Epilepsy and driving
Epilepsy and driving is a personal and safety issue. A person with a seizure disorder that causes lapses in consciousness may be putting the public at risk from their operation of a motor vehicle. Not only can a seizure itself cause an accident, but anticonvulsants often have side effects that include drowsiness. People with epilepsy are more likely to be involved in a traffic accident 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, most 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 suffered 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. After having one during the day they must wait 180 days to get their license back.
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 months to years. EU 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 anti epileptic drugs are taken - for heavy lorries & buses the period is 5 yrs without drugs.
Epilepsy driving laws by country
 |
| Country | Law | Physician required to report | Seizure-free period |
|---|---|---|---|
| Andorra | 2 years | ||
| Argentina | There are no specific laws prohibiting people with epilepsy from driving. Patients generally rely on advice from their physicians.[6] | No | |
| Australia | Patients must be seizure-free for 3–6 months for recently diagnosed seizures, and for two years for chronic epilepsy.[7][8] Exact laws vary by state or territory.[6] | 3 months to 2 years | |
| Austria | The most common seizure-free period required is 2 years, but in some cases, this can be extended to 3. Insurance companies are not required to make liability payments in accidents caused by seizures.[6] | 2–3 years | |
| Belgium | Seizure-free period required depends on the type of seizure.[6] | 1–2 years | |
| Bermuda | 1 year | ||
| Brazil | 1 year | ||
| Bulgaria | Those who have ever had a seizure are prohibited from driving.[9] | ||
| Canada | Exact laws may vary by province/territory. See Canada below. | 1 year | |
| Central African Republic | Those who have ever had a seizure are prohibited from driving.[9] | ||
| China | Those who have ever had a seizure are prohibited from driving.[9] | ||
| Croatia | 2 years | ||
| Cyprus | 1 year | ||
| Czech Republic[10] | Physician may set additional more restrictions (like no night driving), for professional drivers seizure-free period is 10 years | Yes | 1 year |
| Denmark | The national health board is involved in epilepsy cases in determining exact length of disqualification, which is usually 2 years. Physician input is recommended.[6] | 2 years | |
| Egypt | 2 years | ||
| Estonia | Required seizure-free period of one year for cars and motorcycles and of five years for trucks and buses[11] | 1–5 years | |
| France | Required seizure-free period is 2 years, but this may be reduced at the advice of a physician.[6] | 2 years | |
| Germany | In heavy cases the period of time is 2 years.[12] Patients with seizures that do not involve motor activity are not disqualified from driving.[6] | No | 1 year[12] |
| Ghana | Those who have ever had a seizure are prohibited from driving.[9] | ||
| Greece | 2 years | ||
| Iceland | 2 years | ||
| India | Those who have ever had a seizure are prohibited from driving.[9] This law was passed in 1939.[6] | ||
| Ireland | In general, requires driver be seizure-free for one year. Exceptions are given for those with nocturnal seizures, change of medication, non-epileptic seizures, single seizures, or seizures in which consciousness is not lost.[13] | 1 year | |
| Israel | Public vehicle (Bus): Never; Public vehicle (Taxi): 10 years seizure-free on medications or 5 years seizure-free unmedicated; Private Vehicle: 1 year seizure-free or 3 years of sleep-seizures only[14] | Yes | 1 year |
| Italy | Each case is assessed by the regional board.[6] | 2 years | |
| Japan | Japan in the past had some of the world's strictest laws pertaining to epilepsy and driving, requiring all patients to be seizure-free for up to five years before being issued a license.[7][15] This changed in 2002, and Japan now allows those who have been seizure-free for 2 years to drive.[9] Patients must be officially "cured". Physicians are required to report patients who drive.[6] | Yes | 2 years |
| Luxembourg | 2 years | ||
| Malaysia | 2 years | ||
| Malta | 1 year | ||
| Mexico | varies by state | ||
| Netherlands | 1 year | ||
| New Zealand | Default seizure-free period is 12 months, although may be reduced to 6 months by NZTA on advice from a physician. People with nocturnal epilepsy may drive if they have had no seizures while awake in the last 12 months. People with epilepsy cannot hold a heavy vehicle licence (Classes 2, 3, 4, 5), or commercial passenger (P), vehicle recovery (V), driving instructor (I) or testing officer (O) endorsements.[16] | Yes | 1 year |
| Norway | 2-year period may only be reduced in exceptional cases.[6] | Yes | 2 years |
| Pakistan | Those who have ever had a seizure are prohibited from driving.[9] | ||
| Portugal | 2 years | ||
| Romania | 1 year | ||
| Rwanda | Those who have ever had a seizure are prohibited from driving.[9] | ||
| Saudi Arabia | 1 year | ||
| Senegal | 1 year | ||
| Singapore | Those who have ever had a seizure are prohibited from driving.[9] | ||
| Slovenia | 2 years | ||
| South Africa | 2 years | ||
| Spain | 1 year | ||
| Sweden | Must be seizure-free for five years before being allowed to drive professionally.[7] | Yes | 2 years |
| Switzerland | 1 year | ||
| Taiwan | Those who have ever had a seizure are prohibited from driving.[9] | ||
| Turkey | Those who have ever had a seizure are prohibited from driving.[9] Many patients do in violation of this law.[6] | ||
| United Kingdom | It is the responsibility of the patients to inform the Driver and Vehicle Licensing Agency (DVLA) if they have epilepsy.[17] The DVLA rules are quite complex,[18] but in summary,[19] those continuing to have seizures or who are within 6 months of medication change may have their licence revoked, if the Secretary of State's advisory panel feels that that particular licence holder's epilepsy makes him or her unfit to drive. A doctor who becomes aware that a patient with uncontrolled epilepsy is continuing to drive has, after reminding the patient of their responsibility, a duty to break confidentiality and inform the DVLA. The doctor should advise the patient of the disclosure and the reasons why their failure to notify the agency obliged the doctor to act. | Yes | 1 year |
| United States | Laws vary by state. See United States below. | varies by state | |
| Uruguay | 1 year | ||
| Uzbekistan | Those who have ever had a seizure are prohibited from driving.[9] |
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 three months and a year.[20][21] 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.[22] 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.[23]
The Epilepsy Foundation's Jeanne A. Carpenter Epilepsy Legal Defense Fund is dedicated to advancing the rights of people with epilepsy by changing discriminatory practices, policies and laws and to ending epilepsy-related discrimination and injustice through education and increased access to legal services for individuals with epilepsy through a system of managed referrals and legal support to a nationwide network of attorneys committed to this cause.
