Table of Contents

6.2.3 Medical standards for licensing

Given the considerable variation in seizures and their potential impact on safe driving, a hierarchy of standards has been developed that provides a logical and fair basis for decision making regarding licensing. This hierarchy comprises:

  • a default standard, applicable to all cases of seizure, unless reductions are allowed (refer below and to the standards table).
  • reductions for specific types of epilepsy or specific circumstances, including an allowance for exceptional circumstances upon the advice of a specialist in epilepsy (refer below and to the standards table).

In addition, advice is provided on a number of difficult management issues relating to safe driving for people with seizures and epilepsy (refer below and to the standards table).

The default standard (all cases)

The ‘default standard’ is the standard that applies to all drivers who have had a seizure unless their situation matches one of a number of defined situations listed in the table and described below. These situations are associated with a lower risk of a seizure-related crash and therefore driving may be resumed after a shorter period of seizure freedom than required under the default standard. However, the need for adherence to medical advice and at least annual review still applies. If a seizure has caused a crash within the preceding 12 months, the required period of seizure freedom may not be reduced below that required under the default standard. If anti-epileptic medication is to be withdrawn, the person should not drive (refer to table for details). If a driver who is taking anti-epileptic medication has experienced an extended seizure-free period (more than 10 years for private drivers, and more than 20 years for commercial drivers) the driver licensing authority may consider reduced review requirements based on independent specialist advice (refer to Part A section 3.3.7 Role of independent experts/panels).

Variations to the default standard

There are several situations in which a variation from the default standard may be considered by the driver licensing authority to allow an earlier return to driving. These are listed below and discussed on subsequent pages:

  • seizures in childhood
  • first seizure
  • epilepsy treated for the first time
  • acute symptomatic seizures
  • ‘safe’ seizures
  • seizures only in sleep
  • seizures in a person previously well controlled
  • exceptional circumstances.

In most cases, exceptions to the default standard will be considered only for private vehicle drivers. A reduction in restrictions for commercial vehicle drivers will generally only be granted after consideration of information provided by a specialist with expertise in epilepsy.

If a person has experienced a crash as a result of a seizure, the default non-driving seizure-free period applies, even if the situation matches one of those above.

In addition to the reduction for particular circumstances or seizure types, there is also an allowance for ‘exceptional cases’ in which a conditional licence may be considered for private or commercial vehicle drivers on the recommendation of a medical specialist with specific expertise in epilepsy (refer to Exceptional cases and to the standards table). This enables individualisation of licensing for cases where the person does not meet the standard but may be safe to drive.

  • Licensing of drivers with a history of childhood febrile seizures or benign epilepsy syndrome of childhood
    In some specific childhood epilepsy syndromes, seizures usually cease before the minimum age of driving. The driver may hold an unconditional licence if no seizures have occurred after the age of 11 years. If a seizure has occurred after 11 years of age, the default standard applies unless the situation matches one of those in this section (Variations to the default standard).
  • The first seizure
    The occurrence of a first seizure warrants medical specialist assessment, where available. Approximately half of all people experiencing their first seizure will never have another seizure, while half will have further seizures (i.e. epilepsy). The risk of recurrence falls with time. Driving may be resumed after sufficient time has passed without further seizures (with or without medication) to allow the risk to reach an acceptably low level (refer to standards table). If a second seizure occurs (except on the same day as the first), the risk of recurrence is much higher. The standard for Epilepsy treated for the first time will then apply (refer to text and the standards table).

Figure 13: Overview of management of a driver with seizures

  • Epilepsy treated for the first time (refer to Figure 14)
    The risk of recurrent seizures in people starting treatment for epilepsy is sufficiently low to allow driving to resume earlier than required under the default standard. For the purpose of these standards, epilepsy treated for the first time means that treatment was started for the first time within the preceding 18 months.

    When treatment with an anti-epileptic drug is started in a previously untreated person, sufficient time should pass to establish that the drug is effective before driving is recommenced. However, effectiveness cannot be established until the person reaches an appropriate dose. For example, if a drug is being gradually introduced over three weeks and a seizure occurs in the second week, it would be premature to declare the drug ineffective. The standard allows seizures to occur within the first six months after starting treatment without lengthening the required period of seizure freedom. However, if seizures occur more than six months after starting therapy, a longer seizure-free period is required (refer to table for details). For commercial drivers, the default standard applies.

