Epilepsy and driving: considerations on how eligibility should be decided

Although few neurologists are formally trained in traffic medicine, they are frequently asked to assess whether a patient is medically fit to drive. For patients with epilepsy, the physician must assess the risk of the patient having a seizure while driving, and decide what is an acceptable risk. The legislation on this subject is aiming at finding a reasonable balance between two important considerations: public safety and a patient's individual need to drive. For the neurologist to explain and put into practice the legislation may be a demanding task and a challenge to the doctor-patient alliance. The decision on driving capability should be tailored to the individual patient and based on careful evaluation and informed judgement. In Norway, to qualify for a driver's license, a seizure-free interval of at least 12 months is currently required for group 1 drivers (passenger cars), whereas group 2 drivers (heavy motor vehicles, commercial driving) must have been seizure-free for at least 10 years and not have experienced epileptic seizures from the age of 18 years. Norwegian physicians are obliged to report patients with seizures to driving authorities, although this is an unpopular rule. In reviewing the available literature, it is apparent that despite there being relatively few sound studies, the risks of car accidents among persons with epilepsy may previously have been overestimated.