To solve the problem of driving a car in epilepsy: by liberalization or by tightening the license?

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In the modern mobile world, there is no single solution to the problem of issuing a driving license for patients with epilepsy. Most countries do have liberalized laws that allow driving a car to persons with controlled epilepsy. As far as individuals with regular seizures are concerned, there is a temporary prohibition to drive with potential restoration of the driving right if there is no relapse. The existing experience has shown that such strategy can lead not only to higher quality of life of the patients (more than 70% patients with epilepsy has the right to drive a car), but also to ensure the road safety. Even with this quite liberal approach, about 20% of the drivers with epilepsy do not have their epilepsy fully controlled. In the countries with absolute prohibition of the driving in epilepsy, such as the Russian Federation and China, there is no official statistics on the issue. Based on our practical experience, we concluded on a high (at least 35%) prevalence of drivers among patients with epilepsy; this cannot but increase the risk of road accidents, including fatal. Based on a clinical observation, we illustrate the failure of the mechanisms to prevent road accidents related to epilepsy that are currently in force in the Russian Federation. In our opinion, the problem under discussion does not have an exclusively medical solution. Taking into consideration the accumulated world experience, ensuring of the road safety requires that the state law regulations should be in effect that include a differentiated approached to issuing of permissions to drive a car for persons with epilepsy, from one side, and a serious legal treatment of persons with epilepsy who ignore their adequate therapy and become a cause for road accidents inflicting an injury, from the other.

About the authors

I. V. Ponomareva

Regional Clinical Hospital No. 3

ORCID iD: 0000-0001-6499-3054

Irina V. Ponomareva – MD, PhD, Head of Neurological Outpatient Department No. 2, Neurologist, Epileptologist.

287 Pobedy prospekt, Chelyabinsk, 454021

Russian Federation

A. P. Gerzen

Orenburg Regional Clinical Psychoneurological Hospital for War Veterans


Anton P. Gerzen – MD, Head of the Regional Center for Diagnosis and Treatment of Epilepsy, Neurologist, Epileptologist.

202 Komsomol'skaya ul., Orenburg, 460035

Russian Federation

M. N. Lapina

Center for Cardiology and Neurology

ORCID iD: 0000-0001-9910-3285

Marina N. Lapina – MD, Neurologist, Epileptologist, Neurological Center.

8 Verkhosunskaya ul., Kirov, 610007

Russian Federation

M. A. Sherman

Kirov State Medical University

Author for correspondence.
ORCID iD: 0000-0001-5740-1022

Mikhail A. Sherman – MD, PhD, Associate Professor, Head of the Department of Neurology and Neurosurgery.

