Readers' choice June 2012

Seizure: June 2012

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Readers' choice

Each month our Seizure Reviewers read the summaries of the articles in the latest issue of Seizure. They then decide which one should be readers' choice.

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Western driving regulations for unprovoked first seizures and epilepsy

Gavin  Winston  Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, Queen Square, London WC1N 3BG, United Kingdom	Stephen R Jaiser Department of Neurology, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne NE1 4LP, United Kingdom

Purpose

To review the legislation for non-commercial driving licenses in the Western world for unprovoked first seizures (UFS) and recurrence of established epilepsy, and to examine available evidence on the road traffic accident (RTA) risk in people with seizures.

Methods

Regulations for non-commercial driving licenses were sought from appropriate national or state authorities and epilepsy societies. The literature was searched for consensus guidelines and data relevant to risk analysis, including an appropriate seizure-free period (SFP).

Results

The SFP varied widely from 3 to 24 months and in most countries no distinction was made between UFS and recurrence of established epilepsy. In the European Union (EU), harmonisation is underway but implementation of the relevant directive has been slow. The excess risk of RTA in epilepsy is minimal, especially compared to other factors such as alcohol, and few accidents result from seizures at the wheel. Risk analysis supports the shortened SFPs that are being enacted in the EU.

Conclusion

Regulations across the world continue to vary widely, and the available data support rules which are less stringent than those currently in force in many parts of the Western world. The ongoing European harmonisation is encouraging but much work remains to be done in revising legislation elsewhere, and in strengthening the theoretical foundations underpinning driving regulations

Why we chose this article

By – Helen Lowe – Seizure reviewer

Aims of the study

This research aims to:

• Examine the current laws for driving licences in Western countries for people with epilepsy, for individuals both with first seizures and recurrent ones.
• Look at the evidence on road traffic accident risk in PWE

Previous research had found that driving is often viewed as an important part of a person’s day-to-day life. Therefore any restrictions may have an impact upon an individual’s independence. This often leading to people with epilepsy (PWE) considering surgery as a possible way of controlling seizures to enable them to drive/learn to drive.

In the past life time bans were common for PWE. However, due to the view of the importance of driving, laws have been reviewed. The aim is to balance both public safety with providing as few restrictions as possible to PWE.

In reviewing the current driving laws across different countries, this research looked at the perceived risks seizures may cause and how these opinions affect driving regulations. To do this, the authors collected information on driving regulations in a number of countries.

What did the researchers find out?

The research shows that:

• Driving laws for PWE vary, with the required seizure free period varying from three months to 24.
• Reducing the amount of time the law states a person needs to be seizure free does not cause an increased risk of accidents.
• It could be argued that driving laws should be revised based upon the risk of recurrent seizures on the public and PWE.

Why is this research important to people with epilepsy?

I believe that this research is of importance to PWE because it is of relevance to a wide range of individuals regardless of the type of epilepsy they have been diagnosed with. Being unable to drive may affect PWE’s lives, for example their independence and employability. A review of driving laws may make it easier for PWE to reapply for their driving licence/ learn to drive.

Why I like this study

I like this study because it is of relevance to a wide range of individuals. In addition, it gives recognition to the effects of being unable to drive. Importantly, the research suggests ways of reducing the impact of first seizures/recurrent seizures on driving, through reviewing the length of time that PWE need to be seizure free before driving. Overall, it provides reassurance that a possible reduction in the length of a specified seizure free period would not have an impact on public safety/ safety of the PWE.

Interview with the authors - Gavin Winston and Stephan Jaiser

How did you become interested in epilepsy?

Gavin: I became interested in epilepsy while working as a junior doctor in Nottingham in 2005. I subsequently worked with the epilepsy team at the National Hospital for Neurology and Neurosurgery in London.
Stephan: I first became interested in epilepsy as a junior neurology registrar around 2007. Although my current research is mostly about motor neurone disease, I would like to ultimately specialise in epilepsy management.

What issues inspired you to carry out this research?

Driving is a common concern for people with seizures and we often explain the driving rules to them. The UK rules changed recently in the wake of an EU directive, and this prompted us to look at the situation throughout the EU and in other Western nations. It became clear to us that this area had not been reviewed for many years and we therefore decided to summarise our findings in a paper.

Did you involve people with epilepsy when you were designing the study?

The study was designed in response to a very common query in clinic. We wanted to look at the variations across the western world and the evidence supporting the different laws to see if people with epilepsy were being unfairly discriminated against in comparison to other medical conditions.

What methods did you use and why?

We started with a ‘snapshot’ survey of the rules in several countries. However, we did not just want to look at the rules themselves, but also their foundations and potential weaknesses. Hence, we decided to review all the evidence from previous studies.
What did you find out?

Despite several attempts at harmonisation, Western driving regulations for patients with seizures still vary widely between countries and states. Harmonisation in the EU is perhaps the most promising step to date, but many member states have not implemented the new rules yet. The excess risk of road traffic accidents - either after a single seizure or once epilepsy has been controlled - is relatively small. However, research in this area is difficult to conduct so there are relatively few studies.

What impact do you think your findings will have on the diagnosis/treatment/care?

We hope that the study will stimulate discussion and possibly lead to improved driving rules in the future.

What further research is needed in this area?

Large observational studies on the risk of driving in people with seizures. This could be achieved by sharing data between driving authorities, motor insurance companies and police if data protection issues can be addressed. We hope that this would confirm that most people are at low risk of further seizures so can drive safely with minimal restrictions.

What other research are you involved with at the moment?

Gavin: I am using specialist MRI scans of the brain to study the effects of epilepsy and surgical treatment on language, memory and vision. The aim is to better understand the risks of epilepsy surgery and ultimately make it safer.
Stephan: I am studying new markers of motor neuron disease, which aim to accelerate diagnosis and improve follow-up.

Past articles of the month

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