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Individuals with a history of seizures may be granted driving privileges if the risks of future seizure while driving are relatively low. Different nations have defined these risks in a wide variety of ways. Some countries, e.g., Japan, Greece, Brazil, India, and Russia, preclude driving after a single seizure. Other countries, such as Canada and the United States, allow driving < or = 3 months after certain types of seizures. A Joint Commission of the International Bureau for Epilepsy/International League Against Epilepsy has summarized regulations in several countries. From a consideration of medical literature and existing practices, a series of proposed guidelines for driving and epilepsy is recommended. In general, these guidelines suggest use of a seizure-free interval, generally 1-2 years but less in particular instances, to determine fitness to drive. Required physician reporting is discouraged, but physicians should report patients whom they believe pose a danger to themselves and to public safety. Individualized consideration should be given to special circumstances that may modify a general driving prohibition. Education and information programs are necessary for medical and regulatory authorities to develop a rational approach to driving and epilepsy worldwide.

A series of 115 patients was treated with sodium valproate (Epilim) for periods ranging from 6 to 24 months and in dosages ranging from 400 mg to 2400 mg daily. All but six of these patients had intractable epilepsies and had been previously treated unsuccessfully with other anti-epileptic agents. Eighty patients had generalised seizures and 35 had partial seizures which, in 26 cases, were secondarily generalised. Reduction of seizure frequency by over 50 per cent occurred in about 70 per cent of patients with generalised seizures but in only 37 per cent of those with partial seizures. A number of patients reported increased alertness, improvement of mood, increased appetite and improved performance at school. The adverse effects encountered were gastro-intestinal symptoms, weight gain and hair loss.

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There are a number of toxic substances which, after absorption via one route or another, may lead to the development of a disturbance of function in the nervous system with or without ensuing structural damage.Quite often the peripheral nerves appear to be principally involved, this resulting in the production of a more or less symmetrical type of peripheral neuropathy; moreover, in such cases there may be severe structural changes, with the result that recovery of function, although tending ultimately to be complete, may be longdelayed. There may also be involvement of the central nervous system by the toxic action of the ingested substance, and, although the exact modus operandi may not be known, it seems likely that in many such cases the upset of function in the nervous system may well be the result of interferenCe with various enzyme systems.The following case report is of a patient who developed a fairly severe disturbance of central and peripheral nervous function after taking an overdose of a podophyllum extract by mouth. We have not been able to find a similar case in the literature. For this reason, and also because the effects of this substance upon living tissue have recently been the subject of investigation, we felt that the case should be placed on record.Case History A married woman aged 25, believing herself to be pregnant, drank 1 fl. oz. (28.4 ml.) of a proprietary concentrated alcoholic extract of American podophyllum root (P. peltatirn) one evening on the advice of a friend. There were apparently no immediate ill effects, but the next day she began to vomit repeatedly, becoming confused and finally comatose within 24 hours. The same evening vaginal haemorrhage also supervened and she was transferred to hospital as a gynaecological emergency. On admission she was found to be confused, noisy, and restless, hiccuping, yawning, and retching in turn. A bruise was present over the right eye, but her colour was good and her tongue moist and clean. The ocular fundi and pupils were normal, the knee-jerks were present and equal, but the abdominal reflexes were absent and the plantar responses extensor. The pulse rate was 60 a minute, the temperature 97.8' F. (36.6' C.), and the blood pressure 120/80 mm. Hg. On clinical examination no abnormalities could be detected in the cardiovascular, respiratory. or gastro-intestinal systems, and, although a gynaecological examination revealed the presence of a blood-stained watery discharge from the vagina, the cervix and vagina itself were normal in appearance, there being no evidence of enlargement or abnormality of the uterus.A provisionial diagnosis of poisoning was made in view of the clinical history, and gastric lavage was performed shortly afterwards. From the time of admission the patient was able to take fluids by mouth, and a marked lessening in the severitv of her confusional state had occurred two days after admission. It was recorded at this stage that the tendon reflexes had become sluggish, while a lumbar ptinctuire revealed a clear cerebrospinal ...