E-360 Edition 19: Driving and Epilepsy

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The fundamental difficulty of driving restrictions for people with epilepsy lies in getting a balance between safety and practicality. While many factors contribute to safety on the road, driver health and fitness to drive is a very important consideration.

First seizure

Up to 5 percent of people in Australia will experience a one-off (provoked) or unprovoked seizure during their lives, many of whom are otherwise healthy adults who work, drive and live active lives. If another seizure is likely to occur, the risk is at its highest during the period immediately after the first seizure with the overall risk of a second seizure being up to 40 to 50 percent. This risk varies according to the individual circumstances, and steadily decreases over time with each passing month of seizure freedom. Approximately 80–90% of people who do have a second seizure, do so within 2 years of the initial seizure. [i]

Driving restrictions are therefore warranted during the early period (after the seizure) of highest risk. In Australia after an unprovoked or provoked first seizure a driving ban of at least 6 months is recommended for private vehicle licence holders (cars and motorbikes) as this is the highest risk period for seizure recurrence.[ii]

When you can’t drive

There is no doubt that the loss of driving privileges can have a profound impact on the quality of life of people diagnosed with epilepsy, and those around them. For most adults, driving is a primary means of transport and is necessary for employment, maintaining social ties, family commitments and performing other activities essential to independent living.[iii]

Regulations restricting people with epilepsy are based around public safety – to reduce the risk that drivers with epilepsy might pose to themselves and others. The risk of having a seizure behind the wheel is not the only concern here, also the fact that driving ability may be affected by antiepileptic drug (AED) side effects and/or by the underlying pathology causing the persons seizures.

Medical standards for licensing – Seizures and epilepsy

Default Standard for Private Vehicle only – cars, light rigid vehicles or motorcycles

All cases

(default standard)

A person is not fit to hold an unconditional licence if:

 

Applies to all people who have experienced a seizure.

 

Exceptions may be considered only if the situation matches one of those listed below.

  • the person has experienced a seizure.
    A conditional licence may be considered by the driver licensing authority subject to at least annual review,* taking into account information provided by the treating doctor as to whether the following criteria are met:
  • there have been no seizures for at least 12 months;** and
  • the person follows medical advice, including adherence to medication if prescribed or recommended.

* If a driver undergoing treatment for epilepsy has experienced an extended seizure free period (more than 10 years) the driver licensing authority may consider reduced review requirements based on independent specialist advice (refer to section 3.3.7 Independent experts/panels).

** Shorter seizure-free periods may be considered by the driver licensing authority if the person’s situation matches one of those in the remainder of this table.

Exert from: Assessing Fitness to Drive 2017, page 89

This is not a complete version of this table or standards. This is the standard that applies to all drivers who have had a seizure unless their situation matches one of a number of defined situations listed in the table in Assessing Fitness to Drive. There are situations that are associated with a lower risk of a seizure-related crash and therefore driving may be resumed after a shorter period of seizure freedom than required under the default standard.

State and territory driver licensing authorities (DLAs) have the ultimate responsibility of deciding whether a person with epilepsy should receive a driving licence.  However, in practice, the DLAs need to communicate with the treating doctor to make this decision.

Conditional license

Variations to the default standard

There are several situations in which a variation from the above default standard may be considered by the DLA to allow an earlier return to driving. These are:

  • seizures in childhood
  • first seizure
  • epilepsy treated for the first time
  • acute symptomatic seizures
  • ‘safe’ seizures
  • seizures only in sleep
  • seizures in a person previously well controlled
  • exceptional circumstances.

In most cases, exceptions to the default standard will be considered only for private vehicle drivers.

Other factors that may influence licensing status

A number of factors may influence the management of epilepsy with regards to driving and licensing. These include:

  • epilepsy treated by surgery
  • not taking medication as prescribed
  • stopping or changing anti-epileptic medication
  • a seizure causing a crash
  • resumption of an unconditional licence.

It is good practice for any person who has a first seizure to be referred to a specialist, where available, for accurate diagnosis of the specific epilepsy type so that the right treatment is started and all the risks associated with epilepsy, including driving, can be explained. An annual medical review is also recommended.

