Epilepsy & Seizures
Epileptic lesions due to malformation of cortical development
Sep. 06, 2024
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Toll Free (U.S. + Canada): 800-452-2400
US Number: +1-619-640-4660
Support: service@medlink.com
Editor: editor@medlink.com
ISSN: 2831-9125
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People with epilepsy are at increased risk of impaired driving. In this article, the authors provide an overview of issues related to driving for people with epilepsy. Epilepsy affects driving capability due to the paroxysmal nature of the disorder and associated impaired cognition, which may result in loss of vehicle control. It is estimated that people with epilepsy are 1.13 to approximately 2.16 times more likely to be involved in a motor vehicle accident compared to people without epilepsy (12). One study observed that approximately 0.2% of all motor vehicle accidents are related to seizures, more than all other medical conditions, including cardiovascular diseases and diabetes (31). Adding the factors of young driving age (25 years and younger) and alcohol consumption increased the risk of fatal motor vehicle accident by eight times. Among people with medication-resistant epilepsy, restriction from driving is universally accepted as a means to protect the public and the people with epilepsy themselves from driving-related accidents despite the capability to drive being important for both personal and professional life (17). State and federal regulators weigh individual needs versus the potential safety issues and make judgments depending on local factors. The period of restriction varies widely, as there are no clear scientific data to indicate a standard duration. Physicians play an important role in the medical opinion, counseling, and decision-making regarding driving privileges for people with epilepsy.
• About 1 in 500 driving-related fatalities is related to seizures. | |
• Driving restriction periods in people with epilepsy are not uniform and vary widely across jurisdictions. | |
• Physicians should know their local driving laws. | |
• Physicians, patients, and regulating bodies together are responsible for the safety of people with epilepsy with regard to driving. |
The modern car was invented in the 1880s, but it wasn’t until the first report of a motor vehicle accident in 1906 that safety issues related to driving became a focus of public attention and concern (33). Subsequently, when licensing for driving became mandatory, people with epilepsy along with those suffering from other conditions affecting driving capability, were not permitted to drive. In the 1940s, the understanding of epilepsy progressed with the emergence of electroencephalography, and effective antiepileptic medications led to improved clinical outcomes in patients with epilepsy. Sir Charles Symonds of England in 1948 advocated for people with epilepsy and suggested driving permits be granted after a certain seizure-free interval. In 1949, Wisconsin became the first state in the United States to allow patients with epilepsy to drive; by the 1970s, all other the states legalized driving for people with epilepsy (21). The duration of driving restriction for people with epilepsy varies between the states and has changed over time; driving restriction duration currently ranges between 3 to 12 months, but some states do not impose a prespecified duration of driving restriction. For the current status of driving restrictions in each state, see the Epilepsy Foundation website. The laws in other countries outside of the United States are quite different (05).
Data about driving with epilepsy are not entirely clear, but the evidence suggests that having some limits makes sense. A 10-year registry indicates that the rate of emergency room care related to a motor vehicle accident is seven times higher in people with epilepsy (95% CI 2.18 to 26.13) (26). In California, accidents involving people with epilepsy were nearly twice as prevalent as expected (observed 16.0 per 100,000 miles vs. expected 8.2 per 100,000 miles, p< 0.001) (34). A population-based cohort study suggested the possibility of a higher risk for motor vehicle accident among people with epilepsy with a relative risk of 1.38 (95% CI 0.97 to 1.96) (24). Another study analyzed all residents of seven zip codes in and around Marshfield, Wisconsin; they found a standard mishap ratio of 1.31 for people with epilepsy (95% CI 1.00 to 1.73), possibly suggesting there may not be a higher risk (18). These studies taken together seem to suggest a higher chance for emergency room care due to a motor vehicle accident for people with epilepsy and that there seems to be higher risk of motor vehicle accident in general, although the imprecision of the underlying data somewhat limits this latter conclusion.
