Taken from a lecture given by Professor Ernest Somerville, Director, Comprehensive Epilepsy Service, Prince of Wales Hospital, Sydney
Seizures and Driving
Having a seizure or diagnosis of epilepsy directly impacts your driving status. Following a seizure, your first seizure, or a breakthrough seizure, the Australian recommendation is you should not drive for a minimum of 12 months for private vehicle licence holders. Note: this is the default standard, however, there are exceptions and shorter seizure-free periods may be considered depending on your situation. Your specialist will advise you how long your non-driving period will be.
It is important to remember that when your license is initially suspended, it may not be permanent and, if you meet the criteria to be able to drive, you will be able to drive again. It is essential to discuss driving guidelines with your attending doctor, GP or neurologist. There are also driving licensing guidelines to explain fitness to drive.
There are many reasons other than health-related ones that can affect your driving ability or increase the risk of causing a serious crash. This includes blood alcohol or drug levels, sleep deprivation, distractions, medication effects, old age and, especially, young age.
Driver health and fitness to drive is essential to road safety, not only for the drivers but for the safety of passengers, pedestrians and other drivers.
The Rules
Assessing fitness to drive for someone with epilepsy can be very difficult and it is based on the likelihood of any further seizures happening. Your doctor or specialist does not make the rules but provides advice, based on the standards, about how your epilepsy might affect your ability to drive safely and how it might be managed.
It is good medical practice for any person with initial seizures to be referred to a specialist, where available, for accurate diagnosis of the specific epilepsy syndrome so that appropriate treatment is prescribed and all the risks associated with epilepsy, including driving, can be explained.
With regard to licensing, the treating doctor or GP may liaise with the driver licensing authority about whether the criteria are met for driving a private vehicle, but only a specialist may do so for a commercial vehicle driver.
In general, responsible people with well-managed epilepsy may be considered by the driver licensing authority to be fit to drive a private vehicle. They will be issued a conditional licence based on:
- an appropriate seizure-free period,
- the person is taking medication as prescribed and
- following other recommendations such as regular reviews with the doctor.
If a person refuses to follow a treating doctor’s recommendation, they will be assessed as not fit to drive.
The driving licensing authorities will consider the advice of your doctor, but always make the final decision about your licence status. The guidelines for commercial licences are different and much more stringent.
Risks
Fitness to drive for people with epilepsy is different from other conditions. This is because seizures usually happen sporadically, meaning that impairment is only occasional for many people. This might lead some people to think this is OK to drive in-between seizures if they don’t happen very often, but seizures are unpredictable and should a seizure happen whilst driving, there is an enormous risk of having a serious accident with serious consequences. Crashes can be more severe with seizures, because the driver is unconscious, and therefore unable to take evasive action such as braking or swerving.
The driving licence authorities have considerations for different seizure types and when they occur (times of day), so there are exceptions to the default standard, and a conditional license may be issued in some circumstances. You need to discuss this with your neurologist.
Managing Risk
There are a number of things that can increase risk of a seizure or crash, and the fitness to drive rules bear this in mind when issuing a licence. These risks include sleep deprivation, alcohol (a legal blood alcohol limit doubles the risk), age – older or young persons are at increased risk, and the time of driving.
Your doctor should explain that you can’t drive during periods of medication reduction or withdrawal for 3 months after you reach the new dose, or after you stop medication. This does not apply to people who have a dose reduction because of side effects, unless the treating doctor states otherwise.
Not everyone has the same risk, so the rules are complicated, but this allows more people to drive who are considered safe to do so.
Are the rules too complicated?
The individual seizure risk can vary between people with the same type of epilepsy. The standards don’t allow for individual variation and driving variables do not take into account how much time an individual actually spends on the road. For instance, the same legal restrictions are imposed, even if one person drives long distances every day, while the other only drives occasionally within a local area.
The rules can be complicated and difficult to interpret if being followed by someone who is not familiar with the standards in relation to epilepsy. It is best to seek advice from a neurologist about licencing rules, particularly in situations that are complex or unclear.
The rules about health and driving are developed by medical experts and are agreed by road transport authorities. Your doctor or specialist does not make the rules but provides advice, based on the standards, about how your epilepsy might affect your ability to drive safely and how it might be managed. The road transport authorities will consider the advice of your doctor, but always makes the final decision about your licence status.
Speak to your specialist for any further information about driving.
Also see our Epilepsy and Driving Factsheet
