Of 400 drivers with epilepsy questioned, 133 admitted having one or more seizures at the wheel, and 17% had resulting accidents. The authors from the Institut de Reserches Neurologiques, Marseille, France, and Dept Neurology, SUNY Health Sciences Center at Brooklyn, NY, attempting to relate the risk of accidents to the type of seizure, were able to characterize 109 attacks in 82 subjects of which 55% led to an accident. Young drivers accounted for one half those with seizures at the wheel and a complex partial seizure usually without aura was the most common pattern, being responsible for 88% of the accidents. Those with auras were significantly less likely to lead to accidents. Many of the patients were driving illegally, 46% having seizures at least monthly and 74%, at least yearly. Males, 19 to 30 years, in higher socio-economic classes, formed the majority continuing to drive without adequate seizure control. Based on the recommendations of the Ad Hoc Committee of Epilepsy International, the authors proposed that: (1) a driving license may be granted only to an epileptic who has been seizure-free for at least 1 year; (2) temporary permits may be granted in exceptional circumstances to certain individuals on the advice of a certified neurologist having special interest and competence in epilepsy. [1]

COMMENT: In the State of Illinois, patients with epilepsy may obtain a license to drive at the discretion and on the advice of the neurologist in charge of treatment. Temporary permits are not issued. Although questioned concerning the duration of care, the occurrence of attacks in the past 6 months, of a type without warning and with loss of consciousness, and the patient’s compliance in taking medication, a neurologist’s certificate to the effect that the patient is medically fit to operate a motor vehicle is usually sufficient, irrespective of the frequency or pattern of seizures. A more restrictive policy toward epileptics and driving, including a one year period of control, was counterproductive, forcing patients to deny the recurrence of seizures and thereby preventing the prescription of optimal therapy. The present study appears to support the discretionary policy based on individualized applications for driving licenses of epileptics, but the monitoring of young male drivers with complex partial seizures should be close and frequent and should include serum drug levels and when appropriate, repeated EEG’s to check drug compliance and seizure susceptibility.