States use the criteria of seizure freedom length to determine whether a people with epilepsy should be able to drive. The underlying evidence for seizure freedom versus risk of driving for people with epilepsy also seems somewhat limited. The 2-year period after a first-ever seizure is associated with the highest risk of seizure recurrence (40% to 50%); however, this risk is reduced variably with treatment (06). One study noted a reduction in the odds of motor vehicle accident for seizure-free periods of 6 to 12 months as compared to 3 months (20). However, Drazkowski and colleagues observed no significant changes in seizure-related motor vehicle accidents after the state adopted a 3-month instead of a 12-month driving restriction period (09).
It is possible that the difference in the outcomes could be from variations in study design. The relative paucity of data may in part be related to how often it occurs. Also, the data of a seizure-related motor vehicle accident are reported only if there is personal or property damage (21; 20). This disparity may also be the result of not looking at the correct risk factor: one study showed that only 11% of motor vehicle accidents in people with epilepsy were actually related to seizures (34); another study showed only 0.2% of fatal motor vehicle accidents involved seizures (31).
Driving is a complex task that requires intact motor function, visual ability, memory, and alertness (32). Several medical conditions like hypoglycemia, cardiac arrhythmia, severe heart disease, alcoholism, and stroke can affect higher level functions and impair driving capabilities. Understanding the type of seizure and the extent of impairment regarding consciousness, alertness, and motor capability can assist the physician to manage the risks associated with driving. The availability of appropriate physician feedback also helps regulators to make the right decisions regarding driving restrictions. Typically, generalized tonic-clonic seizures are associated with severe alteration of awareness and are usually associated with a postictal phase, which clearly is incompatible with driving safely. The impairment of driving with other types of seizures is variable, and the physician response may depend on local regulations (16).
The likelihood of recurrence after a first-ever seizure ranges from 1.7% to 3.1% per month. If a community accepts an accident risk ratio (ARR) of 3.6, this results in 5 months of driving restriction for a provoked seizure and 8 months for an unprovoked seizure (07).
After a single unprovoked seizure, the predictors with the best evidence include nocturnal seizure, EEG with epileptiform abnormalities, and prior brain insult (22). In a study, seizure frequency was not, in general, associated with motor vehicle accidents; however, patients involved in motor vehicle accidents were noted to have frequent seizures (20). Patients were studied while using a driving simulator in an EMU. Secondarily generalized seizures and focal seizures with impaired consciousness led to impairment. Focal seizures without impaired consciousness did not lead to impairment, and only 1 of 19 with generalized nonmotor (generalized spike-wave) led to impairment (23).
A consensus statement by the American Academy of Neurology jointly with the American Epilepsy Society and the Epilepsy Foundation reported favorable and unfavorable modifiers for the duration of driving restriction (02). According to the consensus statement, there are some favorable factors: seizures from medication changes, sleep deprivation, acute toxic or metabolic states, reversible acute illness, simple partial seizures alone or prolonged with other seizure types, and pure nocturnal seizures. Note that there are some data suggesting simple partial seizures are not safer than other kinds of seizures (29). Unfavorable factors include medication noncompliance, alcohol or drug use in last 3 months, poor driving record, structural brain lesion, worsening seizures, or prior motor vehicle accident due to seizures in last 5 years (02). These factors can be helpful when deciding a proper duration of driving restriction in states where there is no specific duration established by law. Some states like Arizona are explicit about their exceptions to driving restrictions (see ARIZ. ADMIN. CODE R17-4-506(D)). Other states, such as Louisiana, leave it up to the physicians (see LA REV. STAT. ANN. § 32:403.2).
In the United States, physicians are typically not required to report people with epilepsy to the regulatory bodies; however, six states do mandate physician reporting (California, Delaware, Nevada, New Jersey, Oregon, and Pennsylvania (at least to the best of the author’s knowledge). Most consensus statements have opposed mandatory reporting by treating physicians of patients with epilepsy who are actively driving (04). Mandatory reporting creates the risk of undermining the physician-patient relationship, as a patient may lie to preserve the driver license (08). In China, in a survey of 291 people with epilepsy, half disagreed with physician reporting to traffic authorities (36). Moreover, in a retrospective survey comparing two Canadian provinces, one with mandatory reporting and another without, there were no significant differences between either lifetime accidents or accidents in the previous year (27).