112 Karla Marksa ul., Kirov, 610998
Tel.: +7 (912) 826 06 05 

Russian Federation


  1. Mac TL, Tran DS, Quet F, Odermatt P, Preux PM, Tan CT. Epidemiology, aetiology, and clinical management of epilepsy in Asia: a systematic review. Lancet Neurol. 2007;6(6):533–43. doi: 10.1016/S1474-4422(07)70127-8.
  2. GBD 2015 Neurological Disorders Collaborator Group. Global, regional, and national burden of neurological disorders during 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet Neurol. 2017;16(11): 877–97. doi: 10.1016/S1474-4422(17)30299-5.
  3. Cockerell OC, Eckle I, Goodridge DM, Sander JW, Shorvon SD. Epilepsy in a population of 6000 re-examined: secular trends in first attendance rates, prevalence, and prognosis. J Neurol Neurosurg Psychiatry. 1995;58(5):570–6. doi: 10.1136/jnnp.58.5.570.
  4. de Boer HM, Mula M, Sander JW. The global burden and stigma of epilepsy. Epilepsy Behav. 2008;12(4):540–6. doi: 10.1016/j.yebeh.2007.12.019.
  5. Chisholm D; WHO-CHOICE. Cost-effectiveness of first-line antiepileptic drug treatments in the developing world: a population-level analysis. Epilepsia. 2005;46(5):751–9. doi: 10.1111/j.1528-1167.2005.52704.x.
  6. Wang WZ, Wu JZ, Ma GY, Dai XY, Yang B, Wang TP, Yuan CL, Hong Z, Bell GS, Prilipko L, de Boer HM, Sander JW. Efficacy assessment of phenobarbital in epilepsy: a large community-based intervention trial in rural China. Lancet Neurol. 2006;5(1):46–52. doi: 10.1016/S1474-4422(05)70254-4.
  7. Kleinman A, Wang WZ, Li SC, Cheng XM, Dai XY, Li KT, Kleinman J. The social course of epilepsy: chronic illness as social experience in interior China. Soc Sci Med. 1995;40(10):1319–30. doi: 10.1016/0277-9536(94)00254-q.
  8. Arcot Jayagopal L, Samson KK, Taraschenko O. Driving with drug-resistant and controlled seizures from a patient's perspective: Assessment of attitudes and practices. Epilepsy Behav. 2018;81:101–6. doi: 10.1016/j.yebeh.2018.01.023.
  9. Gilliam F, Kuzniecky R, Faught E, Black L, Carpenter G, Schrodt R. Patient-validated content of epilepsy-specific quality-of-life measurement. Epilepsia. 1997;38(2):233–6. doi: 10.1111/j.1528-1157.1997.tb01102.x.
  10. Gilliam F, Kuzniecky R, Meador K, Martin R, Sawrie S, Viikinsalo M, Morawetz R, Faught E. Patient-oriented outcome assessment after temporal lobectomy for refractory epilepsy. Neurology. 1999;53(4):687–94. doi: 10.1212/wnl.53.4.687.
  11. Jehi L, Tesar G, Obuchowski N, Novak E, Najm I. Quality of life in 1931 adult patients with epilepsy: seizures do not tell the whole story. Epilepsy Behav. 2011;22(4):723–7. doi: 10.1016/j.yebeh.2011.08.039.
  12. Welty TE, Willis SL, Welty EA. Effect of limited transportation on medication adherence in patients with epilepsy. J Am Pharm Assoc (2003). 2010;50(6):698–703. doi: 10.1331/JAPhA.2010.09081.
  13. Myers L, Lancman M, Laban-Grant O, Lancman M, Jones J. Socialization characteristics in persons with epilepsy. Epilepsy Behav. 2017;72:99–107. doi: 10.1016/j.yebeh.2017.04.036.
  14. Holland P, Lane S, Whitehead M, Marson AG, Jacoby A. Labor market participation following onset of seizures and early epilepsy: Findings from a UK cohort. Epilepsia. 2009;50(5):1030–9. doi: 10.1111/j.1528-1167.2008.01819.x.
  15. Gordon KE, Dooley JM, Brna PM. Epilepsy and activity – a population-based study. Epilepsia. 2010;51(11):2254–9. doi: 10.1111/j.15281167.2010.02709.x.
  16. Imataka G, Arisue K. Epilepsy-related automobile accidents in Japan: legal changes about a precedent and penal regulations. Eur Rev Med Pharmacol Sci. 2016;20(3):491–7.
