Epilepsy. A medical assessment is crucial to be able to drive

3 simple rules: do not restrain the person, give them space by removing dangerous objects with which they could injure themselves in the seizure, and stay by their side while keeping calm. This is the advice of Jesús Gámez, a player for Atlético de Madrid.

Written by Dr. Elena Klusova
University of Central Madrid, Semergen

Epilepsy, according to the Spanish Epilepsy Federation, is a chronic disease of the central nervous system that presents in the form of unexpected and spontaneous seizures, triggered by an imbalance in the electrical activity or neuronal hyperexcitation of an area of the brain.

The main symptoms of the disease are seizures or muscle contractions that may affect part of the body (partial seizures) or the whole body (generalized seizures). These are sometimes accompanied by loss of consciousness and sphincter control. The seizures last only a few seconds or minutes, after which the brain begins to function normally again. Epileptic seizures occur intermittently.

Transient symptoms may be present, such as the absence or loss of consciousness, and disruption of movement, the senses (particularly vision, hearing and taste), mood and mental function.

People who suffer seizures tend to have more physical problems, such as fractures and bruising, and higher rates of other illnesses or psychosocial problems as well as disorders like anxiety or depression; however, the majority of people who have epilepsy are fully capable throughout the rest of their lives.

It is estimated that about 400,000 people suffer from epilepsy in Spain, with more than 20,000 new cases being diagnosed each year. Despite the large number of people affected by this disease, approximately 70% of people with epilepsy can enjoy a full life, without seizures, thanks to the administration of antiepileptic treatments. Epilepsy can affect people of any race, sex and age, but is most common in childhood and after the age of 65.

“Doctors for Road Safety” highlights the relationship between the health of epilepsy patients and safety on public roads. In the case of pedestrians, seizures can occur at any time, the risk is that they occur when they are crossing the road, for example, and the greatest risk in this situation is a fall, a blow or being run over… However, the consequences of a seizure are even more worrying when the patient is driving. A single seizure does not mean you have epilepsy (up to 10% of the world’s population suffers a seizure at some point in their lives). Epilepsy is defined by two or more unprovoked seizures. In this case, if a patient has suffered more than two seizures and has been diagnosed with epilepsy, can they drive?

Driving is a privilege that gives a great deal of personal freedom. It provides convenience and social opportunities as well as facilitating job opportunities. Driving regulations are put in place to prevent traffic accidents and ensure the safety of anyone on or near the road.

Studies have shown that people diagnosed with epilepsy who have been seizure-free for six or more months are 87% less likely to have a road accident involving a seizure, and that drivers with epilepsy have a lower accident rate due to another cause (not related to epileptic seizures) than the rest of the population.

Most international laws require drivers to report any health conditions, including epilepsy or a seizure disorder, which may affect their ability to drive. There are exceptions, such as in Canada, where physicians are not required to report their patients with a health condition that may interfere with safe driving to the traffic authorities; however, the attending physician is authorized to judge and define the patient’s ability to drive, especially in complex cases.

In Spain, the patient’s doctor can advise them not to drive, and is able to report a patient with a high incidence of seizures who, despite medical advice, continues to drive, putting their own life and the lives of others at risk. Once the high probability of reckless driving due to advanced stage pathology has been reported, the offender’s driving license may be temporarily suspended. In most cases, after 6 months of remission confirmed by the attending physician and with a favorable recommendation from this doctor, the driving license can be reinstated. A medical review committee considers each case on an individual basis, making an assessment based on the personal circumstances of each patient.

In general, people with epilepsy are entitled to a driving license for mopeds and private cars class 5 and 6 (equivalent to the Spanish driving license Class A and B), provided that they comply with the following regulations:

• The doctor believes the patient to be truthful about the frequency of their seizures.
• The doctor believes the individual is a conscientious person who will take their prescribed medication and carefully follow the doctor’s instructions.
• The applicant is having regular medical supervision, and the doctor will be aware of any new seizure activity.
• The seizures appear to be well controlled by the medication and the drugs do not cause side effects that impair driving ability.
• The doctor may be required to sign an affidavit of fact affirming their knowledge of the seriousness of providing false information.

Other situations involved in the reinstatement or changes made to a driving license in patients with seizures:

• An epileptic patient receiving medical treatment who has been asymptomatic for 1 year and whose seizures reappear after stopping the treatment under medical indication, may drive after restarting the treatment.
• A person with epilepsy who has been asymptomatic with or without treatment for 5 years is considered fit for any kind of license.
• People who suffer epileptic seizures only while sleeping or immediately after waking up may be eligible for a Class 5, 6 (A/B) driving license if their EEG monitoring is normal and they are under regular medical supervision. If they remain asymptomatic for 5 years with or without medication, this category of patients can have any class of license.
• A person with simple partial seizures involving a single limb and without altered consciousness may be considered for a class 5/6 (A/B) license after a normal neurological examination. If, 3 years after the first partial seizure, the patient has not suffered generalized seizures or loss of consciousness, they are eligible for any class of license.
• Someone who has experienced an isolated unprovoked epileptic seizure will become ineligible for any class of driving license until they have undergone a full satisfactory neurological evaluation. They will be considered for any class of license after a year has passed without a further seizure and no signs of epileptiform activity on an EEG.

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Road safety tips for safe driving

• If you know you suffer epilepsy, tell your doctor about all your seizures. If you have a first seizure, check with your family doctor immediately to determine the cause.
• If you have seizures, do not drive.
• Take your medication as prescribed by your doctor. If you miss a dose, do not drive until you have resumed your treatment.
• If your treatment changes to another drug or the dose of your regular medication increases, do not drive until you know how the change affects you.
• Avoid driving when you are tired.
• Do not drive for long periods of time without taking a rest. If possible, have a co-driver on long trips to switch with you and reduce uninterrupted driving time.
• Do not skip meals and do not go for long periods of time without sleep.
• Everyone should avoid alcohol before driving, but this is even more important for a person with epilepsy.
• If you have photosensitive epilepsy wear polarized sunglasses.
• Be aware of your seizure triggers, and avoid and manage these.
• Avoid driving if you are experiencing strong emotions, or when you are very stressed.
• For long distance travel consider other means of transportation such as a bus, train or plane. In some cases, transport companies provide a free ticket for a caregiver in case urgent care is needed during the trip. Find out about the caregiver policy when booking the ticket.
• Consider carpooling, and reduce driving time by setting up rotating driving schedules.
• If you are unable to drive, you can always take public transport. Perhaps there are situations where family, friends and colleagues can help, especially if you can help by covering the cost of fuel. We understand that this can be a challenging and difficult transition to make, which is why there are services available like HandiBus – a charitable transport organization for people with disabilities in Canada. In Spain we have transport services for chronic patients, such as AMC, SUMMA 112, LH (some of which are still free) and that require an official medical prescription for the transfer with a set time and destination.

Your local council’s social services, as well as the social worker at the health center, can help you get in touch with the available services and, together with certain charities and church organizations, they may have some financial resources, albeit limited, to help you attend important appointments and medical visits outside the framework of the public health service.

What to do in the event of a seizure: advice and prevention

As doctors, our job is to treat the disease and prevent situations stemming from its symptoms that may affect both the patients themselves and the people around them. We would like to echo the work of the Spanish Epilepsy Federation, together with the Atletico de Madrid Foundation in “Living with Epilepsy”.

Children and adolescents do not drive, but they may suffer their first epileptic seizure in the street, at school, or in the car. Do we know how to deal with a seizure?

“Living with Epilepsy” offers useful information and you can download different practical guides to help you learn about epilepsy and how to deal with it.