    For example, if a patient has a seizure three months after starting therapy, they may be fit to drive six months after the most recent seizure (nine months after starting therapy). However, if a person experiences a seizure eight months after starting therapy, the default standard applies and they may not be fit to drive until 12 months after the most recent seizure.

    If the patient has received no treatment in the last 5 years or more, resumption of treatment is managed as if treated for the first time (as above).
  • Acute symptomatic seizures
    Acute symptomatic seizures are caused by a transient brain disorder or metabolic disturbance (e.g. encephalitis, hyponatraemia, head injury or drug or alcohol withdrawal) in patients without previous epilepsy. Acute symptomatic seizures can be followed by further seizures weeks, months or years after resolution of the transient brain disorder. This may occur because of permanent changes to the brain caused by the process underlying the acute symptomatic seizures (e.g. seizures may return years after a resolved episode of encephalitis) or because the transient brain disorder has recurred (e.g. benzodiazepine withdrawal).

    People who have experienced a seizure only during and because of a transient brain disorder or metabolic disturbance should not drive for a sufficient period to allow the risk of recurrence to fall to an acceptably low level (refer to table for details). Return to driving for commercial vehicle drivers requires input from a specialist in epilepsy. The risk of seizure recurrence varies greatly, depending on the cause.

    If seizures occur after the causative acute illness has resolved, whether or not due to a second transient brain disorder or metabolic disturbance, the acute symptomatic seizures standard no longer applies. For example, if a person has a seizure during an episode of encephalitis and then, after recovery from the encephalitis, has another seizure and begins treatment, the standard for epilepsy treated for the first time applies. Similarly, if a person experiences seizures during two separate episodes of benzodiazepine withdrawal, the default standard applies.

    The management of late post-traumatic epilepsy is discussed below under Head injury.
  • ‘Safe’ seizures (including prolonged aura)
    Some seizures do not impair consciousness or the ability to control a motor vehicle; however, this must be well established without exceptions and corroborated by reliable witnesses or video-EEG recording because people may believe their consciousness is unimpaired when it is not. For example, some ‘auras’ are associated with impaired consciousness that the person does not perceive. For private vehicle drivers, where seizures occur only at a particular time of day (e.g. in the first hour after waking), a restricted licence, which limits driving to certain hours or circumstances, may be acceptable. This applies only to private vehicle drivers.

    Seizures may begin with a subjective sensation (the ‘aura’) that precedes impairment of consciousness. If this lasts long enough, the driver may have time to stop the vehicle. However, this can be relied upon only when this pattern has been well established without exceptions and corroborated by witnesses or video-EEG monitoring. Furthermore, it may be impossible to stop immediately and safely because of traffic conditions. Even if the person is able to stop the vehicle before the seizure, they may then be in a confused state and not appreciate the danger of resuming their journey. For these reasons, such seizures can be considered safe only in exceptional circumstances.
  • Sleep-only seizures
    Some seizures occur only during sleep and hence are not a hazard to driving. In people who have never had a seizure while awake but who have an established pattern of seizures exclusively during sleep, the risk of subsequent seizures while awake is sufficiently low to allow private driving, despite continuing seizures while asleep. In people with an established pattern of sleep-only seizures but a history of previous seizures while awake, the risk of further seizures while awake is higher. Therefore, a longer period of sleep-only seizures is required before driving by this group than in those who have never had a seizure while awake. This applies only to private vehicle drivers.

Figure 14: Epilepsy treated for the first time

  • Seizure in a person whose epilepsy has been previously ‘well controlled’
    Where a single seizure occurs after a long period (defined in these standards as at least 12 months) without seizures, the risk of further seizures is sufficiently low that driving can be resumed after a shorter period than when the epilepsy has not been as well controlled. The duration of the non-driving seizure-free period depends on whether or not a provoking factor was identified and can be reliably avoided (refer below). This applies only to private vehicle drivers who are already under treatment.

