures) for at least 5 years
  • the person has been seizure free on medication for 1 year and seizures recur because of cessation or alteration of medication on their physician's instructions.
Yes6 months
Prince Edward Island Yes
Quebec Yes6 months as of February 2010
Saskatchewan
Yukon Yes

India

In India, people with epilepsy are not permitted to drive. The document puts the onus on both applicant to reveal if the person loses consciousness due to any cause and medical practitioner to provide a certificate that the applicant, to the best of the professional's judgment, has epilepsy, vertigo or any mental ailment likely to affect driving ability. [27]

Flying

While most places allow people with their seizures under control to drive a car, laws regarding the operation of an airplane generally are much more strict. In the United States, the Federal Aviation Administration often prohibits anyone with epilepsy from being issued a pilot's license, even if the seizures are controlled by a medication or have completely ceased. The only epilepsy patients who may be issued a license are those who have had seizures during childhood, but have been seizure-free since, and have a normal EEG. Those with Rolandic seizures may be allowed to fly if they are seizure-free for at least four years. Children who have had a febrile seizure prior to the age of five may fly if they are off of all seizure medication for at least three years. Regardless, all medical records must be submitted to the FAA. [28]

As of 2017, normally, if a person is taking medications for epilepsy, and is free of seizures for five full years, and wishes to obtain a pilot's license for a large aircraft, including any jet, they must then work with their physician and neurologist to wean themselves, and go off the medications. Once the medications have been stopped, if they remain seizure-free for another five full years, they may apply. In any case, the full medical records are reviewed by the FAA, who has the final call and the sole discretion to make modifications and exceptions (Interview with representative of FAA at General Wayne Downing Peoria International Airport).

Collisions caused by a seizure while driving

A study conducted by the National Center for Health Statistics found that fatalities caused by seizures that occurred while driving were relatively rare, resulting in less than 0.2% of all traffic-related fatalities in the years 1995–97. [29] Drivers who experience seizures were more than twice as likely to be involved in a fatal traffic collision than drivers with heart disease and almost five times as likely to be in a fatal wreck as someone with diabetes. [29]

When the person is driving when they have caused multiple wrecks or been ordered not to drive, criminal charges can result. Examples include:

Related Research Articles

<span class="mw-page-title-main">Epilepsy</span> Group of neurological disorders causing seizures

Epilepsy is a group of non-communicable neurological disorders characterized by recurrent epileptic seizures. An epileptic seizure is the clinical manifestation of an abnormal, excessive, and synchronized electrical discharge in the neurons. The occurrence of two or more unprovoked seizures defines epilepsy. The occurrence of just one seizure may warrant the definition in a more clinical usage where recurrence may be able to be prejudged. Epileptic seizures can vary from brief and nearly undetectable periods to long periods of vigorous shaking due to abnormal electrical activity in the brain. These episodes can result in physical injuries, either directly, such as broken bones, or through causing accidents. In epilepsy, seizures tend to recur and may have no detectable underlying cause. Isolated seizures that are provoked by a specific cause such as poisoning are not deemed to represent epilepsy. People with epilepsy may be treated differently in various areas of the world and experience varying degrees of social stigma due to the alarming nature of their symptoms.

<span class="mw-page-title-main">Seizure</span> Period of symptoms due to excessive or synchronous neuronal brain activity

A seizure is a period of symptoms due to abnormally excessive or synchronous neuronal activity in the brain. Outward effects vary from uncontrolled shaking movements involving much of the body with loss of consciousness, to shaking movements involving only part of the body with variable levels of consciousness, to a subtle momentary loss of awareness. These episodes usually last less than two minutes and it takes some time to return to normal. Loss of bladder control may occur.

<span class="mw-page-title-main">Convulsion</span> Medical condition where body muscles contract and relax rapidly and repeatedly

A convulsion is a medical condition where the body muscles contract and relax rapidly and repeatedly, resulting in uncontrolled shaking. Because epileptic seizures typically include convulsions, the term convulsion is often used as a synonym for seizure. However, not all epileptic seizures result in convulsions, and not all convulsions are caused by epileptic seizures. Non-epileptic convulsions have no relation with epilepsy, and are caused by non-epileptic seizures.

