Elsevier

Epilepsy & Behavior

Volume 19, Issue 1, September 2010, Pages 52-54
Epilepsy & Behavior

Frequency of physician counseling and attitudes toward driving motor vehicles in people with epilepsy: Comparing a mandatory-reporting with a voluntary-reporting state

https://doi.org/10.1016/j.yebeh.2010.06.041Get rights and content

Abstract

Driving for the person with epilepsy (PWE) remains an important issue. Requirements for reporting PWE to driving authorities vary across the United States. We studied the prior experiences of PWE regarding counseling for driving in a reporting state (37% in New Jersey) and a nonreporting state (52% in Arizona). A prospective voluntary anonymous survey was conducted among patients with new-onset epilepsy at two epilepsy referral centers. Subjects were queried about prior interactions with health care professionals regarding attitudes toward and knowledge of driving regulations. Practitioners caring for PWE are in the position to provide advice and counsel regarding driving regulations. Fifty percent or fewer subjects were appropriately counseled, regardless of residence requirements. PWE felt they were honest with their physician and 10% of subjects have driven against medical advice. A performance gap exists in the appropriate counseling regarding driving for PWE that has potentially significant safety and legal implications.

Introduction

The ability to drive a motor vehicle continues to be a major concern for people with epilepsy (PWE). Stringent driving regulations, for example, taking away a patient's ability to drive, can be a major hardship. Many communities, especially outside major cities, have poor or no public transportation, which can adversely impact the quality of life and ability to work and retain employment of PWE [1]. For these reasons, physicians may be reluctant to report PWE who drive to motor vehicle departments and many PWE are driving despite continued seizures [2].

Individual state driving restrictions for people with epilepsy, seizures, and other conditions vary widely in the United States [3]. Six states require mandatory reporting of seizures by physicians (Table 1) [3]. In both mandatory-reporting and voluntary-reporting states, there can be societal and legal ramifications for both PWE and treating physicians if driving occurs without appropriate warnings about the risks [4], [5]. Physician confusion about these laws, some of which are poorly drafted [6], further complicates the issue of counseling about driving risks.

Little is known about the frequency of physician reporting as well as the attitudes of PWE regarding driving after they have been counseled about the related risks. We analyzed PWE presenting for the initial visit to tertiary epilepsy referral centers in a mandatory-reporting state (New Jersey) and a voluntary-reporting state (Arizona). We assessed these patients about their attitudes relating to their ability to drive, the extent of their prior counseling about the risks of driving, and their compliance with the counseling.

Section snippets

Methods

After institutional review board approval, a prospective anonymous questionnaire was filled out by consult patients with new-onset epilepsy from February 2008 to September 2009 at Mayo Clinic Arizona in Phoenix and at the New Jersey Neuroscience Institute–JFK Medical Center in Edison. Only patients being treated for epilepsy and having a valid driver's license or previously having had a valid license were included. Questions eliciting the experience of PWE included whether they were counseled

Results

Approximately 50% or fewer of these referral patients had discussions with previous providers about driving restrictions due to seizures (52% Arizona vs 35% New Jersey: NS, P = 0.13). Thirteen percent of PWE in Arizona versus 8% in New Jersey (NS, P = 0.5) continued to drive even after being told not to drive. A small number of PWE report having had a crash because of a seizure (11% Arizona vs 5% New Jersey: NS, P = 0.24]). Approximately two-thirds of PWE feel they can safely drive, and less than

Discussion

This study demonstrates that only one-third to one-half of PWE are counseled about the risks of driving. Given the reported low counseling rates of patients, a potential concern would be that physicians may not be reporting PWE who drive to motor vehicle departments, even in mandatory reporting states. The study also notes that a majority of PWE who drive feel that they can safely do so. A significant minority of PWE are driving despite being told not to and despite the perception that

Conclusions

The majority of PWE feel they are honest with their physicians regarding seizure recurrence and its influence on driving in both reporting and nonreporting states. About 10% of PWE continue to drive against medical advice whether in a mandatory-reporting or voluntary-reporting state. A large number (approximately 50% or more) of PWE report not having been adequately counseled on driving restrictions and epilepsy. Paradoxically, there was a lower frequency of counseling in the

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