    In people with epilepsy, their seizures are often provoked by factors such as sleep deprivation, missed doses of anti-epileptic medication, over-the-counter medications, alcohol or acute illnesses. If the provoking factor is avoided, the risk of subsequent seizures may be sufficiently low to allow private driving to resume after a shorter seizure-free period than following an unprovoked seizure. However, this applies only if the epilepsy has been well controlled until the provoked seizure (refer to previous point). Some provocative factors (e.g. sleep deprivation), unless severe, cannot be reliably avoided. Refer also to Medication noncompliance below.
  • Exceptional cases
    Where a medical specialist experienced in the management of epilepsy considers that a person with seizures or epilepsy does not meet the standards for a conditional licence but nonetheless may be safe to drive, a conditional licence may be considered if the driver licensing authority, after considering clinical information provided by the treating medical specialist, considers that the risk of a crash caused by a seizure is acceptably low.

Other factors that may influence licensing status

A number of other factors may influence the management of epilepsy with regards to driving and licensing. These include:

  • epilepsy treated by surgery
  • medication noncompliance
  • cessation of anti-epileptic medication
  • a seizure causing a crash
  • resumption of an unconditional licence.

These issues are discussed below and criteria are outlined in the standards table.

  • Epilepsy treated by surgery
    Resection of epileptogenic brain tissue may eliminate seizures completely, allowing safe driving after a suitable seizure-free period. The vision standard may also apply if there is a residual visual field defect. If medication is withdrawn, refer to Withdrawal or dose reduction of one or more anti-epileptic medications below.
  • Medication noncompliance
    Compliance with medical advice regarding medication intake is a requirement for conditional licensing. Where noncompliance with medication is suspected by the treating doctor, the doctor may recommend to the driver licensing authority that the licence be granted conditional upon periodic drug-level monitoring. Where a person without a history of noncompliance with medication experiences a seizure because of a missed dose and there were no seizures in the 12 months leading up to that seizure, the situation can be considered a provoked seizure (refer to the standard for Seizure in a person whose epilepsy has been previously well controlled above).
  • Withdrawal or dose reduction of one or more anti-epileptic medications
    In people who have had no seizures while taking anti-epileptic medication over a suitable period, the specialist may attempt a withdrawal of all anti-epileptic medication, a reduction in the number of medications or a reduction in dose. The medication may also be changed because of side-effects or potential side-effects (such as teratogenicity). The person should not drive for the full period of withdrawal or dose change and for 3 months thereafter. However, if the dose is being reduced only because of current dose-related side-effects and is unlikely to result in a seizure, driving may continue. The person will already be on a conditional licence, thus notification of the driver licensing authority is not required. Patients who do not adhere to the prescribed dose should be reminded that compliance is a condition of their licence.

    For commercial vehicle drivers, if anti-epileptic medication is to be withdrawn, the person will no longer meet the criteria to hold a conditional licence. This also applies to a reduction in dose of anti-epileptic medication except if the dose reduction is due only to the presence of current dose-related side-effects (refer to the standards table). Driving may continue despite withdrawal of anti-epileptic medication only after consideration by the driver licensing authority under the Exceptional cases standard (e.g. where anti-epileptic therapy has been started in a patient without seizures).
  • Seizure causing a crash or loss of control of a vehicle
    Not all seizures carry the same risk of causing a crash or lack of control of a vehicle. People who have lost control of a vehicle as a result of a seizure are likely to have a higher crash risk. If a person who has lost control of a vehicle or experienced a crash as a result of a seizure, the default seizure-free non-driving period applies, even if they fall into one of the categories that allow a reduction.
  • Resumption of an unconditional licence
    Where a person has had no seizures for at least five years and has taken no anti-epileptic medication for at least the preceding 12 months, the driver licensing authority may consider granting an unconditional licence. This does not apply to commercial vehicle drivers.

It is important that health professionals familiarise themselves with both the general information above and the tabulated standards before making an assessment of a person’s fitness to drive.

Medical standards for licensing – Seizures and epilepsy

Step 1: Read ‘All cases’. This applies to all people with seizures.

