DRIVING AND EPILEPSY-PART 1

There are few aspects of having epilepsy in adult life that cause greater distress than the necessary legal restrictions on driving. For some people owning and using a car is a hobby in itself—albeit an expensive one. Others, particularly those living in rural areas where public transport is limited or non-existent, find car ownership and driving necessary for shopping and social contact, and for getting to work. There are jobs such as delivery van driver in which driving is the sole function of employment, and any restriction on driving will cause the employee to lose his job.

This book may well be read in a number of countries, and the legal requirements vary from place to place. As an example, however, we consider the UK eligibility to hold a private (Group 1) driving licence in the UK, as determined by the Motor Vehicles (Driving Licences) (Amendment) (No. 2) Regulations 1994 which came into force on 5th August 1994. Epilepsy is prescribed for the purposes of Sections [92 (4) (b)] of the 1988 Road Traffic Act. The 1994 Regulations amended the 1987 Regulations (which specified a seizure-free period of two years) as follows:

‘An applicant for a licence suffering from epilepsy shall satisfy the following conditions, namely that he shall:

a) have been free from any epileptic attack during the period of one year immediately preceding the date when the licence is granted; or

b) have had an epileptic attack whilst asleep more than three years before the date when the licence is granted and shall have had attacks only whilst asleep between the date of that attack and the date when the licence is granted; and that the driving of a vehicle by him in accordance with the licence is not likely to be a danger to the public.. The purpose of clause (b) is to allow someone to drive who has established a long history of seizures whilst asleep without ever having had any whilst awake. It allows someone with continuing seizures only whilst asleep to drive, without requiring a period of one year free from such a seizure.

These Regulations are, we believe, a reasonable attempt to protect the public from the chances of meeting a driver who is briefly incapable of controlling his car because of a seizure. The Regulations are also fair to those with epilepsy insofar as they clearly state the circumstances under which they can drive.

What actually happens in practice? Take the example of a woman who has held a licence for several years, and then has two grand mal seizures at work within a month. Her family doctor or neurologist will explain that she is no longer eligible to hold a driving licence. It is not the responsibility of either doctor to inform the licensing authority of this, but a doctor will record in their notes the fact that they have explained the position to the patient. It is the driver’s responsibility to take action. Inside each UK Driving Licence is the statement that the ‘Drivers Medical Branch, Swansea SA99 ITU MUST be told at once if: you NOW have any physical or mental disability which affects your fitness as a driver or which might do so IN THE FUTURE’. The patient should write a brief note to the Drivers and Vehicle Licensing Authority (DVLA) at Swansea (the address above being sufficient) explaining the details and enclosing the licence, which will be acknowledged. No further action is necessary.

If all goes well for this woman, and she has no further seizures after the first two, she becomes eligible to hold a driving licence one year after the date of the last attack. She then completes an application form as usual. In Section 6d, or in a covering letter if there is insufficient space on the form, she writes briefly exactly what has occurred, refers to her earlier letter, states the date of her last seizure, and gives the name and address of her family doctor or neurologist to whom reference can be made. After a short interval, she will receive her new licence.

All this seems entirely straightforward, but we know that many people with epilepsy find the Regulations hard to accept. Doctors appreciate the difficulties that may be caused by giving up driving. Driving is usually an essential part of their work, so they do not have to make great leaps of imagination to realize the difficulties that a ban on driving may cause. Unfortunately the law does not take hardship into account. Doctors should, however, not only advise their patients of the law, but also, from their experience, advise patients how to cope with their changed circumstances. Doctors are in a position to influence decisions of employers about the nature of their patients’ work. They can write to the employer, with the patient’s consent, supporting a request for a change of job within the same company. In such a letter, a doctor does not necessarily have to say that the person has epilepsy, only that they are not able to drive for medical reasons, and not likely to be able to drive for some time. Such letters may well influence company decisions. We have known many examples of this. A travelling salesman has become a successful office-bound sales manager; a busy surveyor has taken on increased training responsibilities; and a delivery van driver has been employed within the factory making the goods he was previously delivering. Obviously such changes are easier within large organizations with their greater variety of jobs.

We usually advise people living in rural areas not to move house just because of their new inability to drive. If it seems likely that the seizures can be easily controlled, then it is probably better to cope somehow for the time necessary, rather than disturb the whole family’s way of life. The people with epilepsy are the only ones who can decide whether to move, but their doctors should give them sufficient information about the probability of seizure control to allow an informed decision.

Sometimes people with epilepsy will say that they consider it safe to drive as they always get a warning of their attacks. Leaving aside the legal point—that they are ineligible, and unfortunately their opinion does not count—we explain that the warning is the start of the cerebral events which form the early part of the seizure itself. The fact that to date the progression of the seizure discharge has been sufficiently slow to allow the subject to stop his or her car safely does not mean that this will always be the case. Such a person with epilepsy may well have a sudden grand mal seizure without warning.

Again, people with epilepsy may indicate that they consider it safe to drive, as all their seizures are small ones—perhaps temporal lobe seizures in which consciousness is disturbed in only a minor way. We have to say that the law does not distinguish between the various types of seizures. We also have to say that the next seizure may unfortunately be a grand mal one, and that in any event catastrophe is as likely to be caused by a momentary reduction of conscious awareness as by a major fit.

It is useless for the patient to say to his or her doctor that seizures always occur in the evening, or sometimes even: ‘I’ve never had one whilst driving’, as the next seizure may well be when he or she is in the driving seat.

Sometimes a patient may feel that the events which have led him to the doctor are not epileptic in nature. All a doctor can do in such circumstances is to disagree, and advise that the patient seeks a further opinion. As noted above, it is not a doctor’s responsibility to inform the licensing authority of a person’s epilepsy. It may be, however, that if a doctor is convinced of the diagnosis, and believes that there is a real risk to the public, and if the patient refuses to seek a further opinion, he or she may feel that responsibility to the public at large overrides responsibility to the individual patient.

There are, however, circumstances in which the occurrence of epileptic seizures is not automatically associated with loss of eligibility to hold a driving licence. Clause (b) of the Regulations quoted states that an applicant shall ‘have had an epileptic attack whilst asleep more than three years before the date when the licence is granted and shall have had attacks only whilst asleep between the date of that attack and the date when the licence is granted’. There are some people, though not many, who only have fits during sleep; three years seems a reasonable period to allow one to see if that is the case. After that, even if attacks do occur in sleep and never whilst awake, a person can nevertheless drive.

*83/188/2*

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