Ultimately, driving safety in epilepsy relies on the judgment of the person with epilepsy and their compliance with regulations and medical advice. A stronger understanding of the effects of different types of seizures on consciousness and driving ability may help remove driving restrictions for those who pose little risk to themselves and others, potentially improving the quality of life among people living with epilepsy.

Assessing Fitness to Drive. Page 87

Advice to licence holders [iv]

All licence holders should be advised of the following general principles for safety when driving. The person:

  • must continue to take anti-epileptic medication regularly as prescribed.
  • should get adequate sleep and not drive when sleep-deprived.
  • should avoid circumstances, or the use of substances (e.g. excessive alcohol), that are known to increase the risk of seizures.

If a person refuses to follow a treating doctor’s recommendation to take anti-epileptic medication, the person will most likely be assessed as not fit to drive.

Returning to driving

In general, responsible people with well-managed epilepsy (demonstrated by an appropriate seizure-free period and compliance with treatment and other recommendations) may be considered by the DLA to be fit to drive a private vehicle. Every case is assessed individually. A license is usually returned after sufficient time has passed without further seizures (with or without medication) to allow the risk to reach an acceptably low level. If a second seizure occurs (except on the same day as the first), the risk of recurrence is much higher and the standards for epilepsy treated for the first time will apply  (see diagram above and refer to Assessing Fitness to Drive page 86).iv

Because a driving licence is vital for some people to continue work, maintain independence and recreation, and reduce social isolation, the risk of it being withdrawn or not returned, can understandably evoke strong emotions and reactions. People with recurrent seizures who continue to drive put themselves and the community at risk.

People who drive without seizure control may be liable if they continue to drive knowing that they have a condition that is likely to adversely affect safe driving. Drivers should be aware that there may be long-term financial, insurance and legal consequences where there is failure to report an impairment to their DLA.

Conditional licences rely on the person being responsible for management of their condition, including taking medications as prescribed in conjunction with the support of a health professional and regular review.[v]

A Note About License Plate Recognition

All Australian states and territories now use both fixed and mobile automatic number plate recognition Automatic Number Plate Recognition (ANPR) systems.

Fitted to police vehicles, the technology is used to accurately scan vehicle number plates which are then checked against a database which combines two lists from the DLA, the first is of registered vehicles and the other is of driving license holders. The database cross references this information and a “hotlist” of number plates is created.

The database list includes licence plates that have been cancelled, unregistered, reported as stolen, or whose owners are wanted in connection with a crime. Because the recorded database is very much vehicle-focused and not about the individual, so when a person has lost their licence or never held a license and are the registered owner of a vehicle, this would then activate an alert regardless of who is driving the vehicle, in this case usually the partner or the kids. This would be resolved with a simple matter of a basic licence check however can become inconvenient when particular local areas are targeted.

The content in this article refers to private vehicle driving licenses. Commercial licenses have stricter criteria and restrictions.

License regulations can seem complex. If you need to clarify any of this information, call us on 1300 37 45 37 or email [email protected] or speak to your doctor.

For more extensive information in regard to driving and health conditions, visit Austroads – Fitness to Drive http://www.austroads.com.au/drivers-vehicles/assessing-fitness-to-drive

References:

[i] Berg, Anne T. (2008) Risk of recurrence after a first unprovoked seizure. Epilepsia, 49(Suppl. 1):13–18, 2008https://onlinelibrary.wiley.com/doi/epdf/10.1111/j.1528-1167.2008.01444.x

[ii] Brown, J.W., Lawn, N.D., Lee, J.O., & Dunne, J.W. (2015). When is it safe to return to driving following first-ever seizure? Journal of neurology, neurosurgery, and psychiatry, 86 1, 60-4. https://pdfs.semanticscholar.org/abba/c8c7a9b38a0d4943354a9289c6d1b50472a5.pdf?_ga=2.152484665.1474930587.1534821810-1274347625.1534821810

[iii] Chen, William C. et al. (2014). Epilepsy and driving: Potential impact of transient impaired consciousness. Epilepsy & Behavior, Volume 30 , 50 – 57. https://www.epilepsybehavior.com/article/S1525-5050(13)00490-3/fulltext

[iv] Austroads. Assessing Fitness to Drive (Updated 2017).

[v] Austroads. Assessing Fitness to Drive (Updated 2017).