Anticonvulsants and driving

Anticonvulsants and driving Anticonvulsants and driving

The epileptic driver has a potential risk of accident, for the possibility of loss of consciousness and for the side effects of the medication.

The traditional treatment is based on the use of anticonvulsant drugs, that reduce the epileptic activity of the nervous cells and decline or suppress epileptic discharges. This is obtained in 65-75% of the cases.

The purpose of the drugs is to eliminate the crises and assure to the patient social life conditions as close to normal as possible.

The person who suffers epilepsy requires preventive treatment on the long term, with a duration that can range between a couple of years in the cases of better prognostic, and all life long in many of them.

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 develop normal life with precautions.

Most patients with epilepsy are normal among the crises, despite the use of anticonvulsant drugs that can reduce their alertness.

The prescribed drug will vary depending on the type of epilepsy, facility to control it, and sensitivity ad tolerance of the patient to the drug.

Adverse reactions of the drugs most commonly used:

  • Phenytoin: It can lead to ataxia, lack of coordination, confusion, osteomalacia, and exanthema.
  • Carbamazepine: It can cause ataxia, instability, diplopia, dizziness, gastrointestinal irritation, hepatotoxicity, and bone marrow suppression.
  • Phenobarbital: It can cause ataxia, confusion, sedation, instability, depression, and exanthema.
  • Primidone: It can cause ataxia, confusion, sedation, instability, depression, and exanthema.
  • Valproic acid: It can cause ataxia, sedation, tremor, hepatotoxicity, bone marrow suppression, and gastrointestinal irritation.
  • Ethosuximide: It can cause ataxia, lethargy, gastrointestinal irritation, skin exanthema, and bone marrow suppression.
  • Clonazepam: It can cause ataxia, sedation, lethargy, and anorexia. It can precipitate a state of absence if administered with valproic acid. 
  • Trimethadione: It can cause blurred vision, sedation, skin rash, bone marrow suppression, nephrosis and hepatitis.
  • Felbamate: It can cause insomnia, headache, instability, gastrointestinal irritation, nausea, and anorexia.
  • Lamotrigine: It can cause headache, ataxia, instability, diplopia, exanthema, and nausea.
  • Gabapentin: It can originate instability, somnolence, ataxia, and gastrointestinal irritation. It does not show pharmacological interactions.
  • It appears reasonable that the driver with a history of seizures is warned of some precautions, including:
    • Avoid night driving.
    • Rest sufficiently before starting a travel.
    • If the first symptoms of decompensation are noticed, to stop the car in a safe place and remove the key.
    • Avoid prolonged driving times, without resting.
    • Maintain a constant sleep rate.
    • Learn all possible about the disease.
    • Know the side effects of the 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 dose increase.
    • Do not discontinue the treatment suddenly.
    • Not hide the crises to the physician, as this can lead to inadequate treatments, which would increase the risk of suffering new attacks and having an accident.
    • Ask always the physician (neurologist) whether driving is permitted.
    • Know that the control and advice from family members and friends can prevent accidents.
    • Never discontinue the treatment on their own.

Recommendation on anticonvulsants

  • After 3 to 5 years without seizures, the relapse in the first 2 or 3 years is 3-5%, decreasing to 0.5% after 10 or more years.
  • Even with optimal drug therapy, over 30% of the patients with epilepsy continue suffering attacks.
  • The patient should be advised against driving until the disease is stabilized, and subsequently he should be made aware of the adverse events of his medication, that can reduce his ability to drive.
  • The function of the physician is to control the individual characteristics of epilepsy, to achieve in the patient the essential continuation of the treatment, and to advise the epileptic on his adaptation to professional and social life, with driving playing a major role
  • In many of these cases no aura is identified prior to the crisis and there is usually an amnesic period after it. These hinders substantially the prevention of crises during driving.
  • If the patient has no seizures or loss consciousness for one year, he can drive lead, provided the underlying disease, the medication and his physician permit it.
  • Anticonvulsant drugs can cause side effects such as somnolence, ataxia, nystagmus, nausea, visual disturbances, and headache, that should be warned to the driver for their interference with driving.
  • With a favorable report from the neurologist stating the diagnosis, compliance, frequency of crises, and medication without side effects for driving, the patient can obtain an extension of the driving license for the periods set out by the law.
  • If the patient starts to notice prodromal epileptic symptoms while driving, he should stop immediately and ask for assistance.
  • 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 that also carry their emergency medication in an accessible place.
  • All epileptic patients who despite treatment can be at risk of loss of consciousness cannot drive.
  • The patient with myoclonic shakes that could affect the safety of driving will need a minimum period of 3 months without shakes, and favorable report from the neurologist.
  • In the case of a history of non-characterized seizure or that secondary to medicines, drugs or post-operative, a period of 6 months free from crisis should be accredited with a neurological report.
  • Epileptic patients are advised against driving during treatment changes or if compliance is not adequate.