After a patient is reported, the state’s regulatory body must decide if the right to drive should be limited or curtailed. Most states explicitly assert that physicians are not legally liable if they faithfully follow all applicable laws, but every state differs. In some states, a physician who reports a person with epilepsy for having poor driving capabilities may be at risk of a lawsuit for breaching the physician-patient relationship (01). All physicians should clearly detail in the patient's medical chart discussions regarding driving restrictions as documented proof for a potential medicolegal discussion in future (21). Some studies suggest this is not routinely done (30). A systematic review suggested up to 39% of patients with epilepsy choose to drive in violation of restrictions (35).
There is a risk of liability for the physician who inadequately complies with local regulations. Several instances have been reported in which either people with epilepsy were prosecuted for seizure-related motor vehicle accident or physicians treating them were liable to injured third parties during the seizure-related motor vehicle accident (10; 19; 15). There is also a case where courts did not feel that physicians have a duty to injured third parties (Praesel v. Johnson 1998).
Commercial driving. For people with epilepsy, the driving restrictions are significantly more stringent for commercial driving licenses. Federal guidelines stipulate a minimum of 10 years off antiseizure medication and seizure-free (see Advisory criteria to 49 CFR 391.43[f] and Appendix A section H for 49 CFR 391.41[b][8]). Of note, exemptions have rarely been granted. Twenty-two drivers successfully petitioned for exemption in 2013 (03). There were an additional eight who petitioned for exemption from the Federal Motor Carrier Safety Administration (FMCSA) rules in 2022 (Federal Motor Carrier Safety Administration 2022a). Later in 2022, citing the criteria found in Appendix A, section H of CFR 391.41 (b)(8), an additional 16 were granted exemption (Federal Motor Carrier Safety Administration 2022b). Most states follow federal guidelines; exceptions are mentioned in Table 1. Drivers should follow guidelines for each state in which they drive. This is particularly important for commercial drivers in states that do not follow the federal guidelines because they may find that they can drive in their state but may not drive in other states.
State |
Seizure-free period (passenger vehicles) |
Commercial driving |
Mandatory physician reporting |
Periodic medical updates required |
Exceptions |
Alabama |
6 months |
Federal DOT standards*; no waivers granted. Individuals with epilepsy not to be licensed to drive taxi or school bus. |
No |
At DMV discretion |
N/A |
Alaska |
6 months |
Federal DOT standards. |
No |
At DMV discretion |
N/A |
Arizona |
3 months |
Federal DOT standards. |
No |
At DMV discretion |
Individual may be license if physician reports: (1) seizure due to change in prescribed anticonvulsants medication and that seizures are under control after change; (2) was single event and will not reoccur; (3) seizure likely to occur but has established pattern, ie, only at night; (4) established pattern of aura of sufficient duration to allow person to cease operation of vehicle. |
Arkansas |
1 year |
Federal DOT standards. Individuals with epilepsy not qualified for school bus licensing. |
No |
At DMV discretion |
Office of driver services requires state license physician to evaluate person with epilepsy and then office to assess medical report to determine if person should be allowed to operate vehicle. |
California |
3 or 6 months |
Federal DOT standards. Medical certificate required approved by DOT, FAA issued within 2 years of date of operation of that vehicle. |
Yes |
At DMV discretion |
If individual has lapses of consciousness but symptoms are under control and individual is able to drive safely and maintain control, department may not take any action or place individual under probationary period (3 months, 3 to 5 months, 6 months). |
Colorado |
No set seizure-free period |
Must receive medical waiver from Colorado state. Individual with epilepsy may be considered for taxi, bus, or school bus if physician certification is provided. |
No |
At DMV discretion |
N/A |
Connecticut |
No set seizure-free period |
Federal DOT standards. Individual with epilepsy not qualified for public service motor vehicle or service bus licensing. |
No |
At DMV discretion |
If a person experiences an episode in last 6 months, commissioner must request the opinion of medical advisory board. Case-dependent restriction from 3 to 6 months. |
Delaware |
No set seizure-free period |
Federal DOT standards. Individual with epilepsy not qualified for taxis, busses, or school bus licensing. |
