Epilepsy

Epilepsy is the most common cause of collapse at the wheel, accounting for approx 30% of such incidents. In the United Kingdom, epilepsy is a prescribed disability (along with severe mental impairment, sudden attacks of disabling giddiness, and inability to meet eyesight requirements), and car driving is not allowed for at least 1 yr after a seizure. Restrictions vary from country to country. All 50 of the United States restrict the licenses of individuals with epilepsy if their seizures are not well controlled by medication. Most states require a 6-months seizure-free period and a physician's statement confirming that the individual's seizures have, in fact, been controlled and that the individual in question poses no risk to public safety. The letter from the physician is then reviewed by a medical advisory board, which may or may not issue a license. In the United States, even if the patient, at some later date, does have a seizure and cause an accident, the physician's act of writing to the board protects him or her from liability under American law, provided the letter was written in good faith.

Withdrawal of antiepileptic medication is associated with a risk of seizure recurrence. One study showed that 41% of patients who stopped treatment slowly developed a recurrence of seizures within 2 years, compared with only 22% of patients who continued treatment (9). The legal consequences of discontinuing medication without a physician's order can be devastating. Patients who stop taking antiseizure medication and then cause an accident may face future civil liability and possibly even criminal charges if they cause physical injury (10). Of course, rules vary from country to country but, in general, a patient with seizures who does not inform the appropriate regulatory agency may face dire consequences (including the legitimate refusal of the insurance carrier to pay for damages).

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