  17. Devinsky O. Epilepsy: A Patient and Family Guide. 3 rd edition. Demos Health; 2007. 408 p.
  18. Epilepsy Foundation. State Driving Laws Database. [Internet]. Available from:
  19. Sheth SG, Krauss G, Krumholz A, Li G. Mortality in epilepsy: driving fatalities vs other causes of death in patients with epilepsy. Neurology. 2004;63(6):1002–7. doi: 10.1212/01.wnl.0000138590.00074.9a.
  20. Canadian Council of Motor Transport Administrators. Determining Driver Fitness in Canada. September 2013 [Internet]. Available from:
  21. Winston GP, Jaiser SR. Western driving regulations for unprovoked first seizures and epilepsy. Seizure. 2012;21(5):371–6. doi: 10.1016/j.seizure.2012.03.008.
  22. McLachlan RS, Starreveld E, Lee MA. Impact of mandatory physician reporting on accident risk in epilepsy. Epilepsia. 2007;48(8):1500–5. doi: 10.1111/j.1528-1167.2007.01051.x.
  23. Ooi WW, Gutrecht JA. International regulations for automobile driving and epilepsy. J Travel Med. 2000;7(1):1–4. doi: 10.2310/7060.2000.00001.
  24. Austroads. Assessing Fitness to Drive [Internet]. Available from:
  25. Brasil. Codigo de Transito Brasileiro: Instituido pela Lei no. 9503 de 23 de Setembro de 1997 [Internet]. 1a ed. Brasilia: DENATRAN. 2008; 708. Available from:
  26. Al Zaid EH. Prevalence of patients with epilepsy unfit to drive. J Family Community Med. 2019;26(1):51–6. doi: 10.4103/jfcm.JFCM_177_17.
  27. Bonnett LJ, Powell GA, Tudur Smith C, Marson AG. Risk of a seizure recurrence after a breakthrough seizure and the implications for driving: further analysis of the standard versus new antiepileptic drugs (SANAD) randomised controlled trial. BMJ Open. 2017;7(7):e015868. doi: 10.1136/bmjopen-2017-015868.
  28. Schmedding E; Belgian Working Group on Epilepsy and Driving. Epilepsy and driving in Belgium: proposals and justification. Acta Neurol Belg. 2004;104(2):68–79.
  29. International Bureau for Epilepsy. Survey on driving regulations in Europe [Internet]. February 1, 2012. Available from:
  30. Epilepsy and Driving in Europe: A report of the Second European Working Group on Epilepsy and Driving, an advisory board to the Driving License Committee of the European Union [Internet]. Final report; 3 April 2005. Available from:
  31. Kwon C, Liu M, Quan H, Thoo V, Wiebe S, Jetté N. Motor vehicle accidents, suicides, and assaults in epilepsy: a population-based study. Neurology. 2011;76(9):801–6. doi: 10.1212/WNL.0b013e31820e7b3b.
  32. Norton R, Vander Hoorn S, Roberts I, Jackson R, MacMahon S. Migraine: a risk factor for motor vehicle driver injury? Accid Anal Prev. 1997;29(5):699–701. doi: 10.1016/s00014575(97)00018-3.
  33. Pohlmann-Eden B, Hynick N, Legg K. First seizure while driving (FSWD) – an underestimated phenomenon? Can J Neurol Sci. 2013;40(4): 540–5. doi: 10.1017/s0317167100014633.
  34. Inamasu J, Nakatsukasa M, Tomiyasu K. Seizures occurring while driving in patients with and without diagnosis of epilepsy: Frequency and association with automobile accidents. J Clin Neurosci. 2019;59:75–8. doi: 10.1016/j.jocn.2018.11.003.
  35. Naik PA, Fleming ME, Bhatia P, Harden CL. Do drivers with epilepsy have higher rates of motor vehicle accidents than those without epilepsy? Epilepsy Behav. 2015;47:111–4. doi: 10.1016/j.yebeh.2015.04.016.
  36. Krauss GL, Ampaw L, Krumholz A. Individual state driving restrictions for people with epilepsy in the US. Neurology. 2001;57(10):1780–5. doi: 10.1212/wnl.57.10.1780.
