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Mortality in epilepsy

Driving fatalities vs other causes of death in patients with epilepsy

From the Departments of Neurology (S.G. Sheth and Dr. Krauss) and Emergency Medicine (Dr. Li), Johns Hopkins University School of Medicine; and Department of Neurology (Dr. Krumholz), University of Maryland, Baltimore.

Address correspondence and reprint requests to Dr. Gregory Krauss, Neurology Department, Johns Hopkins School of Medicine, 600 N. Wolfe Street, Meyer 2–147, Baltimore, MD 21287.

Objectives: To estimate the risk to public safety posed by drivers with epilepsy, the authors compared annual totals and disease-specific risk for fatal crashes associated with seizures and other medical conditions. They compared individual risks for fatal crashes due to seizures and other causes of mortality in patients with epilepsy.

Methods: The authors analyzed Multiple-Cause of Mortality data files from death certificates provided by the National Center for Health Statistics (NCHS) for the years 1995–97. They analyzed International Classification of Diseases–9 codes for underlying causes of death and other major conditions and determined disease-specific rates of fatal crashes associated with seizures and other medical conditions.

Results: An average of 44,027 US drivers died annually as a result of motor vehicle crashes during 1995–97; however, only 86 (0.2%, range 82 to 97) of these deaths were associated with seizures in mortality reports. The incidence rate of fatal crashes for patients with seizures was 2.3 times the rate for patients with cardiovascular and hypertensive diseases and 4.6 times the rate for patients with diabetes. The proportionate mortality ratio for motor vehicle crashes in patients with seizures was low (0.2); most patients with epilepsy died of common cardiovascular and systemic disorders.

Conclusion: Fatal driver crashes due to seizures are uncommon. This finding supports the current public policy of permitting patients whose seizures are controlled to drive.

Received November 26, 2003. Accepted in final form June 2, 2004.

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