Neurology -- Correspondence for Krauss et al., 57 (10) 1780-1785

Correspondence published:

Reply to Letter to the Editor: Gregory L Krauss (16 March 2002)

Individual state driving restrictions for people with epilepsy in the US: John C DeToledo, Merredith R Lowe (16 March 2002)

Reply to Letter to the Editor 16 March 2002

Gregory L Krauss
John Hopkins University Baltimore MD
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Re: Reply to Letter to the Editor

gkrauss{at}jhmi.edu Gregory L Krauss

In our recent study of epilepsy and driving risk factors, only 36% of patients said they had reported their seizures to their MVA prior to crashing; an additional 30% claimed to report their seizures following their traffic accident (Krauss, 1999). Dr. DeToledo’s experience suggests that patient’s actual reporting of seizures to MVAs may be worse than stated by patients in our survey. One major reason for poor reporting of seizures is that many patients drive despite not meeting their state’s seizure-free requirement (54% of our patients who crashed). This is a concern, since 25% of our patients had more than one seizure-related crash and these are potentially preventable. We agree that accident reporting and MVA registration should be linked. Unfortunately, police generally report seizure-related crashes to their MVAs only when the crash caused personal injuries or major property damage (and vehicles are not included). Patients with frequent seizures are at high risk for crashing and should not drive. The overall public safety risk associated with seizure-linked crashes, however, is not high and we feel that optimizing treatment is the key to reducing the numbers of seizure-related crashes. [1, 2]
We report a revision in Georgia’s state driving restrictions for patients with epilepsy. Georgia reduced their seizure-free requirement for noncommercial drivers from 12 to 6 months in 2000 and also requires that intra-state commercial drivers be seizure-free for 3 years.
References:
1) Krauss GL, Krumholz A, Carter RC, Li G, Kaplan P. Risk factors for seizure-related motor vehicle crashes in patients with epilepsy. Neurology 1999;52:1324.
2) Sheth SG, Krauss GL, Krumholz AJ, Li G. Motor vehicle driver fatalities associated with seizures. Epilepsia, 2001; 42, Suppl A7, 215- 2166.

Individual state driving restrictions for people with epilepsy in the US 16 March 2002

John C DeToledo
University of Miami School of Medicine Miami FL,
Merredith R Lowe
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Re: Individual state driving restrictions for people with epilepsy in the US

jdetoled{at}mednet.med.miami.edu John C DeToledo, et al.

We read with interest the editorial by Chadwick [1] and article by Krauss et al. [2] A number of patients have kept valid drivers licenses after involvement in seizure-related motor vehicle accidents (MVA), and we question whether police responding to these accidents are aware that the MVA was caused by seizures.
We prospectively have questioned patients at the University of Miami and Epilepsy Foundation about seizure-related MVAs. In following these patients over an 8-month period, 13 admitted to being involved in 14 seizure-related MVAs (only one patient was involved in two seizure-related MVAs) out of a population of 1523 patients. Three of the 13 patients had been seizure-free for 6 or more months, 10 patients had incompletely controlled seizures. All 13 patients held a valid Florida’s drivers license at the time of the accident.
The seizure causing the accident was not witnessed by the policy in any of the 14 accidents. Patient’s confusion (post-ictal) was usually ascribed to the accident or suspected drug-use so it did not help cue officers to the occurrence of the seizure. Eleven patients concealed the fact that they just had a seizure from the policy and computerized DMV files had no record about their epilepsy. These findings indicate that these patients had never disclosed their seizures to the DMV, and apparently had no intention of disclosing them despite the accident.
In two out of the 14 instances the seizure was disclosed to the officer. In one case it never made it to the police report and the other patient was fined for reckless driving but did not lose their license. These two cases cause the concern that authorities themselves do not have a clear understanding of the consequences of poorly controlled seizures. Eight of these patients are still driving.
In Florida, information about a patient’s seizures is held in confidence by the patient-doctor relationship. Information is provided to the DMV through the yearly check-up form that is required for patients that have previously reported their seizures to the DMV. [3] However, many of our patients never report their seizures to the DMV thereby avoiding the need of yearly medical clearance. While many patients were honest in reporting seizures to their doctors, they clearly did not do so with the DMV. Voluntary disclosure will not work if patients act irresponsibility in regards to their seizures. We agree with Dr. Chadwick that record linkage between various regulatory agencies and relevant medical information would go a long way in preventing these types of infraction. [1] We also agree with Krauss et al. [2] that to be effective, in a state like Florida, voluntary disclosure must be backed by legislation giving physicians “good faith” immunity for voluntarily reporting patients that pose a threat to public safety.
References:
1)Chadwick DW. Driving restrictions and people with epilepsy. Neurology 2001;57:1749.7150.
2)Krauss GL, Ampaw L, Krumholz A. Individual state driving restrictions for people with epilepsy in the US. Neurology 2001;57:1780- 1785.
3)Florida Statutes Title XXIII, Chapter 322;125: Medical Advisory Board (3b).