Yes |
Annually |
Epileptic patient requires medical certificate from physician stating that condition is under sufficient control. Certificate must then be presented annually. |
District of Columbia |
1 year |
Federal DOT standards. Persons with epilepsy are not licensed for driving commercial vehicles; no waivers granted. No license consideration for taxi or other public vehicle for hire if at the time person has epilepsy. |
No |
Annually until seizure free for 5 years |
Patient with epilepsy must submit to DOT a physician’s certificate indicating knowledge of disease and seizure-free status of at least 12 months. |
Florida |
6 months |
Federal DOT standards. No waiver provision for epilepsy patients. Not eligible to be school bus driver or drive busses designed to seat 15 persons. |
No |
Discretion of MRB |
Person with epilepsy may be licensed to drive after physician recommendation and seizure-free period of 2 years. If under regular medical supervision, then at end of 1-year seizure-free period. |
Georgia |
6 months |
Federal DOT standards. No waivers granted. |
No |
Discretion of MRB |
Nocturnal seizure patients may be eligible for limited license conditioned on periodic medical reports. |
Hawaii |
6 months |
Federal DOT standards. Waivers not available. Epilepsy patients may be licensed to drive taxi. |
No |
At DMV discretion |
Restricted licenses available. ‡ |
Idaho |
No set seizure-free period |
Federal DOT standards. Epileptic patients may not drive busses or school buses but may drive taxi. |
No |
At DMV discretion |
Due to lack of medical board in Idaho, physician recommendations are taken into consideration for seizure-free period. |
Illinois |
No set seizure-free period. |
Federal DOT standards. Epilepsy patients are ineligible for waiver and cannot be licensed to drive vehicle or buses carrying 16 or more people, including school buses. |
No |
At MAB discretion |
If physician statement says epileptic patient can operate vehicle, license is granted. |
Indiana |
No set seizure-free period |
Federal DOT standards. Must pass physical examination by medical examiner. Epilepsy patients may be licensed to drive taxi, buses, or school buses if they meet same criteria as for personal vehicle. |
No |
At MAB discretion |
If individual with epilepsy presents letter form physician stating patient is on epilepsy medication and is seizure free then he or she may not be denied a license. Restricted licensing available. |
Iowa |
6 months |
Federal DOT standards. Epilepsy patients not eligible to drive school bus. |
No |
After first 6 months, then at renewal |
Physicians report and recommendation required. |
Kansas |
6 months |
Same rules as those driving personal vehicle. Must also meet federal regulations or obtain waiver. |
No |
Annually, until 3 years seizure free |
Exceptions to 6-month rule: (1) nocturnal seizures only; (2) seizure resulted from medication change; (3) very minor seizure or odd seizures that do not alter mentation; (4) seizure result of acute illness or injury. |
Kentucky |
3 months or greater |
Federal DOT standards. Epileptic person may apply for waiver if seizure free for 1 year, taking anticonvulsants with blood content proof, and clean driving record for 2 years. These individuals are also eligible to drive taxi and buses. School bus drivers must undergo annual medical examination. |
No |
On renewal |
Epileptic patients applying for license or renewal of license must present physician letter stating condition is controlled by medication and description of the medication with dosages. |
Louisiana |
No set seizure-free period |
Must submit medical report stating no mental or physical disability. No waiver for epilepsy, but epileptic patient may obtain chauffer license to transport fewer than 16 people. |
No |
At DMV discretion |
May be provisioned to drive with medical report from physician stating disease is under control. |
Maine |
3 months to 2 years |
Federal DOT standards. School bus endorsement necessary for school bus carrying 10 or more passengers. |
No |
At DMV discretion |
Person with long-standing seizure (longer than 5 years) is eligible for driver license after being seizure free for 3 months and on medication. Must be evaluated every 4 years. |
Maryland |
3 months |
Federal DOT standards with amendments and exceptions. Epileptic patients may not drive commercial motor vehicle interstate. Epileptic patients also disqualified from driving school buses. |
No |
At DMV discretion |
Restricted licensing available. |
Massachusetts |
6 months |
Federal DOT standards. No medical waiver for epileptic patients. Current epileptics† are ineligible to operate school bus. |
No |
At DMV discretion |
