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Introduction

Neuroscientific Context

Background Research: Legislation and implications of driving

Legal Framework of driving with epilepsy

Overview:

Whilst it is agreed that Epilepsy may increase the incidence or likelihood of accidents, there are yet to be complete accepted guidelines across State or National legislature. According to statistics in Austroads’ Assessing Fitness to Drive 2012, over 1,300 Australians are killed and 32,000 are seriously injured each year in road accidents with economic costs exceeding $18 billion. Similarly “individuals with epilepsy are twice as likely to be involved in a motor vehicle crash compared with the general driving population.”[i]
As seen in the article in Texas Law a man must be seizure free for a period of 6 months before he may drive, however according to NSW Government Roads and Maritime Services a period of one year free of seizures is required. Some exceptions may be relevant to whether it was an individuals’ first seizure, whether the type of seizures experiences were childhood or febrile, sleep only seizures or are medicated. The type of seizures considered most dangerous to driving are the generalised tonic clonic/grand mal or absense. Allowances may also be made when advised by an epilepsy specialist.[ii]

Implications of not being able to drive/psychosocial impacts (Independence, employment and mental health concerns):

In “A report for the Parliamentary Friends of Epilepsy” published by the Joint Epilepsy Council of Australia 2009 the social and psychological implications of epilepsy on the sufferers themselves is discussed. According to the report in Epilepsy sufferers “psychosocial, educational and economic impacts outweigh the clinical symptoms”[iii] and in particular “driving restrictions are socially and economically disabling, especially in rural areas.”[iv] Similarly the report recognises that “if a person feels well and does not fully understand the risks, the pressure to defy driving regulations is considerable.”[v] It also calls into question the efficacy of a system in which “fear of extended restrictions may discourage disclosure of seizures to their doctor.”[vi]
In a cross sectional study of seizure reporting to general practitioners[vii] of 60 subjects 18 patients failed to report a seizure in the past year to their general practitioner. The unemployment rate amongst individuals was 34% as opposed to 9% in the general population and measures of anxiety and depression were statistically higher in patients with uncontrolled epilepsy.

Research and Criticism of Current Legislative and Social Standards for Epilepsy

In a US study of motor-vehicle crashes between 1995-97, an annual average of 86 of 44,027 drivers deaths (0.2%) were found to be seizure related. This is a low figure compared to the 0.5% of the population that is diagnosed with epilepsy, however the percentile who are not entitled to drive must also be taken into account.[viii]
In another cross sectional study conducted in 2007, of 425 individuals with epilepsy and 375 control, 73% and 94% had licenses respectively. The lifetime accident rate was 58% in epilepsy sufferers and 60% in the control group with 9% of both groups having had an accident the previous year. Both groups were of comparable sex, age and demographic.[ix]

Conclusion

As seen in the sources outlined above there is contention on the correlation between epilepsy and road accidents. Whilst in certain opinions legislation is “largely based on expert opinion, practical experience, and political necessity rather than on strong scientific evidence”[x].
Driving is a key aspect of daily life regardless of the country we reside in. Any person eligible to hold a license knows of the independence and freedom it brings not only to daily activities but to broader social, lifestyle and economic factors. Given the lack of independence of people suffering epilepsy, particularly generalised, quality of life is sometimes reduced to a sedentary and supervised existence. It is not surprising that epilepsy sufferers are not willing to give up their licenses automatically and must be supported effectively in this transition. It is vital to both the field of neuroscience and the sufferers of neurological disorders that scientific research and evidence validates legislation. Similarly a holistic government and community approach must support the individuals whom the laws affect directly. This may then seek to improve lives and discourage decisions like that of Klaerner that may endanger others in the future.



[i] Assessing Fitness to Drive, “Seizures and epilepsy” Fourth Edition, Austroads Ltd, Sydney 2012, p75 http://www.austroads.com.au/assessing-fitness-to-drive/,
[ii] Drivers with epilepsy, "Driving and your health", Roads and Maritime Services Last Updated: 28 June 2012, http://www.rta.nsw.gov.au/licensing/healthmedicals/drivingandhealth.html
[iii] Panelli R, Chapman D, Shears G, "A report for the Parliamentary Friends of Epilepsy", Joint Epilepsy Council of Australia, Australian Chapter of the International Bureau for Epilepsy, 2 October 2009, p4
[iv]ibid P9
[v]ibid P29
[vi]ibid p29
[vii] Dalrymple J, Appleby J., Cross sectional study of reporting of epileptic seizures to general practitioners. Bio-Medical Journal. 2000 Jan 8;320(7227):94-7.
[viii] Sheth SG, Krauss G, Krumholz A, Li G., Mortality in epilepsy: driving fatalities vs other causes of death in patients with epilepsy., Neurology. 2004 Sep 28;63(6):1002-7.
[ix] McLachlan RS, Starreveld E, Lee MA., Impact of mandatory physician reporting on accident risk in epilepsy, Epilepsia. 2007 Aug;48(8):1500-5.
[x] Krumholz A, Issues in Epilepsy: Past, Present, and Future, Epilepsy Current, 2009 March; 9(2): 31–35.

Analysis of media item

Criticism of media item

Appendix