Survey presented at a Symposium on Driving and Epilepsy during the Annual Academic Meeting and General Assembly of Taiwan Neurological Society, 2006

Marshal Mo-Song Hsih, M.D., Taiwan Epilepsy Society and Taiwan Epilepsy Association explains:

The issue of Driving and Epilepsy in Taiwan was discussed on occasion at seminars and/or symposiums held in the course of the past ten years at both domestic and international meetings. However, in Taiwan, as in many Oriental countries, people with epilepsy are prohibited from obtaining a driver’s license and many people with epilepsy continue to drive either with or without a driver’s license (Tsai, 2003; Hsih, 2006). Serious traffic accidents which endangered public safety caused by drivers who had epilepsy were sporadically reported by the media in Taiwan.
In Taiwan, the need to be able to drive becomes more urgent and driving itself becomes very essential in modern times. In addition, driving privileges are critical to quality of life. (Gilliam, 1997).
The Press conference, held by the Taiwan Epilepsy Association in October, 2005, called attention to the importance of having a driver’s license in finding and keep a job. A female prosecutor also presented her point of view, supporting the delivery of driver’s license to people with epilepsy if their seizures could be controlled to a required level of safety.

A survey questionnaire was conducted immediately after the Press conference during the months of November and December 2005. The survey covered most major cities. The survey included people with epilepsy (Patient Group, P-G), family members (F-M) of people with epilepsy and the public (P-P). In total 1911 responses were collected, excluding 7 responses being not appropriately completed. They included 486 (25.53%) from P-G, 327 (17.17%) from F-M, 1098 (57.30%) from P-P.

The distributions of genders were almost the same in all three Groups (totally, male in 50.47% of cases, female in 43.43% and not indicated in 6.09%). Nearly 90% of submitted questionnaires were from those completing middle school or higher level of education, with a tendency that both P-G and F-M were of a lower education level (p<.0001).

The results (Hsih, 2006) show:
A high percentage of both P-G (64.20%) and F-M (62.39%) knew that persons with epilepsy were prohibited by Law from having a driver’s license, compared the P-P with only 48.03% knowing this Law (p<.0001). However, more than half of P-G (59.75%) have a driver’s license.

Reasons for driving in P-G were mainly for social activities (53.92%) and for work (52.50%). There was no significant difference (p<.0194) as compared with those from P-P.
There was no significant difference in the three Groups on a question asking if they knew they might have a seizure and cause an accident while driving. In reality, 52.07% of P-G and 53.42% of P-P had a history of car accidents, but only 7.08% stated that the accidents were caused by their epilepsy seizures and 42.08% stated that their accidents were not related to their seizures in P-G. Interestingly, 17.08% of P-G indicated that they would keep on driving even after the accident, while 30.84% said they would stop driving.

The influence of prohibition by Law from driving on schooling, making a friend, finding a job, driving for work, maintaining a marital life and living a better quality of life were about the same in the three Groups, but showed a higher percentage in P-P in items of finding a job (p<.0002) and living a better quality of life (p<.0001).
About 50% of all cases, particularly the P-G group (62.76%), agreed with allowing people with epilepsy to hold a driver’s license if they could meet safety criteria. (p<.0001)
Up to 74.42% of all cases (81.21% of P-P) showed that people with epilepsy will hide their illness and try to get a diver’s license if the Law prohibits them from getting it. (p<.0001)
A more positive and encouraging picture was demonstrated that people with epilepsy will face their illness and have better compliance in treating their own illness if the Law allowed them to get a driver’s license when their seizures were controlled for an appropriate period (supported by 71.69% of all answers, especially the P-G and F-M – up to 81%). (p<.0001)
Scoring estimate for “How much the quality of living in people can be improved if they are allowed to get a driver’s license? was 61.02 (from 0 to 100). This was very promising and encourages us to re-evaluate the Law on driving in the near future.

The conclusion of this survey strongly suggests that changing the law to allow people with epilepsy to get a driver’s license would be very positive and encouraging in:

• improving the living quality of those people;
• changing the state of misunderstanding about epilepsy in both people with epilepsy themselves and improving public social awareness;
• promoting the acceptance of epilepsy and having a therapeutic result in people with epilepsy by an improvement in compliance.

Soon after the survey was completed I organized a “Symposium on Driving and Epilepsy” at the Annual Academic Meeting and General Assembly of Taiwan Neurological Society on April 23, 2006. Medical professionals, including Dr. H. Kubota and 4 national clinical neurologists, a prosecutor and an officer from Ministry of Transportation were invited.

The discussion topics were:

• The Japanese Experiences and Suggestions
• Ethics of Driving and Epilepsy
• Problems of Driving among People with Epilepsy in an Epilepsy * Clinic in Southern Taiwan
• Proposal of Medical Criteria for Driving for People with Epilepsy
• Legislative Point of View on Driving Problems in People with Epilepsy
• Problems of Transportation Regulation and Management.

One of the most impressive discussion topics was the Japanese experience, which emphasized the cooperation of the IBE Commission on Driving Regulations, Japanese Epilepsy Society (ILAE chapter) and Japanese Epilepsy Association (IBE Full Member). The other impressive fact was that a delegate of the JEA was called to the Diet to give a presentation in front of the delegates of the Traffic Accident Bereaved Family Association.

In conclusion, all speakers provided valuable opinions and comments. Our symposium suggested that we can and should take action in setting up professional proposals for the licensing authority to amend the regulations allowing people with epilepsy to hold a driver’s license when they can fit the safety criteria.