Counseling for driving restrictions in epilepsy and other causes of temporary impairment of consciousness: How are we doing?

Bias in counseling of seizure patients following a transient impairment of consciousness: Differential adherence to driver fitness guidelines

“…The main strengths of our study design as compared to others' who have examined the issue (4) are that medically unit drivers experiencing a transient alteration of consciousness were evaluated longitudinally for their driver fitness and using the gold standard of a specialist assessment. The data accumulated from a single specialized seizure clinic likely resulted in a referral bias wherein the numbers of non-seizure subjects were small.…”

“…While driving is critical for independence, employment and overall quality of life (3), physicians must also consider the risks of human injury or property damage when advising their patients. As such, patients with epileptic seizures are frequently counseled against driving by their physician because of safety concerns (4). A sudden and unexpected transient impairment of consciousness, however, can also occur in several conditions that mimic seizures (e.g., syncope, psychogenic seizures, hypoglycemia, sleep attacks), and it has been estimated that these are 3-10 times more prevalent than are seizures (5,6,7).…”

“…In spite of evidence that physicians' driver fitness counselling effectively reduces MVCs and related injuries (16), physicians frequently fail to counsel their patients according to guidelines (17)(18)(19). Omissions in driver fitness counselling may occur more frequently among primary care physicians (PCPs) compared to specialists, as one retrospective chart review of 267 drivers presenting to an Emergency Department (ED) following a transient impairment of consciousness found that counselling against driving increased from 7.1% to 34.5% after a neurologist became involved (4). Primary care physicians have incomplete knowledge of driver fitness guidelines (20,21) and questionnaires of PCPs suggest that they may be preferentially targeting seizure patients (22).…”

A prospective study of loss of consciousness in epilepsy using virtual reality driving simulation and other video games

“…The question of when to restrict driving is emblematic of the dilemmas faced by regulators, patients and their clinicians related to impaired consciousness in epilepsy [6]. On the one hand, a significant body of evidence suggests that patients with epilepsy are at elevated risk of collisions causing injury or death [3,7].…”

Six months following first unprovoked seizure, antiepileptic-treated adults have a recurrence risk in the following 12 months of significantly below the 20% threshold required to regain their driving license

“…Changing the SFI from 12 to 3 months had no effect on crash rates because of seizure2 and SFI length did not correlate with deaths because of seizure-related crashes 3. The lack of awareness about driving regulations may impact on driving safety, and with studies in the USA and the UK revealing a considerable knowledge gap between PWE and healthcare providers 4–6. The study by Bonnet and colleagues suggests the early use of seizure medication reduces recurrence risk, but the potential for untoward effects of such medications impairing the ability to drive, was not considered.…”