Step 2: Look through the list of situations in the left column to see if the person matches one of these situations. If so, the driver licensing authority may consider a conditional licence after a shorter (reduced) period of seizure freedom.

Note that people are not eligible for a reduction if they have had a motor vehicle crash due to a seizure within the preceding 12 months. If withdrawal of all antiepileptic medication is planned, refer to the relevant section of the table.

Condition

Private standards

(Drivers of cars, light rigid vehicles or motorcycles unless carrying public passengers or requiring a dangerous goods driver licence – refer to definition)

Commercial standards

(Drivers of heavy vehicles, public passenger vehicles or requiring a dangerous goods driver licence – refer to definition)

All cases: default standard

All cases (default standard)

Applies to all people who have experienced a seizure.

Exceptions may be considered only if the situation matches one of those listed below.

A person is not fit to hold an unconditional licence:

  • if the person has experienced a seizure.

A conditional licence may be considered by the driver licensing authority subject to at least annual review,* taking into account information provided by the treating doctor as to whether the following criteria are met:

  • there have been no seizures for at least 12 months;** and
  • the person follows medical advice, including adherence to medication if prescribed or recommended.

* If a driver undergoing treatment for epilepsy has experienced an extended seizure free period (more than 10 years) the driver licensing authority may consider reduced review requirements based on independent specialist advice (refer to section 3.3.7 Role of independent experts/panels).

** Shorter seizure-free periods may be considered by the driver licensing authority if the person’s situation matches one of those in the remainder of this table.

A person is not fit to hold an unconditional licence:

  • if the person has experienced a seizure.

A conditional licence may be considered by the driver licensing authority subject to at least annual review,* taking into account information provided by a specialist in epilepsy as to whether the following criteria are met:

  • there have been no seizures for at least 10 years;** and
  • an EEG conducted in the last six months has shown no epileptiform activity and no other EEG conducted in the last 12 months has shown epileptiform activity; and
  • the person follows medical advice, including adherence to medication if prescribed or recommended.

* If a driver undergoing treatment for epilepsy has experienced an extended seizure free period (more than 20 years) the driver licensing authority may consider reduced review requirements based on independent specialist advice (refer to section 3.3.7 Role of independent experts/panels).

** Shorter seizure-free periods may he considered by the driver licensing authority if the person’s situation matches one of those in the remainder of this table.

Possible reductions in the non-driving seizure-free periods for a conditional licence

History of a benign seizure or epilepsy syndrome usually limited to childhood

(e.g. febrile seizures, benign focal epilepsy, childhood absence epilepsy)

A history of a benign seizure or epilepsy syndrome usually limited to childhood does not disqualify the person from holding an unconditional licence, as long as there have been no seizures after 11 years of age.

If a seizure has occurred after 11 years of age, the default standard (refer above) applies unless the situation matches one of those listed below.

A history of a benign seizure or epilepsy syndrome usually limited to childhood does not disqualify the person from holding an unconditional licence, as long as there have been no seizures after 11 years of age.

If a seizure has occurred after 11 years of age, the default standard (refer above) applies unless the situation matches one of those listed below.

First seizure

Note: Two or more seizures in a 24 hour period are considered a single seizure.

A conditional licence may be considered by the driver licensing authority subject to at least annual review, taking into account information provided by the treating doctor as to whether the following criterion is met:

A conditional licence may be considered by the driver licensing authority subject to at least annual review, taking into account information provided by a specialist in epilepsy as to whether the following criteria are met:

  • there have been no seizures for at least five years (with or without medication); and
  • an EEG conducted in the last six months has shown no epileptiform activity and no other EEG conducted in the last 12 months has shown epileptiform activity.

Epilepsy treated for the first time

This applies when anti-epileptic treatment has been started for the first time within the preceding 18 months.

See Figure 14.

A conditional licence may be considered by the driver licensing authority subject to at least annual review, taking into account information provided by the treating doctor as to whether the following criteria are met:

  • the person has been treated for at least six months; and
  • there have been no seizures in the preceding six months; and
  • if any seizures occurred after the start of treatment, they happened only in the first six months after starting treatment and not in the last six months; and
  • the person follows medical advice, including adherence to medication.
There is no reduction. The default standard applies.