<span class="mw-page-title-main">Myoclonus</span> Involuntary, irregular muscle twitch

Myoclonus is a brief, involuntary, irregular twitching of a muscle, a joint, or a group of muscles, different from clonus, which is rhythmic or regular. Myoclonus describes a medical sign and, generally, is not a diagnosis of a disease. It belongs to the hyperkinetic movement disorders, among tremor and chorea for example. These myoclonic twitches, jerks, or seizures are usually caused by sudden muscle contractions or brief lapses of contraction. The most common circumstance under which they occur is while falling asleep. Myoclonic jerks occur in healthy people and are experienced occasionally by everyone. However, when they appear with more persistence and become more widespread they can be a sign of various neurological disorders. Hiccups are a kind of myoclonic jerk specifically affecting the diaphragm. When a spasm is caused by another person it is known as a provoked spasm. Shuddering attacks in babies fall in this category.

Landau–Kleffner syndrome (LKS)—also called infantile acquired aphasia, acquired epileptic aphasia or aphasia with convulsive disorder—is a rare childhood neurological syndrome.

Psychogenic non-epileptic seizures (PNES), also referred to as pseudoseizures, non-epileptic attack disorder (NEAD), functional seizures, or dissociative seizures, are episodes resembling an epileptic seizure but without the characteristic electrical discharges associated with epilepsy. PNES fall under the category of disorders known as functional neurological disorders (FND) and are typically treated by psychologists or psychiatrists.

Frontal lobe epilepsy (FLE) is a neurological disorder that is characterized by brief, recurring seizures arising in the frontal lobes of the brain, that often occur during sleep. It is the second most common type of epilepsy after temporal lobe epilepsy (TLE), and is related to the temporal form in that both forms are characterized by partial (focal) seizures.

Epilepsy surgery involves a neurosurgical procedure where an area of the brain involved in seizures is either resected, ablated, disconnected or stimulated. The goal is to eliminate seizures or significantly reduce seizure burden. Approximately 60% of all people with epilepsy have focal epilepsy syndromes. In 15% to 20% of these patients, the condition is not adequately controlled with anticonvulsive drugs. Such patients are potential candidates for surgical epilepsy treatment.

<span class="mw-page-title-main">Generalized epilepsy</span> Epilepsy syndrome that is characterised by generalised seizures with no apparent cause

Generalized epilepsy is a form of epilepsy characterised by generalised seizures with no apparent cause. Generalized seizures, as opposed to focal seizures, are a type of seizure that impairs consciousness and distorts the electrical activity of the whole or a larger portion of the brain.

Post-traumatic epilepsy (PTE) is a form of acquired epilepsy that results from brain damage caused by physical trauma to the brain. A person with PTE experiences repeated post-traumatic seizures more than a week after the initial injury. PTE is estimated to constitute 5% of all cases of epilepsy and over 20% of cases of acquired epilepsy.

Post-traumatic seizures (PTS) are seizures that result from traumatic brain injury (TBI), brain damage caused by physical trauma. PTS may be a risk factor for post-traumatic epilepsy (PTE), but a person having a seizure or seizures due to traumatic brain injury does not necessarily have PTE, which is a form of epilepsy, a chronic condition in which seizures occur repeatedly. However, "PTS" and "PTE" may be used interchangeably in medical literature.

Sleep-related hypermotor epilepsy (SHE), previously known as nocturnal frontal lobe epilepsy, is a form of focal epilepsy characterized by seizures which arise during sleep. The seizures are most typically characterized by complex motor behaviors. It is a relatively uncommon form of epilepsy that constitutes approximately 9-13% of cases. This disorder is associated with cognitive impairment in at least half of patients as well as excessive daytime sleepiness due to poor sleep quality. This disorder is sometimes misdiagnosed as a non-epileptic sleep disorder. There are many potential causes of SHE including genetic, acquired injuries and structural abnormalities.

