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To the Editor:
We read with interest the article by Krauss et al.1 that demonstrated a minimum seizure-free period of 1 year to be the interval that is the strongest predictor of an epileptic person not having a driving accident. One should be cautious about using their data to infer that all state driving laws should include the seizure-free period of 1 year. Krauss’ population of epileptic persons who had seizure-related accidents had frequent seizures—an average of 2.6 per month (range, 0 to 60). Do the authors have data regarding the frequency of accidents in persons with less frequent seizures (e.g., 1 to 2 seizures per year)? Risk data are most important for this type of patient who may receive unfair treatment regarding driving restriction under current laws.
The requisite seizure-free interval is not the only area of contention in these laws that should be of concern for neurologists. Many laws are biased, ambiguous, and outdated. Most focus on epilepsy and unconsciousness, although several conditions, with driving risks due to inattentiveness and drowsiness, have been associated with impaired driving and increased accident rate.2-3 Yet these disorders have no driving restrictions associated with them under most state laws. Additionally, some laws are far more expansive than one might believe. For example, the applicable New Jersey state law (N.J.S.A. 39:3-10.4-10.8), with a mandated physician reporting requirement, requires restriction from driving for persons not only subject to “recurrent convulsive seizures,” but also for “impairment or loss of motor coordination due to conditions such as, but not limited to, epilepsy…when such conditions persist or recur despite medical treatments” (italics ours). Does this imply that physicians must report persons to the Department of Motor Vehicles (DMV) who drive with vertigo, MS, Parkinsonism, and cerebral palsy? Other laws are poorly drafted …
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