Seizure disorders, diabetes mellitus, and cerebrovascular disease. Considerations for older drivers

For those conditions in which loss of consciousness is the main issue, such as epilepsy, factors that contribute to risk of seizure recurrence are central to the determination of driver safety. Thus, high- and low-risk groups may be identified and factors that contribute to high risk checked. These factors also serve to develop a program to reduce such risk in the future. In the population with seizure disorders, young males under age 25 have the highest risk for traffic accidents and violations. Other factors associated with high risk are partial complex seizure type, history of drug toxicity with anticonvulsant medications, alcohol abuse or poor compliance for medications, and history of psychiatric illness. For conditions such as cerebrovascular accidents or Parkinson's disease, the recognition of the diagnosis alone is insufficient to determine driver competence. In these illnesses, the task is to recognize levels of failure of individual skills and function that specifically render a person incompetent for safe driving. Such a precise determination is currently not possible in individuals with cerebrovascular accidents or other forms of brain injury (e.g., trauma) or degenerative brain disease (e.g., Parkinson's disease). There is intuitive and general agreement that there are those so severely affected that driving has become impossible or very dangerous. Alternately, there are also those with these conditions whose driving skills and competence are virtually unaffected and pose no risk to traffic safety. Physicians vary widely in their ability and experience in judging the competence and safety of those in between these two extremes. For this reason, a standardized approach is essential both to ensure the avoidance of unnecessary bias as well as to ensure the safety of the driver and the general public. At some time in the future when all the necessary driving skills are identified and appropriate tests are developed to judge them, a battery of tests for the elderly at age 65 and at regular intervals thereafter may be used. Until then, some form of clinical judgment and legal regulation may have to be adopted. One option would be to adopt a rule similar to that in the United Kingdom where all persons with TIAs or cerebrovascular accidents would automatically suspend driving for 3 months because of the high risk for recurrence of both cerebrovascular as well as ischemic heart disease in that interval.(ABSTRACT TRUNCATED AT 400 WORDS)