Acute symptomatic seizures

Seizures occurring only during a temporary brain disorder or metabolic disturbance in a person without previous seizures. This includes head injuries and withdrawal from drugs or alcohol. This is not the same as provoked seizures in a person with epilepsy.

A conditional licence may be considered by the driver licensing authority subject to at least annual review, taking into account information provided by the treating doctor as to whether the following criterion is met:

  • there have been no further seizures for at least six months.

If there have been two or more separate transient disorders causing acute symptomatic seizures, the default standard applies.

A conditional licence may be considered by the driver licensing authority subject to at least annual review, taking into account information provided by a specialist in epilepsy as to whether the following criteria are met:

  • there have been no further seizures for at least 12 months; and
  • an EEG conducted in the last six months has shown no epileptiform activity and no other EEG conducted in the last 12 months has shown epileptiform activity.

If there have been two or more separate transient disorders causing acute symptomatic seizures, the default standard applies.

‘Safe’ seizures

These are defined as seizures that do not impair driving ability (which requires consciousness and ability to control the vehicle at all times). Normal responsiveness must have been tested by reliable witnesses or during video-EEG.

A conditional licence may be considered by the driver licensing authority subject to at least annual review, taking into account information provided by the treating doctor as to whether the following criteria are met:

  • ‘safe’ seizures have been present for at least two years; and
  • there have been no seizures of other type for at least two years; and
  • the person follows medical advice, including adherence to medication if prescribed, or recommended.

If the above criteria are not met, the default standard applies.

There is no reduction. The default standard applies.

Sleep-only seizures

Seizures occurring only during sleep.

A conditional licence may be considered by the driver licensing authority, despite continuing seizures only during sleep and subject to at least annual review, taking into account information provided by the treating doctor as to whether the following criteria are met:

  • there have been no previous seizures while awake; and
  • the first sleep-only seizure was at least 12 months ago; and
  • the person follows medical advice, including adherence to medication if prescribed, or recommended.

OR

  • there have been previous seizures while awake but not in the preceding two years; and
  • sleep-only seizures have been occurring for at least two years; and
  • the person follows medical advice, including adherence to medication if prescribed, or recommended.

If the above criteria are not met, the default standard applies.

There is no reduction. The default standard applies.

Seizures in a person under treatment whose epilepsy was previously well controlled

‘Well controlled’ is defined as:

There were no seizures during the 12 months leading up to the last seizure.

A conditional licence may be considered by the driver licensing authority subject to at least annual review, taking into account information provided by the treating doctor as to whether the following criteria are met:

  • the seizure was caused by an identified provoking factor; and
  • the provoking factor can be reliably avoided; and
  • the provoking factor has not caused previous seizures; and
  • there have been no seizures for at least four weeks; and
  • the person follows medical advice, including adherence to medication (periodic serum drug level measurements may be required)

OR

  • no cause for the seizure was identified; and
  • there have been no seizures for at least three months; and
  • the person follows medical advice, including adherence to medication.

If the person has experienced one or more seizures during the 12 months leading up to the last seizure, there is no reduction and the default standard applies.

There is no reduction. The default standard applies.
Exceptional cases

Where a medical specialist experienced in the management of epilepsy considers that a person with seizures or epilepsy does not meet the standards above for a conditional licence but may be safe to drive, a conditional licence may be considered by the driver licensing authority, subject to at least annual review:

  • if the driver licensing authority, after considering information provided by a specialist experienced in the management of epilepsy, considers that the risk of a crash caused by a seizure is acceptably low; and
  • the person follows medical advice, including adherence to medication if prescribed or recommended.

Where a specialist in epilepsy considers that a person with seizures or epilepsy does not meet the standards above for a conditional licence but may be safe to drive, a conditional licence may be considered by the driver licensing authority, subject to at least annual review:

  • if the driver licensing authority, after considering information provided by a specialist experienced in the management of epilepsy, considers that the risk of a crash caused by a seizure is acceptably low; and
  • the person follows medical advice, including adherence to medication if prescribed or recommended.
Other factors that may influence licence status
Epilepsy treated by surgery (where the primary goal of surgery is the elimination of epilepsy)

A conditional licence may be considered by the driver licensing authority subject to at least annual review, taking into account information provided by the treating doctor as to whether the following criterion is met:

  • there have been no seizures for at least 12 months following surgery; and
  • the person follows medical advice with respect to medication adherence.

