6.2.2 General assessment and management guideline
Epilepsy refers to the tendency to experience recurrent seizures. Not all people who experience a seizure have epilepsy.
Epilepsy is a common disorder with a cumulative incidence of 2 per cent of the population, with 0.5 per cent affected and taking medication at any one time. The majority of cases respond well to treatment, with a terminal remission rate of 80 per cent or more. The majority suffer few seizures in a lifetime, and about half will have no further seizures in the first one or two years after starting treatment. Some people with epilepsy may eventually cease medication. For others, surgery may be beneficial.
In general, responsible individuals with well-managed epilepsy (as demonstrated by an appropriate seizure-free period and compliance with treatment and other recommendations) may be considered by the driver licensing authority to be fit to drive a private vehicle.
Conditional licences rely on individual responsibility for management of the condition, including compliance with treatment, in conjunction with the support of a health professional and regular review.
Commercial vehicle driving exposes the driver and the public to a relatively greater risk because of the increased time spent at the wheel, as well as the generally greater potential for injury from motor vehicle crashes due to the greater size or weight of commercial vehicles, or large numbers of passengers carried. For this reason, the acceptable risk of a seizure-related crash for commercial driving is much less, and the requirements applied are much more strict; in addition, sleep deprivation is a common provoking factor in epilepsy and may be experienced in long-distance transport driving and amongst drivers doing shift work.
It is good medical practice for any person with initial seizures to be referred to a specialist, where available, for accurate diagnosis of the specific epilepsy syndrome so that appropriate treatment is instituted and all the risks associated with epilepsy, including driving, can be explained.
With regard to licensing, the treating doctor/general practitioner may liaise with the driver licensing authority about whether the criteria are met for driving a private vehicle, but only a specialist may do so for a commercial vehicle driver.
Advice to licence holders
All licence holders should be advised of the following general principles for safety when driving.
- The person must continue to take anti-epileptic medication regularly as recommended.
- The person should ensure adequate sleep is had and not drive when sleep-deprived.
- The person should avoid circumstances, or the use of substances (e.g. excessive alcohol), that are known to increase the risk of seizures.
It is good medical practice for any person with epilepsy to be reviewed periodically. Patients who are licence holders should also be monitored regarding their response to treatment and compliance with the general advice for safety when driving. Drivers of private vehicles who hold a conditional licence should be reviewed at least annually by the treating doctor. Commercial vehicle drivers should be reviewed at least annually by a specialist regarding any conditional licence that has been issued.
If a patient refuses to follow a treating doctor’s recommendation to take anti-epileptic medication, the patient should be assessed as not fit to drive and the doctor should consider notifying the driver licensing authority (refer to Part A section 3.3.1 Confidentiality, privacy and reporting to the driver licensing authority). Refer also to Medication noncompliance in this section.
Where epilepsy is associated with other impairments or conditions, the relevant sections covering those disorders should also be consulted.
Other conditions with risk of seizure
Seizures can occur in association with many brain disorders. Some of these disorders may also impair safe driving because of an associated neurological deficit. Both the occurrence of seizures, as well as the effect of any neurological deficit, must be taken into account when determining fitness to drive. Management of acute symptomatic seizures caused by a transient brain disorder or a metabolic disturbance (e.g. encephalitis, hyponatraemia, head injury or drug or alcohol withdrawal) are covered in this standard. Refer also to section 6.3 Other neurological and neurodevelopmental conditions for seizures associated with head injury and intracranial surgery.