Epilepsy and driving

Background: Epilepsy influences social aspects of epileptic patient’s life including work, driving, interpersonal relations and education. Among these, prohibition of driving particularly causes adverse effects on quality of life, independence and working capabilities and decision making by physicians on how and when these patients could start driving is of great importance. However lack of adequate practical data and absence of a uniform protocol in our country have caused some problems in this regard. This study aimed to present a comprehensive practical protocol for Iranian neurologists who are involved in this issue. Methods: The literature was searched within 2000-2017 using PubMed, Embase and Cochrane databases with the keywords: seizure, epilepsy, driving, guideline, protocol and Iranian. Fitness to drive protocols was sought separately from driver licensing authorities and epilepsy societies all over the world. Findings: The expert opinion and guidelines regarding fitness to drive are different between countries and even states but despite several factors intervening legislation about driving in epileptic patients, an annual seizure risk of 20% including 50% for private drivers and 1–2% for commercial drivers are generally acceptable to allow driving. There is also a general agreement that once a seizure occurs, the driving license would be suspended and a defined seizure free period should be elapsed before issuing a new license. Different conditions including history of febrile seizures or benign epilepsy syndromes of childhood, first symptomatic and unprovoked seizure, seizures in previously well controlled epilepsy, safe seizures, sleep-related epilepsy, planned tapering or withdrawal of antiepileptic drugs, patients undergone epilepsy surgery and many related issues are discussed separately in private and commercial drivers. Conclusion: Preparing comprehensive fitness to drive guidelines by all countries, updating them based on new evidences and also a general effort by experts to provide a common international and detailed guideline might prevent wrong or unnecessary individualized decision makings and improve quality of life of epileptic patients.

Keywords:

Epilepsy , driving , private , commercial