Should patients with psychogenic nonepileptic seizures be allowed to drive? Recommendations of German experts

In the absence of evidence-based regulations on the driving ability of patients with psychogenic nonepileptic seizures (PNES), we asked 41 German epileptologists via e-mail for their recommendations on driving with PNES. This survey was modeled on an earlier study by Benbadis et al. in the United States and was compared with it. Thirty-four (82.9%) epileptologists responded. Three responses were possible: (A) same restrictions as stipulated for patients with epilepsy, answered by 11 epileptologists (32.4%); (B) no restrictions at all, which no German expert gave as an answer (0%); (C) decision on an individual basis, answered by 23 experts (67.6%). The divergent approaches reflect the poor data on motor vehicle accidents of patients with PNES and the great variability of PNES with respect to semiology, psychiatric morbidity, and prognosis. In the study by Benbadis et al., 49% chose A, 32% B, and 19% C. The considerable national differences may be explained by differences between the two countries with respect to driving regulations and cultural aspects.