Epilepsy and recommendations for driving

Types of epilepsy

• Tonic-clonic seizures: these sometimes begin with a partial aura of epigastric pain followed by loss of consciousness, falling to the floor and tonic contractions with extensor rigidity and then clonic contractions of the limb, trunk and head muscles.
  The seizure usually lasts 2-5 minutes and is followed by deep sleep, headache and muscle pain.
• Atypical absence seizures: these are distinguished from tonic-clonic seizures by the unilateral predominance of motor phenomena, the absence of the tonic or clonic phase, and even the absence of any convulsive phenomena, such as generalised seizures manifested by a sudden loss of consciousness with a fall and urinary incontinence.
• Absence seizures: these are characterised by an abrupt loss of mental activity for 10-30 seconds, sometimes with loss of muscle tone, and with activity interruption that resumes after the seizure, but without drowsiness or confusion.
  These seizures are characterised by bilateral, synchronised muscle jerks in the form of short bursts in the upper limbs, the back of the neck and sometimes in the lower limbs together with a fall to the ground.
  Absence seizures of the akinetic type are indicated by the dropping of an object or a sudden fall without loss of consciousness due to failure of the lower limbs.
• Bravais-Jacksonian local motor epilepsy: this has localised onset and a regular progressive extension. Each muscle or muscle group has its own brief tonic, then clonic seizure.
  It often starts in the upper limb, reaching the face and then the lower limb. Other times it starts in the face and then reaches the upper and lower limbs.
  The seizure is followed by a motor deficit, but there is no loss of consciousness, except in cases of secondary generalisation.
• Frontal lobe seizures: these are characterised by a conjugated deviation of the head and eyes to the side opposite the epileptic focus, usually followed by a generalised seizure.
• Other: supplementary motor, sensitivity, sensory and temporal lobe seizures.
• Ulegyria: it is estimated that between one and six out of every thousand newborns suffer from perinatal encephalopathy. Ulegyria occurs when perinatal asphyxia occurs in a full-term newborn.
  Ninety-five percent of these newborns survive to adulthood, many of them with motor and cognitive impairment and epileptic seizures.
  These patients present specific symptoms that focus the disease in the occipital lobes, which are related to vision, the tracking of moving objects, spatial orientation and the integration of visual information.
  In seizure-free periods, patients have difficulty paying attention to visual information or orienting themselves. However, at the onset of seizures, visual symptoms appear, such as seeing lights or transient blindness, the involuntary shifting of the eyes to one side or repetitive blinking.
  Epileptic seizures may begin in adulthood, not only in childhood, and should be diagnosed early, linking visual symptoms with a history of perinatal hypoxia.
  Although some patients present mental disability, in others overall function is normal, allowing them to live independently and even obtain a driving license.

Advice on epilepsy

• An epileptic driver has the potential risk of suffering a traffic accident, due to the possibility of loss of consciousness and the side effects of medication.
• Patients who suffer epileptic seizures are not allowed to drive, nor are those with neurological consequences that interfere with driving.
• A multidisciplinary approach is required to treat patients with epilepsy, given the number of road accidents involving this type of driver.
• Doctors must strongly warn these patients about the high number of accidents they cause. The most general measures therefore include making the patient aware of their disease so that they comply with the treatment, do not drink alcohol, and can lead a normal life albeit with precautions.
• A doctor, being familiar with the individual characteristics of epilepsy, will get their patient to follow the treatment regime, which is indispensable, and will advise them on their adaptation to their professional and social life, with driving being key in this.
• If the patient has been seizure free and has not lost consciousness for one year, they can drive, provided that the underlying disease, the medication and their physician allow them to do so.
• With a favorable report from their neurologist stating their diagnosis, treatment compliance, seizure frequency, side-effect-free medication for driving, the patient can extend their driving license for the periods stipulated by law.
• It is advisable that these drivers carry this medical report in a prominent place inside the vehicle so that they can be properly cared for, and that they also carry their emergency medication in an easily accessible place.
• No epileptic patient who, despite their treatment, may be at risk of loss of consciousness may drive.
• A patient who suffers myoclonic jerks that could affect safe driving will need a minimum period of 3 months jerk-free, and a favorable report from their neurologist.
• For patients who have had a history of a single seizure not related or secondary to medication, drugs or post-surgery, a period of 6 months without seizures should be accredited by means of a neurological report.
• Patients with epilepsy are discouraged from driving during treatment changes or if they are not following their treatment protocol correctly.
• A driver with a history of seizures should be made aware of certain precautions, including the following:
  • Avoid driving at night.
  • Rest sufficiently before taking a trip.
  • At the first signs of seizure, stop the vehicle in a safe place and turn off the ignition.
  • Avoid long periods of driving without breaks.
  • Maintain a regular sleep pattern.
  • Learn as much as possible about your disease.
  • Familiarize yourself with the side effects of your medications, as well as the adverse effect that prescribed medications have on driving ability.
  • Learn to avoid trigger situations.
  • Avoid driving in the first week of a new treatment or after an increase in the dose.
  • Do not stop your treatment abruptly.
  • Do not hide seizures from your doctors, as this may lead to inadequate treatment, which could increase the risk of suffering new attacks.
  • Always ask your doctor (neurologist) if you can drive.
  • Remember that the control and advice of family and friends can help in prevention.
  • Avoid trigger situations as much as possible.
  • Never stop your treatment on your own.