Physicians report must state seizure-free period and recommendation for driving. May be extended if required by registrar. |
Michigan |
6 months |
Michigan state will license epileptic patients with CDL, for trucks, taxi, and buses if they have been seizure free for 1 year. Denied school bus driving if epileptic. |
No |
At DMV discretion |
Epileptic patients must present certification of controlled symptoms and be seizure free for 6 months. Time restrictions may be reduced or eliminated on physicians’ report. Restricted licensing available. |
Minnesota |
3 months |
Same as personal vehicle for commercial drivers. Stringent for taxi drivers. School bus drivers must be epilepsy free for 5 years and off medication for 2 years. |
No |
Once every 6 months |
Exceptions can be made if: (1) seizures due to temporary illness; (2) seizure occurred under physician order to change medication; (3) was first seizure experienced by driver in 4 years. (Patient must submit physician report every 6 months for 4 years then once every 4 years.) |
Mississippi |
6 months |
Individuals who are seizure free for 6 months may be issued a commercial driver’s license for driving within Mississippi. Those who meet seizure-free criteria may also drive passenger transport vehicles. |
No |
At MAB discretion |
N/A |
Missouri |
6 months |
Federal DOT standard |
No |
At DMV discretion |
Conditional license can be issued for a year at the end of which the bureau verifies that individual has been seizure free for the year. |
Montana |
No set seizure-free period |
For commercial trucks, patient must be seizure free for 5 years and provide physician certificate. Must also follow federal DOT laws. |
No |
At DMV discretion |
If physician verifies that patient condition will not affect his or her driving, he or she can be granted a license. |
Nebraska |
No set seizure-free period |
Federal DOT standards. Same DOT rules for school bus driver. May be granted waiver for commercial licenses. |
No |
No |
None |
Nevada |
3 months |
Federal DOT standards for truck drivers. CDL may be given if physician certifies seizure free for 1 year preceding application. May be licensed for passenger vehicle, taxi, buses, or school bus if they obtain federally approved waiver or have been seizure free for 3 years. |
Yes |
Annually for 3 years |
Epileptic patient may be granted license if not seizure free for 3 years if physician certifies symptoms are under control or incident was isolated. Restricted license available (requires annual medical report). |
New Hampshire |
1 year |
Federal DOT standard for all commercial driving licenses. |
No |
No |
May be licensed earlier if physician certifies that patient condition is stable enough to not cause harm to others. Restricted licenses are available. |
New Jersey |
6 months |
Federal DOT standard for all commercial licensing. |
Yes |
Every 6 months for 2 years then annually |
None |
New Mexico |
6 months |
Federal DOT standard for interstate drivers. No waivers for patients with epilepsy. Patients with single unprovoked seizure may be licensed if seizure free and off medication for 5 years. |
No |
At MAB discretion |
Restricted license available. |
New York |
1 year |
Federal DOT standard for commercial drivers. Those who obtained CDL before September 1999 are able to retain license without medical examiner certificate. Patients with epilepsy are disqualified from driving buses. |
No |
At DMV discretion |
May be licensed if: (1) loss of consciousness was due to medication change, (2) physician certificate states patient is safe to drive despite symptoms that are under control, and (3) department’s medical consultant has no objection to such issuance. No restricted license. |
North Carolina |
6 months |
Federal DOT standard for commercial interstate vehicles. Waivers are granted. Person with epilepsy may be licensed to drive passenger carrying vehicle such as taxi but restricted from driving buses or school buses. |
No |
Annually (less at DMV discretion) |
May be less on physician recommendation. Restricted licensing is available. |
North Dakota |
6 months |
Federal DOT standard for commercial interstate truck driver. If licensed before march 1991, may continue despite having epilepsy. Bus and school bus also follow federal DOT standard. |
No |
Annually for 3 years |
Patients who have had single episode may be licensed without restriction. Restricted license available after 3 months. |
Ohio |
No set seizure-free period |
State has NOT adopted federal DOT standard. To drive transit bus or taxi, person with epilepsy must meet same requirement as personal vehicle license. Cannot be licensed to operate school bus. |
No |
At DMV discretion |
