A youtube video - Dr. Robert Fisher, an expert on epilepsy and driving, sheds light on what the situation is, what the rules are, and where it's headed.
Not being able to drive is a big social issue for patients with epilepsy. They are not able to live independently and exercise the freedom of driving.
Should people with Epilepsy be driving?
Dr. Fisher replied by stating “sometimes and it depends” – He further stated that generally individuals with epilepsy have about 50% increased risk of having a seizure while driving. However, this risk is much lower compared to elderly patients driving and having an event such as cardiac arrest or teenagers; especially boys who have a much higher risk of getting into an accident while driving. Dr. Fisher recommends that people whose seizures are not in control should not drive.
As seizure has a wide range of effects on individuals, it’s especially important for the treating physician and patient to have a discussion. The physician can write exceptions to eligible patients for whom seizure will not affect their ability to drive. This supporting document can be presented to the State DMV for considering, who will ultimately decide if the patient is eligible for a driving license.
The length of the trip also does not matter, so if seizures are not in control, patients are advised not to drive.
If an individual has an aura or sense that seizure is coming while driving, they should pull over if it’s safe to do so, and if stuck on a busy road or highway, they should put on emergency signals and remain in the car and wait for seizure to pass and inform the authority and get help.
It’s highly recommended not to start driving post-seizure as an individual might still not be in control or fully alert.
Also, learned that there are some States which requires physicians to mandatory report to the health department anyone who has loss of consciousness disorder and seizure.
Thank you Trusha for your clip and notes you shared on driving for people with epilepsy. Most of AED cause somnolence and dizziness and I go ahead and counsel patients not to drive, and I was totally unaware of the fact that patients with epilepsy could not drive.
Noha
Hi Noha, Thank you for your comment, I totally agree, it's not something we all think about perhaps because its not talked about as much or we observe it ourselves. I become interested in this topic and was made aware of this after a few of my patients mentioned that they had difficulty getting to the pharmacy as they had to rely on family members for transportation. - Trusha Patel
Trusha, thank you for sharing your post. Like Noha, I did not know that patients with epilepsy had these limitations imposed on them. It is yet another contributing factor to the psycho-social aspect of living with epilepsy that can lead to depression, anxiety and loneliness. Thanks Louise Brown
Hi Louise, I totally agree, it can be quite difficult for patients with epilepsy and like you pointed out it is yet another contributing factor to the psycho-social aspect of living with epilepsy. It can be quite frustrating for patients who have been quite independent before the diagnosis to have to start relying on public transportation and family members. Another issue is securing employment, many employer requires that their employee have a driving license and a mode of transportation, at least its true for the province I live in and individuals can run into issue with employer. Trusha Patel
Very interesting topic Trusha. Many of my patients faced this issue in their lives. In an already challenging life that patients with epilepsy have, taking away their driving license looks counterproductive . However, I feel it is in the best interest of everyone that patients with seizures should not drive until they get stable on certain medications. Syed Rashid
Hi Syed, I do agree that it is required in many instances, especially for public and patient's own safety. In Ontario, Canada, physician and hospitals are required to report all seizure related events to Service Ontario which is an agency under the Ministry of Transportation. Thank you for your comment, I appreciate it! - Trusha Patel
Trusha,
I had a friend who had seizures, had major accident because he had seizure while driving. He was airlifted, but survived. It is difficult for the patients with epilepsy to rely on others drive them around but their driving can be dangerous to them and others. Sajimon George
Hi Sajimon, I am sorry to hear about your friend, and I am happy to hear that he survived. I also agree it can be most challenging for patients to continuously having to rely on others for transportation and it can definitely make the diagnosis a little bit bitter. I wonder if you friend was given a go ahead to drive again, and if yes, do he drive? I also have a family friend who has a diagnosis of epilepsy, seizures are controlled with medications, and she was given a go ahead to drive by the physician and also by the our province yet, she is reluctant to drive. For her own and others safety is her main reason. Thank you for sharing a personal story. - Trusha Patel
My friend's license was revoked for one year and his wife was driving him around and it was a very difficult situation for both of them. After one year he started driving again, however only driving to work and back. He was on epilepsy medications both before and after the accident. I am not sure what the was medication. Sajimon
Hi Sajimon, thank you for sharing this story. It really sheds light on the difficulties patients with Epilepsy face while driving, especially when they have to rely on family members or friends for rides which can be quite a burden for others. I can also understand the difficulty weighing out the pros and cons in terms of protecting our patients from causing harm to themselves and to others. - Samantha Varghese
Hi Trusha,
Driving and mobility is definitely a huge concern for persons with epilepsy. I know from practice that physicians need to document their seizure therapy interventions with patients and report to the Secretary of State, the body responsible for Driver licensing in the US.
I am concerned though especially with the RIDESHARE industry, that individuals with epilepsy might sneak on to the road and drive for living, when they are behind on their medication. This should become a public policy consideration.
Tosh Bolanle
Hello Tosh, you bring up an important point for RIDESHARE industry, I am not very familiar with the rules and regulations and requirements around signing up for these program, but it is my hope that these companies would take necessary steps such as required physical assessment by a physician to ensure that they are fit for the job. But I do agree that a public policy or something biding by law would be reassuring. Thank you for your post, I really appreciate it. - Trusha Patel
Trusha: Another consequence of driving restriction is the impact on a family business. One of my patients son has seizures and has been unable to drive for years. The father would like to retire and give the business, (janitorial) to his son but the only way the son gets around is by being driven by his father. Kevin Glick
Hello Kevin, thank you for your post and highlighting the issue. This must a tough issue for the family and I can imagine that the son would be frustrated with the situation as much as his father. One can possible get by taking public transportation and perhaps living close to work to avoid having to reply on others for transportation. However, its much more difficult when your livelihood relies on you being able to transport yourself. Hope they can make it work somehow. -Trusha Patel
I had a chance to talk to one of the epilepsy patient who had seizure when she was a teenager (now she is in her 30's). She is stable on Lamotrigine ever since. She does not want to take a chance to stop her Lamotrigine just due to the fact that she would not be able to drive for next 6 months. Just thought to share with you guys, Syed
Hi Syed, thank you for sharing, I appreciate it! I can understand the anxiety of loosing the ability to drive and hence the need to continue to take anti-epileptic drug. I am sure many patients who has only had a few seizure in their lifetime will continue to take medication in fear of having an attack and loosing their driving license. I know for sure that if I were in a similar situation, I would do anything in my power to keep my independence. - Trusha Patel
The point that Syed brings up is important to think about when considering discontinuing medication. It is likely that the young woman could stop the drug, and not have another seizure. But there is a pretty high recurrence rate. Make sure she is on folic acid in case she wants to get pregnant. In fact, any woman of child bearing age who wants to get pregnant should really be on folic acid daily. http://pediatrics.aappublications.org/content/104/2/325 Ruth Nemire