Generally, seizures are observed in patients who do not have epilepsy. There are many causes of seizures. Organ failure, medication and medication withdrawal, cancer, imbalance of electrolytes, hypertensive encephalopathy, may be some of its potential causes. The factors that lead to a seizure are often complex and it may not be possible to determine what causes a particular seizure, what causes it to happen at a particular time, or how often seizures occur.

Migralepsy is a rare condition in which a migraine is followed, within an hour period, by an epileptic seizure. Because of the similarities in signs, symptoms, and treatments of both conditions, such as the neurological basis, the psychological issues, and the autonomic distress that is created from them, they individually increase the likelihood of causing the other. However, also because of the sameness, they are often misdiagnosed for each other, as migralepsy rarely occurs.

Vertiginous epilepsy is infrequently the first symptom of a seizure, characterized by a feeling of vertigo. When it occurs, there is a sensation of rotation or movement that lasts for a few seconds before full seizure activity. While the specific causes of this disease are speculative there are several methods for diagnosis, the most important being the patient's recall of episodes. Most times, those diagnosed with vertiginous seizures are left to self-manage their symptoms or are able to use anti-epileptic medication to dampen the severity of their symptoms.

Epilepsy can affect employment for a variety of reasons. Many employers are reluctant to hire a person they know has epilepsy, even if the seizures are controlled by medication. If the employee has a seizure while at work, they could harm themselves depending on the nature of the work. Employers are often unwilling to bear any financial costs that may come from employing a person with epilepsy, i.e. insurance costs, paid sick leave etc. Many people whose seizures are successfully controlled by a medication experience a variety of side effects, most notably drowsiness, which may affect job performance. Many laws prohibit or restrict people with epilepsy from performing certain duties, most notably driving or operating dangerous machinery, thereby lowering the pool of jobs available to people with epilepsy. People with epilepsy are also prohibited from joining the armed forces, though they may work in certain civilian military positions.

Epilepsy is a condition defined by unprovoked or reflex seizures, often occurring without warning. The condition impacts much of a patient's life, including personal safety, memory, and views by others. Those who have active seizures live with the fact that they can have a seizure at any time. Those whose seizures are controlled by medication live with the underlying side effects and the need to remember to take the medication at the correct times.

<span class="mw-page-title-main">Epilepsy in children</span>

Epilepsy is a neurological condition of recurrent episodes of unprovoked epileptic seizures. A seizure is an abnormal neuronal brain activity that can cause intellectual, emotional, and social consequences. Epilepsy affects children and adults of all ages and races, and is one of the most common neurological disorders of the nervous system. Epilepsy is more common among children than adults, affecting about 6 out of 1000 US children that are between the age of 0 to 5 years old. The epileptic seizures can be of different types depending on the part of the brain that was affected, seizures are classified in 2 main types partial seizure or generalized seizure.

Jet's Law is the first eponymous law to be created in the state of Queensland, Australia. It protects people from motorists who have a medical condition that may affect their ability to drive. The most common conditions reported are Epilepsy and Diabetes.

An epilepsy syndrome is defined as "a characteristic cluster of clinical and Electroencephalography (EEG) features, often supported by specific etiological findings ."