The vision standard may also apply if there is a visual field defect.

If medication is withdrawn, refer to Planned withdrawal of all anti-epileptic medication.

A conditional licence may be considered by the driver licensing authority subject to at least annual review, taking into account information provided by a specialist in epilepsy as to whether the following criteria are met:

  • there have been no seizures for at least 10 years; and
  • an EEG conducted in the last six months has shown no epileptiform activity and no other EEG conducted in the last 12 months has shown epileptiform activity; and
  • the person follows medical advice with respect to medication adherence.

The vision standard may also apply if there is a visual field defect.

If any anti-epileptic medication is to be withdrawn, the person will no longer meet the criteria to hold a conditional licence.

Medication noncomplianceRefer to Medication noncompliance.Refer to Medication noncompliance.
Planned withdrawal of one or more anti-epileptic medications in a person who satisfies the standard to hold a conditional licence

The person should not drive:

  • during the period in which the dose is being tapered; and
  • for three months after the last dose.

If seizures recur, the driver licensing authority may allow the person to resume driving on a conditional licence subject to at least annual review, taking into account information provided by the treating doctor as to whether the following criteria are met:

  • the previously effective medication regime is resumed; and
  • there have been no seizures for four weeks
  • after resuming the medication regime; and
  • the person follows medical advice, including adherence to medication.

If seizures do not recur, the person may become eligible for an unconditional licence (refer to Resumption of unconditional licence).

If anti-epileptic medication is to be withdrawn, the person will no longer meet the criteria to hold a conditional licence. Driving may continue only after consideration by the driver licensing authority under the Exceptional cases standard.
Recommended reduction in dosage of anti-epileptic medication in a person who satisfies the standard to hold a conditional licence

Driving may continue:

  • if the dose reduction is due only to the presence of current dose-related side effects and is unlikely to affect seizure control.

In circumstances other than above, the person should not drive:

  • during the period in which the dose reduction is being made; and
  • for 3 months after completion of the dose reduction.

If seizures recur, the driver licensing authority may allow the person to resume driving on a conditional licence subject to at least annual review, taking into account information provided by the treating doctor as to whether the following criteria are met:

  • the previously effective medication dose is resumed; and
  • there have been no seizures for 4 weeks after resuming the previously effective dose; and
  • the person follows medical advice, including adherence to medication.

Driving may continue:

  • if the dose reduction is due only to the presence of current dose-related side effects and is unlikely to result in a seizure.

In circumstances other than the above, the person will no longer meet the criteria to hold a conditional licence.

Seizure causing a crashIf a person has experienced a crash or has lost control of the vehicle as a result of a seizure, the default seizure-free non-driving period applies, even if they fall into one of the seizure categories that allow a reduction.If a person has experienced a crash or has lost control of the vehicle as a result of a seizure, the default seizure-free non-driving period applies, even if they fall into one of the seizure categories that allow a reduction.
Resumption of non-conditional licence

The driver licensing authority may consider granting an unconditional licence, taking into account information provided by the treating doctor as to whether the following criteria are met:

  • the person has had no seizures for at least five years; and
  • has taken no anti-epileptic medication for at least the preceding 12 months.

Refer to Resumption of non- conditional licence.

Resumption of an unconditional commercial licence will not be considered.

IMPORTANT: The medical standards and management guidelines contained in this chapter should be read in conjunction with the general information contained in Part A of this publication. Practitioners should give consideration to the following:

Licensing responsibility

The responsibility for issuing, renewing, suspending or cancelling, or reinstating a person’s driver licence (including a conditional licence) lies ultimately with the driver licensing authority.

Licensing decisions are based on a full consideration of relevant factors relating to health and driving performance.

Conditional licences

For a conditional licence to be issued, the health professional must provide to the driver licensing authority details of the medical criteria not met, evidence of the medical criteria met, as well as the proposed conditions and monitoring requirements.

