Project: National Guidelines for Driving for People with Epilepsy

Driving is an important aspect of our modern society. It has a major influence on quality of life, and a great impact on working and social issues. Driving a motor vehicle is a complex task involving perception, good judgement, adequate response time and physical capability. A range of medical conditions, as well as certain treatments, can impair any of these factors.

Seizures are sudden, unpredictable events that can temporarily interfere with a person’s ability to think or act normally, having also, the chance of recurrence. This exposes a great dilemma for people with epilepsy.

At the present time in Argentina there is no consensus on driving licenses for people with epilepsy. It is very important that this issue be addressed, and for current laws and regulations to be reviewed, in order to encourage people with epilepsy to voluntarily report their illness; to improve clinical and neurological follow up for people with epilepsy; to avoid injury to people with epilepsy or others, or damage to property; and to protect physicians and people with epilepsy from possible legal procedures due to social, medical and legal issues related to this issue.

Another important aspect is that in Argentina there is one of highest percentages of risk for accidents (nonmedical related). While in England this is 2.1 deaths through vehicle accidents for every 10,000 cars, in Argentina this index is 16 per 10,000 cars. Traffic accidents constitute the first cause of death for people under 35-years of age and the third cause in general in Argentina. 85 percent of accidents happen due to absence of prevention, education and concentration, security, human error, lack of use of a seat belt, excess of speed, consumption of alcohol, as well as the poor state of roads.

In Argentina at the present time, people with epilepsy are automatically denied a driver’s licence, irrespective of whether or not the epilepsy is controlled. This is one of the reasons why there are so few people who declare their epilepsy. In a study, data on the applications for driver licenses between 1998 and 2002 were studied. 218,385 licenses were processed, of which only two applications indicated the presence of epilepsy. In both cases the application was immediately rejected. In another 32 cases details provided on the licence application form suggested that the applicants had epilepsy and again the applications were rejected. If we consider that in our country the lifetime prevalence of epilepsy is 6.2/1,000 (6.3/1,000, age adjusted to the world standard population) and total point prevalence for active epilepsy is 3.8/1000, it is evident that the majority of people with epilepsy hide their condition when applying for a driving licence.

Objectives

• To establish who determine who drives?
• To establish the risk to drive in people with epilepsy
• To define the optimal seizures free interval to obtain Licences
• To determine the percentage of epilepsy-related crashes
• To determine the fatality rate for epilepsy in road accidents Vs other medical conditions
• To improve driving regulations
• To obtain a better assessment of the true level of risk
• To use ability to drive as an outcome measure
• To support uniform regulations and to avoid ambiguity for the practitioner to improve patient outcomes
• To establish the average annual risk for non-medical related accident Vs medical related

Methods

• To establish who determine who drives?
• To establish what factors affect driving, such as age, judgement, coordination, vision and hearing, reaction time, etc.
• To consider European Guidelines (Epilepsy 12 month SFI; First seizure 6 month SFI; Tapering AEDs/breakthrough 3- month SFI; if back on AEDs; No practitioner reporting)
• To achieve a proposal with consensus for driving for people with epilepsy

The activity will be developed in three areas:

• In the hospital with people with epilepsy and their relatives, self-help groups, with special training provided
• In the hospital, university, and for NGOs with a professional specialist in epilepsy and driving. Organization of events; circulation of results to inform both medical professionals and the general public.
• With the regulatory Government Department to encourage the introduction of new legislation.