References

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  2. ↑ Kaufman, David Myland (2007). Clinical neurology for psychiatrists - Google Books. Elsevier Health Sciences. ISBN   978-1-4160-3074-4. Archived from the original on 2024-07-06. Retrieved 2010-09-16.
  3. ↑ Lings, Svend (2001-08-14). "Increased driving accident frequency in Danish patients with epilepsy". Neurology. 5 (3): 435–9. doi:10.1212/wnl.57.3.435. PMID   11502909. S2CID   35652890. Archived from the original on 2010-07-12. Retrieved 2010-09-16.
  4. ↑ Wyllie, Elaine; Gupta, Ajay; Lachhwani, Deepak K. (2006). The treatment of epilepsy : principles & practice (4th ed.). Philadelphia: Lippincott Williams & Wilkins. p. 1203. ISBN   0781749956.
  5. ↑ "Neuroscience for Kids - Epilepsy/Driving". Faculty.washington.edu. Archived from the original on 2022-10-23. Retrieved 2010-09-16.
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  8. ↑ http://www.epilepsyassociation.com.au/info/lifestyle/driving.html Archived 2007-08-29 at the Wayback Machine .
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  11. ↑ https://www.riigiteataja.ee/akt/104012011006 Archived 2022-03-19 at the Wayback Machine §4.1.9
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  15. ↑ "Driver's license and epilepsy". ISE - Israeli Society for Epilepsy (in Hebrew). Archived from the original on 2013-07-12. Retrieved 2016-09-10.
  16. ↑ Hashimoto K, Fukushima Y, Saito F, Wada K (June 1991). "A study on driving status in 98 epileptic patients with driving licences". Jpn. J. Psychiatry Neurol. 45 (2): 323–6. doi:10.1111/j.1440-1819.1991.tb02480.x. PMID   1762210. S2CID   30893696.
  17. ↑ "Can you drive with epilepsy". 8 February 2016. Archived from the original on 9 June 2023. Retrieved 29 April 2018.
  18. ↑ "Factsheet 17 -- Epilepsy/seizures and driving" (PDF). NZ Transport Agency. March 2012. Archived (PDF) from the original on 25 January 2015. Retrieved 16 December 2012.
  19. ↑ UK Epilepsy Action: Driving and Epilepsy, I've had a seizure. What should I do? Archived 2008-10-15 at the Wayback Machine
  20. ↑ UK Driver and Vehicle Licensing Agency Guide to the Current Medical Standards Of Fitness to Drive Archived 2006-08-20 at the Wayback Machine . Full details for doctors regarding epilepsy are given in the Appendix Archived 2006-08-15 at the Wayback Machine . Information for drivers can be found in Medical Rules - Group 1 Licence Holders Archived 2006-07-21 at the Wayback Machine
  21. ↑ UK Epilepsy Action: booklet with further details about driving PDF Archived 2011-09-27 at the Wayback Machine
  22. ↑ Epilepsy Foundation Driving and You - Can you drive an automobile if you have epilepsy? Archived 2008-04-20 at the Wayback Machine .
  23. ↑ Epilepsy Foundation Driver Information by State Archived 2008-05-09 at the Wayback Machine
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  25. ↑ Devinsky, Orrin (2007-10-28). Epilepsy: Patient and Family Guide - Google Books. Springer. ISBN   978-1-932603-41-5. Archived from the original on 2024-07-06. Retrieved 2010-09-16.
  26. ↑ "Archived copy". Archived from the original on 2011-09-29. Retrieved 2023-01-17.{{cite web}}: CS1 maint: archived copy as title (link)
  27. ↑ "Motor Vehicles Act 1939". www.commonlii.org. Archived from the original on 2020-05-01. Retrieved 2020-04-13.
  28. ↑ "Guide for Aviation Medical Examiners". www.faa.gov. Archived from the original on 2013-10-17. Retrieved 2008-06-17.
  29. 1 2 Sheth SG, Krauss G, Krumholz A, Li G (September 2004). "Mortality in epilepsy: driving fatalities vs other causes of death in patients with epilepsy". Neurology. 63 (6): 1002–7. doi:10.1212/01.wnl.0000138590.00074.9a. PMID   15452290. S2CID   23183235.
  30. ↑ "Md. Driver Indicted in Deaths of Man, Sons; Epileptic Blamed Seizure for Crash". 22 May 2002. Archived from the original on 13 November 2017.
  31. ↑ "Driver in Frederick Crash That Killed 4 Has Epilepsy; Man Tried to Treat Himself Before Accident, Authorities Say", The Washington Post
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  34. 1 2 "Man sentenced to seven years for causing deaths of sisters". Irish Times. 2014-03-14. Archived from the original on 2014-04-13. Retrieved 2014-04-12.
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