Evidence-based review on epilepsy and driving.

Area of Science:

• Neurology
• Public Health
• Road Safety

Background:

• Driving cessation is a significant concern for people with epilepsy (PWE).
• Understanding predictors of driving status and crash risk is crucial for clinical and policy decisions.
• Existing literature on driving in PWE is heterogeneous and requires synthesis.

Purpose of the Study:

• To systematically review and synthesize the evidence on factors predicting motor vehicle crashes (MVCs) and driving status in PWE.
• To provide evidence-based recommendations for clinicians and policymakers regarding PWE and driving.

Main Methods:

• An evidence-based review of the English literature published between 1994 and 2010.
• Data extraction from 77 primary studies, with 16 included in the final analysis.
• Studies were classified by the American Academy of Neurology criteria (Class I-IV) to guide recommendations (Level A-U).

Main Results:

• Epilepsy and seizure-free intervals under 3 months are not predictive of crash risk (Level B/C).
• Epilepsy surgery, longer seizure-free intervals (6-12 months), and fewer prior non-seizure crashes are protective (Level B).
• Employment and epilepsy surgery predict driving status (Level C), while other factors lack sufficient evidence.

Conclusions:

• Current evidence on predictors of driving and crashes in PWE is limited by study heterogeneity.
• This review provides the first evidence-based synopsis and recommendations for PWE and driving.
• Further high-quality research (Class I) is needed to establish definitive recommendations.