The American Academy of Neurology (AAN), the American Epilepsy Society (AES), and the Epilepsy Foundation of America (EFA) released a new joint position statement that includes 11 key points and recommendations, published in the journal Neurology in March. An update to their 2007 position statement, the new version takes into account recent research and focuses “on a fair and uniform approach to driving and epilepsy,” says David C. Spencer, MD, FAAN, professor of neurology at Oregon Health and Science University and deputy editor of Brain & Life.

The statement recommends that patients be seizure-free for at least three months before obtaining a new driver’s license or resuming driving. This period could be extended based on factors unique to each patient, it adds, although legally requiring patients to wait more than three months does not appear to reduce vehicle accidents or fatalities, and many people with seizures disregard those laws. All epilepsy is not the same, either, Dr. Spencer says, so a seizure-free period that works for one patient might not work for another.

“In some situations, an unexpected seizure might need only a very limited observation period before resuming driving—for example, if someone has an illness with nausea and vomiting and experiences a seizure after not being able to keep their medications down,” he says. “For someone who has regularly had seizures every four to five months for the last several years, a three-month observation period may not be sufficient, and a longer seizure-free interval may be needed to determine that it is truly safe to drive.” 

The authors push for “an approach based on evidence instead of fear or misunderstanding of epilepsy,” a condition Dr. Spencer notes “should not be singled out among other medical conditions that could also affect driving.”

“A uniform approach across the country is recommended, rather than the current patchwork of rules based on what state you live in,” Dr. Spencer says. “And rules based on actual data about risk of driving with varying degrees of seizure control are used as the basis for recommended driving guidelines.”

While “a modest but real increased risk of motor vehicle accidents associated with epileptic seizures” exists, that risk actually is lower than that of young drivers, people with alcohol use disorder, and the general public, according to the statement. The longer patients go without seizures, the more that risk declines, particularly after six and 12 months.

Medical care providers also should counsel patients about the risks their condition may pose to themselves and others while driving, according to the statement. This should include advising patients to self-report their epilepsy diagnosis and seizures and follow any related legal restrictions.

“There is no perfect way to handle this,” Dr. Spencer says. “Some patients will see an incentive to not report themselves as a way to maintain driving privileges, but I am always impressed by how many of my patients with epilepsy approach this issue thoughtfully and honestly and have a strong desire to not put themselves or others at risk.”

He adds that the alternative—requiring health care providers to report their patients to state departments of motor vehicles (DMVs)—“is greatly problematic.”

“It makes the health care provider the ‘police’ and interferes with the doctor-patient relationship,” Dr. Spencer says. “Here the incentive is to not report your seizures to your doctor, which not only potentially puts unsafe people on the road … but also makes it harder to adequately treat the epilepsy, as the doctor does not know the true seizure frequency.”

The statement also recommends that patients taking antiseizure medications that impair their cognition or coordination, including medical cannabis, do not drive. Additionally, they should consider limiting the amount of time they spend behind the wheel when they taper or stop taking an antiseizure medication and do not start a new one, the authors say.

The authors suggest that the United States use a system such as the Uniform Law Commission—a nonprofit that provides states with non-partisan, uniform laws—to promote national driving standards. That “would reduce confusion” and help both patients and their care providers better adhere to these standards, the authors say.

Until that occurs, though, they encourage states to pass laws that let their respective DMVs, medical advisory boards, and consultants establish processes for licensing drivers and handling drivers’ appeals. These processes would include individualized assessments by medical advisory boards and adhere to evidence-based recommendations, they add.

Other recommendations included in the statement:

• That care providers be authorized to report any patients they suspect have not self-reported their condition and may be endangering others by driving;
• That DMVs provide care providers with forms where they can include a patient’s medical information and recommend whether the patient should hold a driver’s license;
• That patients who have seizures not be required to take a road test to determine their fitness to drive “unless other relevant medical conditions or symptoms such as cognitive impairment are in question”;
• And that local, state, and national authorities “should provide alternative methods of transportation and accommodations for individuals whose driving privileges are restricted due to medical conditions.”

For more information about epilepsy and seizures, visit Brain & Life’s epilepsy information hub or check out Dr. Spencer’s book, Navigating Life with Epilepsy, part of the Brain & Life Book Series.