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Epilepsy and Driving

Epilepsy can impact a person's capacity to drive, with personal and legal consequences. Consultant neurologist Dr Emma Whitham discusses the medical standards for licensing and driving restrictions in people with epilepsy.

 Epilepsy is an episodic, sometimes unpredictable condition that can often impair consciousness.1 Any medical condition that impairs a person’s capacity to drive has to be notified to the state or territory’s vehicle licensing body.2

 Losing the right to drive can be restrictive and greatly impact a person’s life. 3 In my experience, this is an emotive topic and often a cause of much angst and distress for people with seizures and epilepsy. In Australia, being unable to drive can be very restrictive, with access to work, schools and shops being affected, especially if the person lives in rural Australia.3

   However, given the potential risk of having a seizure at the wheel of a vehicle and the damage it can do, it is an important aspect of diagnosis of epilepsy or a first seizure. Health professionals should allow patients time to ask questions, understand an individual’s situation and advise accordingly. For example, people with uncontrolled seizures should not drive.4

   Australia still has differences from state to state as to the notification responsibilities, so it is important to know your own state or territory’s rulings.2 For example, it is mandatory to report your concerns about capacity to drive to the driver licensing body in South Australia, whereas in other states it is the person’s responsibility to provide notifications regarding their health challenges.2

   You need to be familiar with the Austroads Guidelines for Assessing Fitness to Drive as to the recommended restriction durations that apply for all people who have experienced a seizure.2 There is a section in this booklet outlining medical standards for licensing for people with seizures and epilepsy, including a useful summary table on page 89. These guidelines have been generated with assistance from experts in the field to increase road safety in Australia by helping health professionals assess their patients’ fitness to drive, promote the responsible behaviour of their patients and conduct medical examinations as required by driver licensing authorities.2

   Overall, people with epilepsy are twice as likely to be involved in a motor vehicle crash compared with the general driving population. In general, responsible individuals with well-managed epilepsy (as demonstrated by an appropriate seizure-free period and compliance with treatment and other recommendations) may be considered by the driver licensing authority to be fit to drive a private vehicle.2 A ‘default standard’ restriction applies to all drivers who have had a seizure unless they meet criteria for other ‘defined situations’ (such as a childhood seizure). For the default standard, a conditional licence may be considered if a person has not had a seizure for at least 12 months and they follow medical advice.2

   Driving restrictions can last longer if the person drives on a commercial licence, as they spend more time at the wheel and are generally driving heavier vehicles or carrying public passengers. These patients usually require specialist opinion and supporting normal EEG.2 These restrictions can have a greater impact on the person’s working capacity if they drive for a living.

   When it comes to communicating with the driver licencing authority, our job as specialists is to give them the information regarding a patient's epilepsy, date of last seizure, if they are medicated or not, whether their seizures were provoked etc. It is not our job to declare the length of restriction or deem someone fit to drive; this is the job of the driver licencing body.2 However, we can provide guidance to the patient and also direct them to the guidelines.

   It is important to recognise that there are some types of seizures that are deemed “safe” when it comes to driving. These, and “sleep-only” seizures, require specific conditions and/or periods of observation before a conditional license can be granted.2 Some other types of epilepsy require a specialist neurologist opinion to assess capacity to drive and we are always happy to try and assist with difficult cases or when the vehicle licensing body requests our review.2

Complete the ThinkGP epilepsy online learning modules to learn more.

References:

  1. Tan M. Epilepsy in adults. Australian Family Physician. 2014;43:100–4.
  2. Austroads. Assessing fitness to drive 2016 (as amended up to August 2017). https://austroads.com.au/drivers-and-vehicles/assessing-fitness-to-drive Accessed 2 March 2020.
  3. Epilepsy Action Australia. Driving. https://www.epilepsy.org.au/about-epilepsy/living-with-epilepsy/lifestyle-issues/driving/ Accessed 3 March 2020.
  4. Drazkowski J. An overview of epilepsy and driving. Epilepsia. 2007;48(Suppl. 9):10–12.

 

Dr Emma WhithamDr Emma Whitham
BSc, PhD, BMBChir (Oxon), FRACP
Dr Emma Whitham is a consultant neurologist at Flinders Medical Centre in Adelaide. She is a general neurologist with a specialist interest in epilepsy and is one of 2 epileptologists at Flinders.

 

 

This blog is sponsored by UCB.