Western driving regulations for unprovoked first seizures and epilepsy

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.