Epilepsy. A medical assessment is crucial to be able to drive
3 key points: Do not try to hold a person and give them some space but make sure that there are no dangerous objects nearby that could cause them injury during the fit and stay with them to try to keep them calm.This is the advice of Jesús Gámez, Atlético Madrid player.
Written by Dr Elena Klusova
University of Central Madrid, semergen
Epilepsy, according to the Spanish Epilepsy Federation (FEDE) is a chronic illness affecting the central nervous system and manifests itself as unexpected and spontaneous seizures triggered by an electrical imbalance or neuronal overstimulation in part of the brain.
The principal symptom of the illness is the seizures or muscle contractions that can affect just part (partial seizure) or all of the body (generalised seizures), sometimes they are accompanied by a loss of consciousness and control of the sphincter. The convulsions can last for a few seconds or minutes , after which the brain returns to normal function.The epileptic seizures appear intermittently.
They can produce transitory symptoms such as a mental lapse or passing out or disorders affecting movement, the senses (in particular, vision, hearing and taste), mood and mental function.
People that have convulsions often suffer other physical problems such as fractures and bruising and higher levels of psychosocial issues as well as other disorders such as anxiety or depression, however the majority of epileptics are perfectly capable of living a normal life the rest of the time.
It is estimated that in Spain 40,000 people suffer from epilepsy and another 20,000 are diagnosed every year. Although a lot of people are affected by this illness, approximately 70% of people with epilepsy enjoy a full life without seizures thanks to antiepileptic treatments. Epilepsy can affect people from any race, sex or age but it manifests itself more frequently in infancy or from 65 years of age.
“Road Safety Doctors” think that the relationship between the health of epileptic patients and public road safety is very relevant.For epileptic pedestrians, a seizure can happen at any time, the danger is it happening in the middle of the road, crossing a zebra crossing, when the biggest risk is of falling, a knock or a car hitting them, although their biggest worry is the consequences of a seizure while driving. Having one convulsion does not signify epilepsy (up to 10% of the world’s population have a convulsion at some point in their lives) Epilepsy is defined by having suffered two seizures and being diagnosed with epilepsy. Can they drive?
Driving is privilege offering a lot of personal freedom, convenience, social opportunities and often making it possible to work. Driving regulations were developed to prevent accidents and guarantee the safety of all road users.
Studies have shown that people diagnosed with epilepsy that have been free from attacks during the previous 6 months or more have an 87% less probability of being in an accident related to the seizures and that epileptic drivers show a lower level of accidents due to other causes (unrelated to epilepsy) than the rest of the population.
In most International legislation, drivers are obligated by law to inform the authorities if they have any health condition, including epilepsy or a convulsive disorder, that can affect their ability to drive. There are exceptions, such as Canada, where the Doctor has no obligation to inform the Traffic Department about patients with a health condition that could affect their ability to drive safely but their Doctor is authorised to judge and determine the capacity of a patient to drive, particularly in complicated cases.
Once notified, the chances are that due to the high risk of dangerous driving as a result the condition reaching an advanced stage, the patient’s driving license will be temporarily suspended.In the majority of cases, once a Doctor has confirmed that the condition has been in remission for 6 months and has given a favourable recommendation, the driving license is usually returned.A medical review committee will look at every case individually and reach a decision based on the personal circumstances of each patient.
Generally, people with epilepsy have the right to apply for a license to drive a motorbike or a private vehicle from class 5 and 6 (equivalent in Spain to Class A and B). once they fulfill the following criteria:
- The Doctor is sure that they are being honest about the frequency of attacks.
- The Doctor believes that the patient is a responsible person and is taking their medication according to the prescription and is carefully following the Doctor’s instructions.
- The patient is receiving regular medical supervision and the Doctor is made aware of any new attacks.
- The attacks appear to be under control using the prescribed medication and the drugs are not causing any secondary effects that cause a deterioration in their ability to drive.
- The Doctor may be obliged to sign a sworn declaration under penalty of perjury that he is aware of the consequences of providing false information.
Other situations involved in the reinstatement or changes to the driving license of a patient suffering from seizures:
- An epileptic patient undergoing medical treatment that has shown no symptoms during a full year and whose attacks reappear after medical advice to suspend the treatment, can drive as soon as they restart the treatment.
- An asymptomatic epileptic patient, treated or untreated during 5 years is considered eligible for any class of driving license.
- Patients that suffer an attack only when they are sleeping or immediatly after waking up, are eligible for a class 5 and 6 (A and B) license if their EEG is normal and they are subject to regular medical checkups.If they continue to show no symptoms during 5 years, with or without medication, patients can obtain any class of license.
- A person suffering from partial seizures which involves only one extremity and doesn’t suffer any change in consciousness , can be considered for a class 5 /6 (A/B) license after an normal neurological examination.Where it has been 3 years since the first partial seizure and the patient has never suffered a general seizure or lost conscientiousness, they are eligable for any license.
- Anyone that has experienced an isolated, unprovoked epileptic attack will be disqualified from driving until a complete neurological evaluation has been successfully carried out.Furthermore they will be considered for any class of license after a year without a seizure and there are no signs of eleptiforme activity on the EEG.
You are obliged to inform your insurance company about your epilepsy.If you don’t your policy may be invalid in the event of an accident regardless of the cause.Think carefully about this.
Is it a risk you are willing to take? Can you allow this to happen?
Once you have had a new or reissued license,usually accompanied by a medical certificate from your Doctor, you have a right to insurance cover.Unless you have been involved in an accident, the policy will not necessarily be more expensive.Although, like everything else, shop around for the best deal.Since the perception and the decision of the insurer is an important consideration, it may be wise to make your application in person.If they see with their own eyes, a healthy person, it can help to dispel any preconceptions they may have about people with epilepsy or their capabilities.
Road safety advice
- If you are a known epileptic patient, always inform your Doctor about any seizures.When you suffer your first seizure inform your GP immediatly to try and determine the cause.
- If you are having fits do not drive.
- Take your medication as prescribed. If you forget to take it, do not drive until you have resumed the treatment.
- If your medication has been changed or the dose has been increased, don’t drive until you know how you are affected.
- Try not to drive when you are tired.
- Do not drive for long periods without a break.whenever possible be accompanied on long journeys and share the driving.
- Do not miss meals or go too long without sleep.
- None of us should drink and drive, this is more even important for someone with epilepsy.
- If your epilepsy is photosensitive, use polarized sun glasses.
- Be aware of the triggers
- Avoid driving when feeling emotional or when very stressed.
- For a long journey consider another form of transport such as the bus, the train or by plane.In certain cases the transport company will offer a free ticket for a carer if you think medical attention may be required.Find out about company policy when reserving a ticket.
- Consider company on the journey, limiting the time you drive by sharing it.
- If you are incapable of driving, public transport is a viable option.There may be situations where family, friends and partners can help out, particularly if you are willing to pay for the fuel.
Social services or the social worker attached to your surgery can help to put you in touch will available services such as charitable organisations and church groups that may be able to offer some financial help, although it may be limited, also to help with attending important appointments and Doctors visits which may be outside of that provided by the health service
How to react to an epileptic fit, advice and prevention
As Doctors, our job is the to treat illness and to prevent situations arising from the symptoms of that illness that could affect the patient or those around them.This is why we wish to reflect the work of the Spanish Epilepsy Federation (FEDE) and Atlético Madrid Foundation, “Living with Epilepsy”
Children and adolescents don’t drive but they can suffer their first epileptic seizure in the street, at school or even in a car. Do we know how to react to a fit?
In Living with Epilepsy you can find more information and download. A practical guide to understand and react to epilepsy.