If patient has epilepsy, physician must certify that he or she is under treatment, and symptoms are under control; restricted 6-month license can be granted. At 6 months if patient remains symptom free, he or she may be granted extension of restricted license or unrestricted license. |
Oklahoma |
6 months |
Must be seizure free for 5 years and have normal examination and normal EEG. However, patient may be licensed earlier for interstate commerce if patient shows proof of no symptoms for 2 years and is off all medication for 2 years. |
No |
At DPS discretion |
May be exempt if (1) due to medication change, (2) isolated occurrence, (3) nocturnal seizure. In these cases, patient must be seizure free for 3 months and submit proof of episode control. |
Oregon |
3 months |
Federal DOT standards. Waiver can be obtained if seizure free for 2 years while on medication with medical evaluation including history, current prescription, recent EEG, anticonvulsant blood level. These requirements apply to driver of busses and taxis. School bus driver have additional requirement set by education department. |
Yes |
At DMV discretion |
Restricted licenses are available. |
Pennsylvania |
6 months |
Federal DOT standard for commercial vehicles interstate. |
Yes |
At MAB discretion |
May be exempt if: (1) nocturnal seizure, seizures occurring on wakening, with or without medication, established for at least 2 years; (2) aura with or without meds, established over period of 2 years; (3) was seizure free for 6 months but subsequent seizure occurred due to prescription change; (4) was seizure free for 6 months subsequent and seizure occurred due to some illness, toxic ingestion, metabolic imbalance, or trauma. |
Rhode Island |
18 months |
To qualify for commercial license, applicant must have no medical history or clinical diagnosis of epilepsy or any other condition likely to cause loss of consciousness. |
No |
At DMV discretion |
May be less if physician certifies patient is stable enough to drive safely. |
South Carolina |
6 months |
Federal DOT standard. Epileptic patients not approved for passenger vehicles carrying more than 16 people. Passenger vehicle rules apply for taxi and bus driver licensing. |
No |
At 6 months then annually or 3 years |
Restricted licenses available. |
South Dakota |
6 to 12 months |
Federal DOT standard for commercial vehicle. Federal DOT for school bus as well. |
No |
Every 6 months until 1 year seizure free |
May be less with doctor recommendation. Restricted licenses available. |
Tennessee |
6 to 12 months |
Federal DOT standard for CDL. Epilepsy patients are eligible for CDL if he or she is seizure free for 1 year with physician recommendation or 6 months with physician recommendation and MRB approval. Waiver granted if off medication and seizure free for 10 years. |
No |
At MAB discretion |
If symptoms controlled for 6 months with doctor recommendation, may be approved for license. |
Texas |
3 months |
Must be seizure free and off medication for 5 years. Federal DOT standards do apply. No waiver granted. |
No |
At MAB discretion |
Restricted licensing on following conditions: (1) epilepsy under physician observation; (2) no evidence of clinical seizure in 3-month driving restriction period; (3) physician vouches for patient taking medication, avoiding sleep deprivation and fatigue, and avoiding alcohol abuse; (4) if seizure was due to drug change. |
Utah |
3 months |
Federal DOT standards for commercial driving. But may be issued to epileptic patients depending on disease severity. No specific mention of taxi or buses. |
No |
At MAB discretion |
Restricted licenses are available. Circumstances in which license may be issued: (1) single seizure or cluster of seizures; (2) seizure only in sleep over period of 3 or more years; (3) low intensity seizure not affecting control, if stable for 1 year; (4) seizure occurred due to medication change; (5) seizure caused by identifiable cause. |
Vermont |
No set seizure-free period |
Federal DOT standards for interstate truck rivers. No waivers are available. Epileptic patients may be licensed to drive taxi or other vehicle that carries less than seven passengers if he or she meets requirements for personal license. |
No |
At MAB discretion |
Restricted licenses available. May be licensed if medical report by physician is submitted and the commissioner grants permission on physician recommendation. |
Virginia |
6 months |
Federal DOT standards for commercial driving. No waivers. |
No |
At MAB discretion |
Restricted licenses available. Department may (1) suspend driving privileges, (2) require driver to submit periodic medical and vision reports every 3, 6, 12, or 24 months. |
Washington |
6 months |
Federal DOT standards for interstate commercial drivers. Patients with epilepsy may petition waivers that are granted based on seizure-free period of 6 months and under adequate medication and supervision. Annual medical reports required. |