Additionally, the Epilepsy Foundation is a vigorous advocate for people with epilepsy. In the United States, the Foundation has been active in Congress, the executive branch, and the courts, focusing attention on the needs of those with epilepsy. Priorities for the Foundation include: the availability of affordable quality health care, the search for the cure, and the protection of civil rights for people with epilepsy.
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.
Template:Epilepsy driving laws US
Canada
The following are the driving laws for people with epilepsy in each province/territory of Canada:
Template:Epilepsy driving laws Canada
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 seizure-free for at least 4 years. Children who have suffered a febrile seizure prior to the age of 5 may fly if off of all seizure medication for at least three years. Regardless, all medical records must be submitted to the FAA.[24]
Accidents 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.[25]
In March 2002, a Frederick, Maryland, man was charged with vehicular manslaughter after a seizure he had while operating a motor vehicle resulted in an accident that killed 4 people.[26] The man had been using a nerve stimulating device to treat his epileptic condition rather than seeking medical treatment.[27] 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 license.
An Essex, UK, man was jailed for an accident 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.[28]
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. The woman 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.[29]
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.[30]
References
- ^ Risk of accidents in drivers with epilepsy - J Taylor, D Chadwick, and T Johnson
- ^ Clinical neurology for psychiatrists - Google Books. Books.google.com. 2007. ISBN 978-1-4160-3074-4. Retrieved 2010-09-16.
- ^ "Increased driving accident frequency in Danish patients with epilepsy - Lings 57 (3): 435". Neurology. 2001-08-14. Retrieved 2010-09-16.
- ^ The treatment of epilepsy: principles & practice By Elaine Wyllie, Ajay Gupta, Deepak K. Lachhwani: Page 1203
- ^ "Neuroscience for Kids - Epilepsy/Driving". Faculty.washington.edu. Retrieved 2010-09-16.
- ^ a b c d e f g h i j k l http://onlinelibrary.wiley.com/doi/10.2310/7060.2000.00001/pdf
- ^ 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.
- ^ http://www.epilepsyassociation.com.au/info/lifestyle/driving.html.
- ^ a b c d e f g h i j k l http://faculty.washington.edu/chudler/epid.html
- ^ http://www.epilepsie.cz/verejna/verejna_cast.php?id=50
- ^ https://www.riigiteataja.ee/akt/104012011006 §4.1.9
- ^ a b http://www.betanet.de/betanet/soziales_recht/Epilepsie---Autofahren-556.html
- ^ http://www.ibe-epilepsy.org/downloads/CopenhagenDriving.pdf
- ^ "Driver's license and epilepsy". ISE - Israeli Society for Epilepsy (in Hebrew).
- ^ 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.
- ^ "Factsheet 17 -- Epilepsy/seizures and driving" (PDF). New Zealand Transport Agency. March 2012. Retrieved 16 December 2012.
- ^ UK Epilepsy Action: Driving and Epilepsy, I've had a seizure. What should I do?
- ^ 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
- ^ UK Epilepsy Action: booklet with further details about driving PDF
- ^ Epilepsy Foundation Driving and You - Can you drive an automobile if you have epilepsy?.
- ^ Epilepsy Foundation Driver Information by State
- ^ Epilepsy: A Guide to Balancing Your Life - Google Books. Books.google.com. 2006-12-15. ISBN 978-1-932603-20-0. Retrieved 2010-09-16.
- ^ Epilepsy: Patient and Family Guide - Google Books. Books.google.com. 2007-10-28. ISBN 978-1-932603-41-5. Retrieved 2010-09-16.
- ^ Aviation Medical Examiner
- ^ 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.
- ^ Md. Driver Indicted in Deaths of Man, Sons; Epileptic Blamed Seizure for Crash | Article from The Washington Post | HighBeam Research
- ^ Driver in Frederick Crash That Killed 4 Has Epilepsy; Man Tried to Treat Himself Before Accident, Authorities Say | Article from The Washington Post | HighBeam Research
- ^ "Epileptic driver jailed for death". BBC News. December 12, 2008. Retrieved May 2, 2010.
- ^ "Manslaughter conviction for driver with epilepsy". Explore Howard. 2007-04-23. Retrieved 2010-09-16.
- ^ "Man sentenced to seven years for causing deaths of sisters". Irish Times. 2014-03-14. Retrieved 2014-04-12.