Driving Restrictions in Photosensitive Epilepsy: Evidence, Assumptions, and Unanswered Questions

Driving restrictions for people with epilepsy are primarily based on the risk of seizure recurrence. Photosensitive epilepsy (PSE) could increase the risk of traffic accidents due to visually provoked seizures. However, the magnitude of this potential increase in risk remains unclear.

Following a PRISMA-based methodology, a structured PubMed search was performed and subsequently complemented by an AI-assisted semantic literature search using Elicit. To maximize retrieval of relevant evidence on visually provoked seizures (VPS) and seizure-related traffic accidents in drivers with epilepsy, reference screening and citation tracking were additionally undertaken to identify studies not adequately captured by database searches alone. Studies were selected according to predefined eligibility criteria, with only relevant full-text publications included in the final analysis.

The available literature on driving safety in PSE is extremely limited. The structured PubMed search yielded 31 records, of which only a limited number fulfilled the relevance criteria after screening. Most identified studies consisted of laboratory EEG investigations, mechanistic analyses, environmental simulation studies, retrospective reviews, or case reports. Several studies demonstrated VPS or photoparoxysmal responses (PPR) under laboratory conditions, whereas no study systematically demonstrated seizure induction during ordinary real-world driving. Despite retrieval of up to 1,000 semantically ranked publications per Elicit query, only one publication directly addressed VPS in a driving-related context. No confirmed traffic accidents directly attributable to VPS in PSE were identified.

Current evidence regarding driving risk in PSE is remarkably sparse and largely indirect. Although VPS are biologically plausible under experimental conditions, it remains unclear whether ordinary traffic environments provoke seizures or contribute meaningfully to traffic accidents in real-world settings. Both conventional and AI-assisted literature searches failed to identify sufficient empirical evidence supporting current driving restrictions specific to PSE. Prospective real-world studies and registries are urgently needed to clarify the actual driving risk associated with PSE, and to evaluate the potential role of traffic-approved optical filters in risk reduction and evidence-based driving regulations.