The nature of the driving task

The driver licensing authority will take into consideration the nature of the driving task as well as the medical condition, particularly when granting a conditional licence. For example, the licence status of a farmer requiring a commercial vehicle licence for the occasional use of a heavy vehicle may be quite different from that of an interstate multiple combination vehicle driver. The examining health professional should bear this in mind when examining a person and when providing advice to the driver licensing authority.

The presence of other medical conditions

While a person may meet individual disease criteria, concurrent medical conditions may combine to affect fitness to drive, for example, hearing, visual or cognitive impairment (refer to Part A section 2.2.7 Multiple medical conditions and age-related change).

Reporting responsibilities

Patients should be made aware of the effects of their condition on driving and should be advised of their legal obligation to notify the driver licensing authority where driving is likely to be affected. The health professional may themselves advise the driver licensing authority as the situation requires (refer to section 3.3.1 and step 6 of the assessment and reporting process).

References and further reading

  1. Monash University Accident Research Centre. Influence of chronic illness on crash involvement of motor vehicle drivers, 2nd edition, November 2010. Available: http://monashuniversity_mobi/muarc/reports/muarc300.html.
  2. Fisher RS, Parsonage M, Beaussart M, Bladin P, Masland R, Sonnen AEH, Remillard G. Epilepsy and driving: an international perspective. Epilepsia. 1994; 35: 675–684.
  3. Hansotia P, Broste SK. The effects of epilepsy or diabetes mellitus on the risk of automobile accidents. New England Journal of Medicine. 1991; 324: 22–26.
  4. Taylor J, Chadwick D. Risk of accidents in drivers with epilepsy. Journal of Neurology, Neurosurgery and Psychiatry. 1996; 60: 621–627.
  5. Gastaut H, Zifkin BG. The risk of automobile accidents with seizures occurring while driving. Neurology. 1987; 37: 1613–1616.
  6. Berger JT, Rosner F, Kark P, Bennett AJ. Reporting by physicians of impaired drivers and potentially impaired drivers. Journal of General Internal Medicine. 2000; 15: 667–672.
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  8. Somerville ER, Black AB, Dunne JW. Driving to distraction: certification of fitness to drive with epilepsy. Medical Journal of Australia. 2010; 192(6): 342–344.
  9. Second European Working Group on Epilepsy and Driving. Epilepsy and driving in Europe, 2005. Available: http://ec.europa.eu/transport/road_safety/behavior/doc/epilepsy_and_driving_in_europe_final_report_v2_en.pdf.
  10. Queensland Civil and Administrative Tribunal 2015, Medical Board of Australia v Andrew.
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  14. Drazkowski J, Fisher RS, Sirven JI, Demaerschalk BM, Uber-Zak L, Hentz JG, Labiner D. Seizure-related motor vehicle crashes in Arizona before and after reducing the driving restriction from 12 to 3 months. Mayo Clinic Proceedings. 2003; 78: 819–825.
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  19. Brodie MJ, Perucca E, Ryvlin P, Ben-Menachem E, Meencke HJ; Levetiracetam Monotherapy Study Group. Comparison of levetiracetam and controlled-release carbamazepine in newly diagnosed epilepsy. Neurology. 2007; 68(6): 402–408.
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  21. Marson A, Jacoby A, Johnson A, Kim L, Gamble C, Chadwick D; Medical Research Council MESS Study Group. Immediate versus deferred anti-epileptic drug treatment for early epilepsy and single seizures: a randomised controlled trial. Lancet. 2005 Jun 11–17; 365(9476): 2007–2013.
  22. Englander J, Bushnik T, Duong TT, Cifu DX, Zafonte R, Wright J, Hughes R, Bergman W. Analyzing risk factors for late posttraumatic seizures: a prospective, multicenter investigation. Archives of Physical Medicine and Rehabilitation. 2003 Mar; 84(3): 365–373.
  23. Christensen J, Pedersen MG, Pedersen CB, Sidenius P, Olsen J, Vestergaard M. Long-term risk of epilepsy after traumatic brain injury in children and young adults: a population-based cohort study. Lancet. 2009 Mar 28; 373(9669): 110–1110.
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