Epilepsy and driving.

www.neurosciencesjournal.org E is a neurological disorder characterized by recurrent seizures, which result in an altered level of consciousness.1 Although appropriate management with antiepileptic drugs can result in seizure remission, 3040% of epileptic patients are incompletely controlled.1 A number of studies have shown that epileptic patients are more likely than age-matched controls to experience motor vehicle accidents (MVAs).2 As a result, most developed countries impose driving regulations on epileptic patients.3,4 However, the exact risk of epilepsy and MVAs is difficult to assess because of methodological flaws in most studies.5,6 A recent review of the literature found that there was limited class one studies evaluating the risk of crashes in epileptic patients.5,6 Therefore, there is a need to identify those epileptic patients with a high likelihood of seizure recurrence. The seizure-free interval is a simple measure that is attractive to regulatory agencies. A number of studies were conducted to look at various seizure-free intervals on the risk of recurrence.5-7 The first report of an MVA attributable to a seizure was by Thalwitzer in 1906,8 resulting in a general prohibition against driving by persons with epilepsy. Hierons (UK) in 19569 proposed that patients with epilepsy could drive safely if they had been seizure free for more than 5 years. This established the criterion of a seizure-free interval, which has been used ever since.5-7 Patients with frequent seizures (short seizure-free intervals) should not drive. Patients with no or rare seizures (long seizurefree intervals) should be allowed to drive. It is difficult to guarantee seizure freedom for any particular patient, one can only express probabilities.6,7 International epilepsy and driving regulations. A questionnaire was sent to 231 neurologists (chosen from American neurological and epilepsy societies) from 84 countries, and to 230 official (embassies and consulates) representatives of 134 countries asking for the local rules and regulations, and their comments on driving and epilepsy. One hundred and sixtysix responses were received from 96 of 134 (72%) countries. One hundred and six neurologists (of 231 queried [46%]) responded. In 16 countries, epileptic patients are not permitted to drive. In the remaining countries, these patients must have a seizure-free period of 6-36 months.10 This period varies according to the type of seizure. In 5 countries, physicians must report the names of these patients to their local authorities. In many countries, the rules and regulations are being reevaluated and changed.10 Unfortunately, laws that govern driving for epileptic patients are variable from country to country, and from one state to the other in the United States, requiring individual practitioners to be familiar with the local regulations.11 In 16 countries, patients are not allowed to drive after having a seizure. These countries include Bulgaria, Mexico, Central African Republic, China, Portugal, Estonia, Rwanda, Ghana, Singapore, India, Taiwan, Japan, Turkey, Korea, and Uzbekistan.11 In Japan, the driving regulations were amended in 2002, lifting the absolute ban on driving by epileptic patients, and granting licenses to them after a 2-year seizure-free period.12 In other countries, patients with epilepsy are permitted to drive a motor vehicle after they have been free of seizures for a variable period of time.11 Countries requiring a 24-month seizure-free interval include Andorra, Australia, Italy, Belgium, Luxembourg, Denmark, Malaysia, Norway, France, Slovenia, Germany, South Africa, Greece, Spain, Iceland, Sweden, and Ireland.10,11 Countries requiring a 12-month seizure-free interval include Australia, New Zealand, Bermuda, Brazil, Romania, Canada, Cyprus, Germany, Switzerland, United Kingdom, Malta, Uruguay, and the Netherlands.11 In the USA, the seizure-free period varies from 3-12 months between different states.13 It is worth noting that regulations in 39 of the 51 American states require seizure-free periods