Epilepsy and recommendations for driving

The epileptic driver has a potential risk of accident

Types of epilepsy

  • Tonoclonic crisis or Grand Mal: Sometimes they start with a partial aura of epigastric discomfort followed by loss of consciousness, falling on the floor and tonic contractions with rigidity on extension and then clonic contractions of the muscles of the limbs, trunk and head.
    The crisis usually lasts 2-5 minutes and is followed by a deep sleep, headache, and muscle pain.
  • Atypical generalized crises: They are distinguished from the Grand Mal by the unilateral predominance of the motor phenomena, the absence of the tonic or clonic phase, and even absence of any convulsive event.
    It is the case of generalized crises occurring as a sudden loss of consciousness with fall and emission of urine.
  • Crisis of absence or Petit Mal: It occurs as a sudden loss of mental activity for 10-30 seconds, sometimes with loss of muscular tone, and with interruption of the activity that is resumed after the crisis, without somnolence or confusion.
    Myoclonic Petit Mal is characterized by bilateral, synchronized muscle shakes occurring as brief fits in the arms, the nape, and sometimes in the legs falling on the floor.
    The akinetic Petit Mal occurs as leaving an object or suddenly falling with no loss of consciousness, due to a failure in the lower extremities.
  • Bravais-Jackson motor epilepsy: It has a localized onset and a progressive, regular extension. Every muscle or muscle group carries out its brief tonic crisis and then clonic on its own.
    It often starts in the arm then reaching the face and afterwards the lower extremity. Other times, it starts in the face to then reach the arm and the leg.
    The crisis is followed by a motor deficit, but there is no loss of consciousness, except for the cases of secondary generalization
  • Frontal crises: They are characterized by the conjugated deviation of the head and the eyes toward the contralateral side of the epileptic focus, usually followed by a generalized crisis.
  • Others: Sensitive, sensory and temporal crises of the supplementary motor area.
  • The ulegiria: It is estimated that between one and six out of one thousand newborns suffer perinatal encephalopathy. Ulegyria occurs when perinatal suffocation occurs in the newborn to term.
    95% of these newborns survive and reach the adult age, many of them with motor and cognitive sequels, and epileptic crises.
    These patients show specific symptoms, with the disease located in the occipital lobes, related to vision, follow-up of moving objects, spatial orientation, and integration of visual information.
    In the periods free from crisis, the patients have difficulty in paying attention to the visual information or in being oriented.
    However, at the start of the crises visual symptoms appear, such as vision of lights or transient blindness, involuntary displacement of the eyes toward a side, or repetitive blinking.
    Epileptic crises can start in the adult age and not only in childhood, and should be diagnosed promptly, relating the visual symptoms with the history of perinatal hypoxia.
    Although some patients show mental retardation, in others the global performance is normal, permitting them an independent life and obtaining the driving license.

Advice on epilepsy

  • The epileptic driver has a potential risk of accident for the possibility of loss of consciousness and for the drug side effects.
  • The patient with epileptic crises cannot drive.
  • The epileptic patient with neurological sequels interfering with driving cannot drive.
  • A multidisciplinary approach is compulsory in the treatment of patients with epilepsy, given the traffic accident rate in this type of drivers.
  • Physicians should advise insistently these patients to avoid the high accident rate they cause.
  • Hence, the general measures are based on making the patient aware of his disease so that he complies with the treatment, does not drink alcohol, and can fulfill a normal life with precautions.
  • When the physician establishes the individual characteristics of the epilepsy, he will obtain in his patient the essential treatment continuity and will advise the epileptic for adjustment in his professional and social life, with driving as a major issue.
  • If the patient has been 1 year free from seizures or loss of consciousness, he can drive, provided the underlying disease, the medication and his physician permit it.
  • With a favorable report from the neurologist stating the diagnosis, treatment compliance, frequency of crises, and medication without side effects for driving, the patient can extend the driving license as established by the law.
  • It is advisable that these drivers take the medical report in a visible place inside the car so that they can be adequately managed, and also carry their emergency medication in an accessible place.
  • All epileptic patients who despite the treatment can be at risk of loss of consciousness cannot drive.
  • The patient with myoclonus episodes that could affect the safety of driving will need a period of at least 3 months free from shakes, and a favorable report from the neurologist.
  • In case of a history of a non-characterized single convulsive disorder or secondary to drugs, abuse drugs, or post-surgical, a period of 6 months free from crisis should be accredited with a neurological report.
  • Epileptic drivers are advised against driving during treatment changes or if they do not comply with it properly.It seems reasonable that the driver with a history of seizures is warned of the following precautions:
    • Avoid driving at night.
    • Rest sufficiently before undertaking a journey.
    • When he notices the first symptoms of decompensation, stop the car in a safe place and remove the contact key.
    • Avoid long driving periods, without resting
    • Keep a constant sleep rate.
    • Learn all possible about the disease.
    • Know the side effects of his drugs, and also the impairment caused by the drugs prescribed on the ability to drive.
    • Learn to avoid triggering situations.
    • Avoid driving in the first week of a new treatment or after a dosage increase.
    • Do not discontinue the treatment suddenly.
    • Do not hide the crises to your physicians, since this can result into improper treatments, that would increase the risk of suffering new attacks and having an accident.
    • Always ask your physician (neurologist) if you can drive
    • Know that the control and advice from relatives and friends can prevent accidents
    • Avoid as far as possible the triggering situations
    • Never discontinue a treatment on your own