Epilepsy and Driving

April 11, 2002
Updated: June 1, 2005

Everyone looks forward to getting a driver's license. Once you have a driver's license (and a car), you have the freedom to go where you want, when you want. You don't have to ask anyone for a ride; you don't have to wait for a bus. For people with epilepsy, however, a driver's license comes with significant restrictions. In fact, in some countries, people who have had a seizure can't get a driver's license at all! In other countries, drivers must be free of seizures for a specific period of time.

According to a research team led by Dr. Gregory L. Krauss at Johns Hopkins University, approximately 700,000 of the 180 million drivers in the United States have epilepsy. People with uncontrolled seizures do have an increased risk of a car crash; however, those whose seizures are controlled do not have a higher risk for a car accident. Therefore, many places have laws that regulate driving for people with epilepsy. Dr. Krauss and his coworkers reviewed the laws regarding driving restrictions in the United States and found many differences among the laws in the 50 states.

The researchers found two basic approaches that are used to determine if people with epilepsy are allowed to drive:

  1. Must be seizure-free for a specific period of time (28 states and Washington, D.C.)
    1. Seizure-free for 3 months (7 states).
    2. Seizure-free for 6 months (14 states).
    3. Seizure-free for 12 months (6 states and Washington, D.C.).

  2. A physician or a medical advisory board evaluates the person with epilepsy (23 states)
    1. Only a doctor's recommendation is used (10 states).
    2. A specific seizure-free period is required, but doctors can lengthen or shorten this period for particular people (10 states). The methods that physicians use to evaluate a patient's driving abilities are not standardized, however, and thus vary from one doctor to another.
    3. A clinical assessment is used (3 states).

Some states require doctors to report patients with epilepsy to motor vehicle agencies. Doctors who do not report such patients may be fined and run a small risk of being sued if an accident occurs with one of their patients. Because some patients are afraid that they will lose their driving privileges, they may not tell their doctors about their seizures. This is dangerous because a patient's seizures may go untreated.

Unfortunately, there is little research to support the laws that govern driving by people with epilepsy. In other words, the decision to restrict driving after people are seizure-free for 3, 6 or 12 months is not based on the relative risk of having these people on the road. Further studies are needed to keep the roads safe while at the same time allowing people with epilepsy to drive.

UPDATE
July 16, 2003
A research team lead by Dr. Joseph Drazkowski (Mayo Clinic, Scottsdale, AZ) examined the number of seizure-related motor vehicle crashes for three years before and three years after the state of Arizona reduced the seizure-free driving interval requirement from 12 months to 3 months. They found that the rate of seizure-related crashes did NOT increase after the seizure-free interval was reduced to 3 months. (Reference: Drazkowski, J.F., Fisher, R.S., Sirven, J.I., Demaerschalk, B.M., Uber-Zak, L., Hentz, J.G. and Labiner, D. Seizure-related motor vehicle crashes in Arizona before and after reducing the driving restriction from 12 to 3 months. Mayo Clinic Proceedings, 78:819-825, 2003)

Did you know?

These countries prohibit driving by people who have had a seizure:

Bulgaria, Central African Republic, China, Estonia, Ghana, India, Korea, Pakistan, Portugal, Rwanda, Singapore, Taiwan, Turkey and Uzbekistan.

These countries require that people are free from seizures for 24 months before they are allowed to drive:

Andorra, Australia, Belgium, Denmark, Egypt, France, Germany, Greece, Iceland, Italy, Luxembourg, Malaysia, Norway, Slovenia, South Africa, Spain and Sweden.

These countries require that people are free from seizures for 12 months before they are allowed to drive:

Bermuda, Brazil, Canada, Cyprus, Ireland, Malta, Netherlands, New Zealand, Romania, Saudi Arabia, Senegal, Switzerland, United Kingdom and Uruguay.

Some countries such as Australia, Germany, Israel and Mexico require different seizure-free durations depending on the region.

Strict driving regulations may cause some people to hide their condition from their doctors in order to obtain a driver's license. In Japan before 2002, people with epilepsy could not drive. However, Japanese law was changed and now allows people who are seizure free for two years to get a driver's license.

(References: Inoue, Y., et al., Epilepsy and driving in Japan, Epilepsia, 5:1630-1635, 2004; Ooi, W.W. and Gutrecht, J.A., International regulations for automobile driving and epilepsy, Int. J. Travel Med., 7:1-4, 2000 - Note: this paper was published in 2000. If you know of any changes to the laws that permit people with epilepsy to drive, please let me know: chudler@u.washington.)


Reference and further information about epilepsy and driving:

  1. Krauss, G.L., Ampaw, L. and Krumbolz, A. Individual state driving restrictions for people with epilepsy in the US. Neurology, 57:1780-1785, 2001.
  2. Epilepsy - from Neuroscience for Kids
  3. Driving and Epilepsy


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