Epilepsy and Traffic Safety

Abstract

We previously reported that drivers with epilepsy have somewhat higher age-adjusted rates of traffic accidents and moving violations than do drivers without epilepsy. We attempted to identify medical and other factors contributing to this increase. Medical records of 241 drivers with a history of seizures, representing essentially all such persons from a contiguous seven ZIP postal code area served by the Marshfield Clinic were studied. This zip code refers to a defined geographic area around Marshfield where virtually the entire population receives its care at the Marshfield Clinic and for which we have accurate records. Information abstracted from medical charts was used to identify potential risk factors for traffic accidents and violations among these drivers. Careless driving violations, alcohol or drug violations, and accidents (especially injury accidents) occurred at higher rates and speeding violations occurred at lower rates for drivers with epilepsy. Young age, unmarried state, history of multiple seizures, and lack of antiepileptic drug (AED) treatment appear to be risk factors for accidents among drivers who had a history of seizures. Male sex, psychiatric disorders, alcohol abuse, and generalized seizures or complex partial seizures (CPS) were also suggestively associated with higher risk. For moving violations, young age, male sex, unmarried state, symptomatic etiology, and history of alcohol abuse contributed to increased risk. We conclude that drivers with epilepsy appear to have identifiable risk factors for traffic mishaps, especially accidents.

Should Patients with Psychogenic Nonepileptic Seizures be Allowed to Drive?

“…Third, it is not known how many (or indeed whether any) of the eight MVCs were directly caused by a psychogenic episode. However, in most studies on the risk of MVCs in epilepsy (5,21,27) thermore, even assuming that all crashes were caused by a PNES (a "worst-case scenario"), we did not find an increased risk of crashes. Finally, our sample was small, so our findings warrant caution and should be confirmed by a larger, preferably prospective, study.…”

Neurologic Conditions: Assessing Medical Fitness to Drive

“…Risk factors for motor vehicle collisions in patients with seizures include age, marital status, gender, history of multiple seizures, psychiatric disorders, alcohol abuse, generalized or complex seizures, partial complex seizures, noncompliance with AEDs, or history of drug intoxication. 74,[77][78][79] When discussing risk, it is important to distinguish between high and low risk groups. Other factors associated with an increased risk include idiopathic cases, the presence of neurologic findings, and the duration since the previous seizure.…”

Useful Field of View Impairment in Partial Epilepsy

“…Patients with ongoing seizures may have legal or medical restrictions on driving privileges, but patients with seizure-free intervals lasting several months or longer may regain driving privileges in many states (Fisher, 1004;Rizzo, 1996). Drivers with epilepsy have long been a focus of public safety concern due to increased risk for motor vehicle crashes (Hansotia, 1991;1993;Lings, 2001). Previous studies of driving and epilepsy have largely focused on the risk of seizure occurrence while driving (Andermann, 1988), and complex partial seizures have raised special concerns (Gastaut, 1987).…”

“…Risk factors for increased collision risk in drivers with epilepsy include co-morbid psychiatric disorders and alcohol abuse (Hansotia, 1993). Epilepsy-related factors likely to affect driving performance include cognitive deficits associated with brain lesions causing the patient's epilepsy and the effects of antiepileptic drug effects on visual and cognitive functions that are necessary for safe driving, such as perception, attention, processing speed, decision making, and motor agility (Seppala, 1979;Meador, 1995;1998).…”

“…The goal of this pilot study was to determine whether attention factors that are critical to safe driving are impaired in drivers with partial epilepsy. In particular, the Useful Field of View (UFOV) provides a quantitative index of divided and spatial attention and visual processing speed, and UFOV impairments predict an elevated crash risk in state records and in simulated collision avoidance scenarios (Ball, 1991;1993;Owlsey, 1991;Rizzo, 1997;.…”