  37. Al Rajeh S, Awada A, Bademosi O, Ogunniyi A. The prevalence of epilepsy and other seizure disorders in an Arab population: a community-based study. Seizure. 2001;10(6):410–4. doi: 10.1053/seiz.2001.0602.
  38. Sillanpää M, Shinnar S. Obtaining a driver's license and seizure relapse in patients with childhood-onset epilepsy. Neurology. 2005;64(4):680–6. doi: 10.1212/01.WNL.0000151957.80848.0E.
  39. Elliott JO, Long L. Perceived risk, resources, and perceptions concerning driving and epilepsy: a patient perspective. Epilepsy Behav. 2008;13(2):381–6. doi: 10.1016/j.yebeh.2008.04.019.
  40. Bautista RE, Wludyka P. Driving prevalence and factors associated with driving among patients with epilepsy. Epilepsy Behav. 2006;9(4): 625–31. doi: 10.1016/j.yebeh.2006.08.020.
  41. Lings S. Increased driving accident frequency in Danish patients with epilepsy. Neurology. 2001;57(3):435–9. doi: 10.1212/wnl.57.3.435.
  42. Krumholz A, Hopp J. Driving Restrictions for Patients with Seizures and Epilepsy [Internet]. UpToDate. Topic 2226, Version 13.0. Available from:
  43. Drazkowski J. An overview of epilepsy and driving. Epilepsia. 2007;48 Suppl 9:10–2. doi: 10.1111/j.1528-1167.2007.01392.x.
  44. Punia V, Farooque P, Chen W, Hirsch LJ, Berg AT; Multicenter Study of Epilepsy Surgery, Blumenfeld H. Epileptic auras and their role in driving safety in people with epilepsy. Epilepsia. 2015;56(11):e182–5. doi: 10.1111/epi.13189.
  45. Brown JW, Lawn ND, Lee J, Dunne JW. When is it safe to return to driving following first-ever seizure? J Neurol Neurosurg Psychiatry. 2015;86(1):60–4. doi: 10.1136/jnnp-2013307529.
  46. U.S. Department of Transportation's Federal Motor Carrier Safety Administration. Seizure Disorders and Commercial Motor Vehicle Drivers Safety: Expert Panel Recommendations. [Internet]. October 2007. Available from:
  47. Smith SJ. EEG in the diagnosis, classification, and management of patients with epilepsy. J Neurol Neurosurg Psychiatry. 2005;76 Suppl 2(Suppl 2):ii2–7. doi: 10.1136/jnnp.2005.069245.
  48. Salinsky MC, Wegener K, Sinnema F. Epilepsy, driving laws, and patient disclosure to physicians. Epilepsia. 1992;33(3):469–72. doi: 10.1111/j.1528-1157.1992.tb01693.x. PMID: 1592021.
  49. Dalrymple J, Appleby J. Cross sectional study of reporting of epileptic seizures to general practitioners. BMJ. 2000;320(7227):94–7. doi: 10.1136/bmj.320.7227.94.
  50. Berg AT, Vickrey BG, Sperling MR, Langfitt JT, Bazil CW, Shinnar S, Walczak TS, Pacia S, Spencer SS. Driving in adults with refractory localization-related epilepsy. Multi-Center Study of Epilepsy Surgery. Neurology. 2000;54(3): 625–30. doi: 10.1212/wnl.54.3.625.
  51. Bacon D, Fisher RS, Morris JC, Rizzo M, Spanaki MV. American Academy of Neurology position statement on physician reporting of medical conditions that may affect driving competence. Neurology. 2007;68(15):1174–7. doi: 10.1212/01.wnl.0000259514.85579.e0.
  52. Xu Y, Zhou Z, Shanthosh J, Hackett ML, Anderson CS, Glozier N, Somerville E. Who is driving and who is prone to have traffic accidents? A systematic review and meta-analysis among people with seizures. Epilepsy Behav. 2019;94:252–7. doi: 10.1016/j.yebeh.2019.03.032.
  53. Chen J, Yan B, Lu H, Ren J, Zou X, Xiao F, Hong Z, Zhou D. Driving among patients with epilepsy in West China. Epilepsy Behav. 2014;33:1–6. doi: 10.1016/j.yebeh.2014.01.020.

Copyright (c) 2020 Ponomareva I.V., Gerzen A.P., Lapina M.N., Sherman M.A.

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