No |
At MAB discretion |
6 months may be waived on physician recommendation and medical report. |
West Virginia |
6 months |
Federal DOT standards for truck or passenger-carrying vehicles. Waivers granted if seizure free for 3 years. |
No |
At MAB discretion |
None |
Wisconsin |
3 months |
Federal DOT standards for CDL. For CDL, person must show that he has only had a single nonrecurring episode of loss of consciousness or body control for at least 2 years preceding application and that the cause of the episode was identified and requires no treatment or that the seizure disorder was diagnosed and the person has been episode free for the past 5 years preceding application for licensing. Same requirements apply for school buses and other passenger-carrying vehicles. |
No |
At MAB discretion |
Restricted licenses available. |
Wyoming |
3 months |
Federal DOT standards for CDL with exceptions. Medical proof from physician stating control of symptoms may allow grant of license to truck drivers WITHIN the state. Same requirement for passenger vehicles. Waivers are available for medically qualified drivers to drive commercial vehicles interstate only if DOT-certified physician determines it is safe. |
No |
At MAB discretion |
License cancellation may be reconsidered if DMV is notified by physician that there has been either no loss of consciousness or motor function for at least 1 year or the disorder no longer exist or symptoms have been medically controlled for a period of 3 months. |
Abbreviations: MRB, medical review board; DOT, department of transportation; FAA, federal aviation administration; CDL, commercial driving license; DPS, department of public safety; MAB, medical advisory board * United States Department of Transportation allows people with a history of epilepsy who have been seizure-free off and medication for 10 years to obtain a commercial driver’s license. People with epilepsy cannot obtain a commercial driver’s license if they have ongoing seizures or are seizure-free but taking seizure medication. There may be other restrictions, depending on a person’s risk; laws may vary state to state. Check your state department of motor vehicles for up-to-date laws and how to apply for a commercial driver’s license. † Patients with past history of epilepsy may be licensed to drive school bus. ‡ Restricted licenses are those that may have limitations on speed, highway restriction and time of day restrictions. |
State |
2001 |
2017 |
Connecticut |
3 |
No set period |
Florida |
24 |
6 |
Georgia |
12 |
6 |
Hawaii |
None |
6 |
Louisiana |
6 |
No set period |
Minnesota |
6 |
3 |
Mississippi |
12 |
6 |
Nebraska |
3 |
No set period |
New Jersey |
12 |
6 |
Oklahoma |
12 |
6 |
Oregon |
6 |
3 |
Rhode Island |
None |
18 |
Texas |
6 |
3 |
West Virginia |
12 |
6 |
|
The basic problem with data related to the issues concerning driving and epilepsy is the risk of bias. The studies conducted were not prospective, cohort studies with a broad spectrum of patients, so the risks for various kinds of epilepsies, risk of different seizure-freedom lengths, and risk with mandatory reporting of epilepsy patients cannot be addressed. If studies with lower risk of bias were performed, a model policy that states could choose or not choose to adopt would be possible.
For states without a set period of seizure freedom before allowing driving, two Asian studies may be informative. One study describes subgroups of patients in Japan who had an increased risk of fatal crashes, but the data are somewhat limited because 95% confidence intervals were not provided (28). Nevertheless, the study reports a relative risk for fatal crashes compared to all drivers of 1.35 for those who were seizure-free for 6 months and of 1.22 for those who were seizure-free for one year. For comparison, the relative risks for subgroups of the general population were as follows: 1.31 for those over the age of 60, 1.52 for those over the age of 65, 1.71 for males in their twenties, and 2.69 for those over the age of 75. A study in China created a normogram for a motor vehicle accidents based on various risk factors (25).
All contributors' financial relationships have been reviewed and mitigated to ensure that this and every other article is free from commercial bias.
David Gloss MD
Dr. Gloss of The NeuroMedical Center in Baton Rouge has no relevant financial relationships to disclose.
See ProfileJohn M Stern MD
Dr. Stern, Director of the Epilepsy Clinical Program at the University of California in Los Angeles, received honorariums from Ceribell, Jazz, LivaNova, Neurelis, SK Life Sciences, Sunovian, and UCB Pharma as advisor and/or lecturer.
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