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Epilepsy and driving

From Wikipedia, the free encyclopedia

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]

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

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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

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United States

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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

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Canada

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

Laws by province

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Province Law Physician required to report Seizure-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. yes 3 months
British Columbia No law specified for non-commercial driver's on site. Commercial drivers may be prohibited. No 6 months
Manitoba Yes 6 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.
Yes 6 months
Prince Edward Island Yes
Quebec Yes 6 months as of February 2010
Saskatchewan
Yukon Yes

India

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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

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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

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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:

  • In March 2002, a Frederick, Maryland man was charged with vehicular manslaughter after a seizure he had while operating a motor vehicle resulted in a wreck that killed four people.[30] The man had been using a nerve-stimulating device to treat his epileptic condition rather than seeking medical treatment.[31] He had been using this home remedy out of fear that if he had reported his condition to a physician, he would be stripped of his driver's license.
  • An Essex, UK man was jailed for an car wreck he caused on April 18, 2008, that killed a female pedestrian. He had already been ordered by a judge not to drive. His sentence was 8 years, and he was disqualified from driving for 10 years.[32]
  • A 28-year-old Halethorpe, Maryland woman was sentenced to 30 weekends in jail in April 2009 after being convicted of vehicular manslaughter stemming from a fatal 2007 crash. She blamed side effects from the anti-seizure medication she was taking.[33] She had previously experienced seizure-related car wrecks but still qualified for a driver's license under Maryland state law and continued driving.[33] She was also sentenced to 10 months of home detention, five years of supervised probation, during which time she may not drive a car, and a 10-year suspended prison sentence.[33]
  • In Galway, Ireland, a 41-year-old man with a lifelong history of epilepsy was jailed for 7 years and disqualified from driving for 20 years for causing the death of two baby sisters on October 21, 2012.[34] He had been told in June 2012 not to drive until he had been seizure-free for at least a year.[34]

References

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  1. ^ Taylor, J; Chadwick, D; Johnson, T (1 June 1996). "Risk of accidents in drivers with epilepsy". Journal of Neurology, Neurosurgery, and Psychiatry. 60 (6): 621–7. doi:10.1136/jnnp.60.6.621. PMC 1073944. PMID 8648327. Archived from the original on 6 July 2024. Retrieved 28 June 2010.
  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.
  6. ^ a b c d e f g h i j k l Ooi WW (2000). "International Regulations for Automobile Driving and Epilepsy". Journal of Travel Medicine. 7 (1): 1–4. doi:10.2310/7060.2000.00001. PMID 10689230.
  7. ^ a b c Ben-Menachem E (2004). "Toward a more pragmatic view of driving and epilepsy". Epilepsy Curr. 4 (4): 133–4. doi:10.1111/j.1535-7597.2004.44003.x. PMC 1176346. PMID 16059474.
  8. ^ http://www.epilepsyassociation.com.au/info/lifestyle/driving.html Archived 2007-08-29 at the Wayback Machine.
  9. ^ a b c d e f g h i j k l "Neuroscience for Kids - Epilepsy/Driving". faculty.washington.edu. Archived from the original on 2022-10-23. Retrieved 2009-11-01.
  10. ^ "Epilepsie - veřejná část". Archived from the original on 2008-09-23. Retrieved 2016-09-10.
  11. ^ https://www.riigiteataja.ee/akt/104012011006 Archived 2022-03-19 at the Wayback Machine §4.1.9
  12. ^ a b GmbH, beta Institut gemeinnützige. "betanet - Epilepsie > Autofahren - Soziales & Recht". betanet - Epilepsie > Autofahren - Soziales & Recht. Archived from the original on 2018-06-20. Retrieved 2016-09-10.
  13. ^ "ایست پلیس به رانندگان مصروع". Archived from the original on 2017-12-01. Retrieved 2017-11-28.
  14. ^ Glynn, Mike (August 5, 2006). Epilepsy and Driving in Europe (PDF). IBE Epilepsy & Society Conference. Copenhagen. pp. 1–19. Archived (PDF) from the original on July 6, 2024. Retrieved July 4, 2024.
  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
  24. ^ Ilo e. Leppik, MD; Neurology, American Academy of (2006-12-15). Epilepsy: A Guide to Balancing Your Life - Google Books. Springer. ISBN 978-1-932603-20-0. Archived from the original on 2024-07-06. Retrieved 2010-09-16.
  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. ^ a b 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
  32. ^ "Epileptic driver jailed for death". BBC News. December 12, 2008. Archived from the original on December 13, 2008. Retrieved May 2, 2010.
  33. ^ a b c "Manslaughter conviction for driver with epilepsy". Explore Howard. 2007-04-23. Archived from the original on 2012-07-07. Retrieved 2010-09-16.{{cite web}}: CS1 maint: unfit URL (link)
  34. ^ a b "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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