Epilepsy and driving explained

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

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
AlbertaThose 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 ColumbiaNo law specified for non-commercial driver's on site. Commercial drivers may be prohibited.No6 months
ManitobaYes6 months
New BrunswickYes
Newfoundland and LabradorYes
Northwest TerritoriesYes
Nova Scotia
Nunavut
OntarioPersons 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 IslandYes
QuebecYes6 months as of February 2010
Saskatchewan
YukonYes

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.

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

External links

Notes and References

  1. J. Taylor. D. Chadwick. T. Johnson. Risk of accidents in drivers with epilepsy.. 1 June 1996. Journal of Neurology, Neurosurgery, and Psychiatry. 60. 6. 1073944. 8648327. 621–7. 10.1136/jnnp.60.6.621. 28 June 2010. 6 July 2024. https://web.archive.org/web/20240706164306/https://europepmc.org/scanned?pageindex=1&articles=PMC1073944. live.
  2. Book: Clinical neurology for psychiatrists - Google Books . 2010-09-16 . 978-1-4160-3074-4 . 2007 . Kaufman . David Myland . Elsevier Health Sciences . 2024-07-06 . https://web.archive.org/web/20240706164304/https://books.google.com/books?id=5HseAi06oRwC&q=epilepsy+driving&pg=PA225#v=snippet&q=epilepsy%20driving&f=false . live .
  3. Svend. Lings. Increased driving accident frequency in Danish patients with epilepsy. 5. 3. 435–9. Neurology. 2001-08-14. 2010-09-16. 11502909. 10.1212/wnl.57.3.435. 35652890. 2010-07-12. https://web.archive.org/web/20100712003446/http://www.neurology.org/cgi/content/abstract/57/3/435. live.
  4. Book: Wyllie. Elaine. Gupta. Ajay. Lachhwani. Deepak K.. The treatment of epilepsy : principles & practice.. 2006. Lippincott Williams & Wilkins. Philadelphia. 0781749956. 1203. 4th.
  5. Web site: Neuroscience for Kids - Epilepsy/Driving . Faculty.washington.edu . 2010-09-16 . 2022-10-23 . https://web.archive.org/web/20221023215142/https://faculty.washington.edu/chudler/epid.html . live .
  6. 10.2310/7060.2000.00001 . 7 . 1 . International Regulations for Automobile Driving and Epilepsy . Journal of Travel Medicine . 1–4 . Ooi WW . 10689230 . 2000. free .
  7. http://www.epilepsyassociation.com.au/info/lifestyle/driving.html .
  8. Web site: Neuroscience for Kids - Epilepsy/Driving. faculty.washington.edu. 2009-11-01. 2022-10-23. https://web.archive.org/web/20221023215142/https://faculty.washington.edu/chudler/epid.html. live.
  9. Web site: Epilepsie - veřejná část . 2016-09-10 . https://web.archive.org/web/20080923193254/http://www.epilepsie.cz/verejna/verejna_cast.php?id=50 . 2008-09-23 . dead .
  10. https://www.riigiteataja.ee/akt/104012011006 §4.1.9
  11. Web site: betanet - Epilepsie > Autofahren - Soziales & Recht. beta Institut gemeinnützige. GmbH. betanet - Epilepsie > Autofahren - Soziales & Recht. 2016-09-10. 2018-06-20. https://web.archive.org/web/20180620012359/http://www.betanet.de/betanet/soziales_recht/Epilepsie---Autofahren-556.html. live.
  12. Web site: ایست پلیس به رانندگان مصروع . 2017-11-28 . https://web.archive.org/web/20171201042008/http://press.jamejamonline.ir/newspreview/2679679491810215496 . 2017-12-01 . dead .
  13. Epilepsy and Driving in Europe . Mike . Glynn . August 5, 2006 . IBE Epilepsy & Society Conference . Copenhagen . 1-19 . July 4, 2024 . July 6, 2024 . https://web.archive.org/web/20240706164302/https://www.ibe-epilepsy.org/downloads/CopenhagenDriving.pdf . live .
  14. Web site: Driver's license and epilepsy. ISE - Israeli Society for Epilepsy. he. 2016-09-10. https://web.archive.org/web/20130712042029/http://www.epilepsy.org.il/Apps/WW/page.aspx?ws=bfd6d0f0-17fb-4cdd-b576-739a05b065a1&page=6a8db319-2052-47ca-9ab8-20ccd8189758&fol=e3de9236-5547-40cd-9716-42450aba45eb&box=e70b9724-f26c-45a1-8f52-39034d6197ba&_pstate=item&_item=f98e8efc-c11b-48e1-8da9-287c61f0947e. 2013-07-12. dead.
