Epilepsy and driving: considerations on how eligibility should be decided

Epilepsy and driving: A preliminary survey of people with epilepsy at an epilepsy clinic in China

BACKGROUND

Driving is an important part of the daily life for most adults, and restrictions on driving can significantly affect the quality of life for people with epilepsy. This study aimed to investigate the current driving status of patients at an epilepsy clinic in China.

METHOD

Study participants were administered a survey by a questionnaire including the demographic and clinical characteristics of seizure, driving-related questions and attitudes to driving.

RESULTS

A total of 101 patients responded the survey. Among 33(32.7%) who hold the driving license, 20 (60.6%) still drive, 3 had seizures while driving, and the rate of traffic accidents was 0. There was no significant difference in seizure frequency and type of medication between patients with and without the driving license, but compliance with medication was significantly better for those who held the driving license.

CONCLUSIONS

One-third of people with epilepsy hold the driving license and good drug compliance is a favorable factor for driving. Standardizing different levels of restriction on driving for people with epilepsy is urgently needed.

The use of prophylactic antiepileptic medication and driving restrictions for craniotomies among Australian and New Zealand neurosurgeons

Prophylactic antiepileptic drug (pAED) use for craniotomy surgery is currently not supported in literature [1-5] except possibly in traumatic brain injury (TBI) [6]. Post craniotomy driving restrictions using the Austroad guidelines are based upon literature on TBI and not specifically craniotomy [16-18]. This study was to review Australian and New Zealand neurosurgeons on their use of pAED and advice on driving restrictions post craniotomy surgery. A voluntary and anonymous survey link was distributed to the members of the Neurosurgical Society of Australasia (NSA) through the NSA newsletter. The survey was available on the SurveyMonkey platform in the year 2021 August to December. Questions regarding the use of pAED and duration of driving restrictions were presented to survey participants. Sixty-one (26 %) out of 231 neurosurgeons responded to the survey. Thirty-six percent of respondents stated that they prescribed pAEDs regularly whilst thirty-two percent of respondents did not routinely prescribe pAEDs for craniotomy surgery. Driving restrictions varied but the most common driving restriction post craniotomy surgery was 6 months. There were divided opinions among NSA members in regards to pAED use and driving restrictions. The rationale for pAED use and prolonged driving restrictions for craniotomy surgery needs to be re-evaluated with current literature. The significant effect this may have on the well-being and quality life of patients need to be considered before prescribing pAEDs or long driving restrictions.

Epilepsy and driving: Local experience from Saudi Arabia

INTRODUCTION

The issue of epilepsy and driving has legal, social, and psychological implications. Many countries in the world restrict driving to people prone to epilepsy. There is no data from Saudi Arabia regarding the prevalence of driving among patients with epilepsy and their driving practices. In addition, to the best of our knowledge, there are no local laws or guidelines concerning driving for patients with epilepsy in Saudi Arabia. This study aimed to determine the prevalence of driving among male patients with epilepsy at King Abdulaziz Medical City in Jeddah, Saudi Arabia and determine the barriers and difficulties that they are suffering from especially when it comes to driving.

METHODS

This is a cross-sectional study that was conducted between July 2017 and June 2018 at King Abdulaziz Medical City in Jeddah, Saudi Arabia. The inclusion criteria of this study were male patients with epilepsy 18 years of age or above. The exclusion criteria were female patients at any age (since they were not allowed to drive at the time of the study) and male patients less than 18 years of age. This study utilized a self-made self-administered 25-item questionnaire.

RESULTS

A total of 182 surveys were distributed, and 164 individuals completed the survey (90.1% response rate). Most of the participants have a driving license (95.7%) and drive a car (98.8%). Almost all participants (99.4%) mentioned that nobody asked them whether they have epilepsy or not when issuing a driver's license. In addition, 94.5% were never told not to drive after the diagnosis of epilepsy. Regarding restrictions to driving, 98.7% reported that they drive at all times without any restrictions, and 92.7% reported that they drive both inside and outside the city.

CONCLUSION

This study showed that the number of male patients with epilepsy driving cars was extremely high, accounting for almost all the patients in this study, with most of them doing several wrong practices during driving. Other major issues include the lack of specific laws regulating driving for patients with epilepsy and no counseling from physicians about driving after the diagnosis of epilepsy. We recommend developing the Saudi driving regulations for patients with epilepsy, and this study is considered an urgent call for action for the formation of a local driving regulations taskforce. Health education about the risk of driving should be disseminated, especially for patients with uncontrolled epilepsy.

Tackling Societal Challenges Related to Ageing and Transport Transition: An Introduction to Philosophical Principles of Causation Adapted to the Biopsychosocial Model

In geriatrics, driving cessation is addressed within the biopsychosocial model. This has broadened the scope of practitioners, not only in terms of assessing fitness to drive, but also by helping to maintain social engagements and provide support for transport transition. Causes can be addressed at different levels by adapting medication, improving physical health, modifying behaviour, adapting lifestyle, or bringing changes to the environment. This transdisciplinary approach requires an understanding of how different disciplines are linked to each other. This article reviews the philosophical principles of causality between fields and provides a framework for understanding causality within the biopsychosocial model. Understanding interlevel constraints should help practitioners overcome their differences, and favor transversal approaches to driving cessation.

Epilepsy and the consciousness system: transient vegetative state?

Recent advances have shown much in common between epilepsy and other disorders of consciousness. Behavior in epileptic seizures often resembles a transient vegetative or minimally conscious state. These disorders all converge on the "consciousness system" -the bilateral medial and lateral fronto-parietal association cortex and subcortical arousal systems. Epileptic unconsciousness has enormous clinical significance leading to accidental injuries, decreased work and school productivity, and social stigmatization. Ongoing research to better understand the mechanisms of impaired consciousness in epilepsy, including neuroimaging studies and fundamental animal models, will hopefully soon enable treatment trails to reduce epileptic unconsciousness and improve patient quality of life.