  15. Hashimoto K, Fukushima Y, Saito F, Wada K . A study on driving status in 98 epileptic patients with driving licences . Jpn. J. Psychiatry Neurol. . 45 . 2 . 323–6 . June 1991 . 1762210 . 10.1111/j.1440-1819.1991.tb02480.x. 30893696 .
  16. Web site: Can you drive with epilepsy. 8 February 2016. 29 April 2018. 9 June 2023. https://web.archive.org/web/20230609120348/https://www.drivingtests.co.nz/resources/can-you-drive-with-epilepsy/. live.
  17. Web site: Factsheet 17 -- Epilepsy/seizures and driving . . March 2012 . 16 December 2012 . 25 January 2015 . https://web.archive.org/web/20150125040219/http://nzta.govt.nz/resources/factsheets/17/docs/17-epilepsy.pdf . live .
  18. Ben-Menachem E . Toward a more pragmatic view of driving and epilepsy . Epilepsy Curr . 4 . 4 . 133–4 . 2004 . 16059474 . 1176346 . 10.1111/j.1535-7597.2004.44003.x .
  19. UK Epilepsy Action: Driving and Epilepsy, I've had a seizure. What should I do?
  20. UK Driver and Vehicle Licensing Agency Guide to the Current Medical Standards Of Fitness to Drive . Full details for doctors regarding epilepsy are given in the Appendix . Information for drivers can be found in Medical Rules - Group 1 Licence Holders
  21. UK Epilepsy Action: booklet with further details about driving PDF
  22. Epilepsy FoundationDriving and You - Can you drive an automobile if you have epilepsy? .
  23. Epilepsy Foundation Driver Information by State
  24. Book: Epilepsy: A Guide to Balancing Your Life - Google Books . 2006-12-15 . 2010-09-16 . 978-1-932603-20-0 . Ilo e. Leppik . MD . Neurology . American Academy of . Springer . 2024-07-06 . https://web.archive.org/web/20240706164305/https://books.google.com/books?id=iQQ1jMtU6HwC&q=epilepsy+driving&pg=PA140 . live .
  25. Book: Epilepsy: Patient and Family Guide - Google Books . 2007-10-28 . 2010-09-16 . 978-1-932603-41-5 . Devinsky . Orrin . Springer . 2024-07-06 . https://web.archive.org/web/20240706164305/https://books.google.com/books?id=4SOA3rg5DK0C&q=epilepsy+driving&pg=PA262 . live .
  26. Web site: Archived copy . 2023-01-17 . 2011-09-29 . https://web.archive.org/web/20110929191706/http://www.epilepsyontario.org/client/EO/EOWeb.nsf/web/Epilepsy+%26+Driving+in+Ontario . dead .
  27. Web site: Motor Vehicles Act 1939. www.commonlii.org. 2020-04-13. 2020-05-01. https://web.archive.org/web/20200501190818/http://www.commonlii.org/in/legis/cen/num_act/mva1939172/. live.
  28. Web site: Guide for Aviation Medical Examiners. www.faa.gov. 2008-06-17. 2013-10-17. https://web.archive.org/web/20131017045628/http://www.faa.gov/about/office_org/headquarters_offices/avs/offices/aam/ame/guide/app_process/exam_tech/item46/amd/nc/. live.
  29. Sheth SG, Krauss G, Krumholz A, Li G . Mortality in epilepsy: driving fatalities vs other causes of death in patients with epilepsy . Neurology . 63 . 6 . 1002–7 . September 2004 . 15452290 . 10.1212/01.wnl.0000138590.00074.9a. 23183235 .
  30. Web site: Md. Driver Indicted in Deaths of Man, Sons; Epileptic Blamed Seizure for Crash. https://web.archive.org/web/20171113003751/https://www.highbeam.com/doc/1P2-353707.html. dead. 13 November 2017. 22 May 2002.
  31. News: Epileptic driver jailed for death . BBC News . December 12, 2008 . May 2, 2010 . December 13, 2008 . https://web.archive.org/web/20081213052447/http://news.bbc.co.uk/2/hi/uk_news/england/essex/7780717.stm . live .
  32. Web site: Manslaughter conviction for driver with epilepsy . https://archive.today/20120707223346/http://archives.explorehoward.com/news/60641/manslaughter-conviction-driver-with-epilepsy/ . dead . 2012-07-07 . Explore Howard . 2007-04-23 . 2010-09-16 .
  33. News: Man sentenced to seven years for causing deaths of sisters . Irish Times . 2014-03-14 . 2014-04-12 . 2014-04-13 . https://web.archive.org/web/20140413123543/http://www.irishtimes.com/news/crime-and-law/courts/man-sentenced-to-seven-years-for-causing-deaths-of-sisters-1.1726012 . live .