Almanac of Clinical MedicineAlmanac of Clinical MedicineАльманах клинической медицины2072-05052587-9294Moscow Regional Research and Clinical Institute (MONIKI)123010.18786/2072-0505-2020-48-001POINT OF VIEWТОЧКА ЗРЕНИЯTo solve the problem of driving a car in epilepsy: by liberalization or by tightening the license?Решение проблемы вождения автомобильного транспорта при эпилепсии – путем либерализации или ужесточения допуска?https://orcid.org/0000-0001-6499-3054PonomarevaI. V.ПономареваИ. В.
Russian Federation

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

287 Pobedy prospekt, Chelyabinsk, 454021

Пономарева Ирина Викторовна – канд. мед. наук, заведующая неврологическим отделением № 2 поликлиники № 2, врач-невролог, врач-эпилептолог.

454021, г. Челябинск, проспект Победы, 287

irina_victorovna@mail.ruGerzenA. P.ГерценА. П.
Russian Federation

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

202 Komsomol'skaya ul., Orenburg, 460035

Герцен Антон Петрович – заведующий областным центром диагностики и лечения эпилепсии, врач-невролог, врач-эпилептолог.

460035, г. Оренбург, ул. Комсомольская, 202

antngercen@yandex.ruhttps://orcid.org/0000-0001-9910-3285LapinaM. N.ЛапинаМ. Н.
Russian Federation

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

8 Verkhosunskaya ul., Kirov, 610007

Лапина Марина Николаевна – врач-невролог, врач-эпилептолог неврологического центра.

610007, г. Киров, ул. Верхосунская, 8

pleasant79@mail.ruhttps://orcid.org/0000-0001-5740-1022ShermanM. A.ШерманМ. А.
Russian Federation

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

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

Шерман Михаил Айзикович – д-р мед. наук, доцент, заведующий кафедрой неврологии и нейрохирургии.

610998, г. Киров, ул. Карла Маркса, 112Тел.: +7 (912) 826 06 05 

sherman@list.ruRegional Clinical Hospital No. 3ГБУЗ «Областная клиническая больница № 3»Orenburg Regional Clinical Psychoneurological Hospital for War VeteransГУЗ «Оренбургский областной клинический психоневрологический госпиталь ветеранов войн»Center for Cardiology and NeurologyКОГБУЗ «Центр кардиологии и неврологии»Kirov State Medical UniversityФГБОУ ВО «Кировский государственный медицинский университет» Минздрава России1703202048165720702202007022020Copyright ©; 2020, Ponomareva I.V., Gerzen A.P., Lapina M.N., Sherman M.A.Copyright ©; 2020, Пономарева И.В., Герцен А.П., Лапина М.Н., Шерман М.А.2020Ponomareva I.V., Gerzen A.P., Lapina M.N., Sherman M.A.Пономарева И.В., Герцен А.П., Лапина М.Н., Шерман М.А.https://creativecommons.org/licenses/by/4.0https://almclinmed.ru/jour/article/view/1230

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.

В современном мобильном мире не существует единого решения проблемы допуска страдающих эпилепсией пациентов к управлению автомобильным транспортом. Большинство стран имеет законы либеральной направленности, разрешающие лицам с контролируемыми эпилептическими приступами (ЭП) водить автомобиль. В отношении людей с сохраняющимися припадками накладывается временный запрет на управление автомобилем с перспективой восстановления права вождения в случае отсутствия рецидивов приступов. Опыт показывает, что подобный подход позволяет не только повысить качество жизни больных (свыше 70% пациентов с эпилепсией имеют право на управление автомобилем), но и обеспечить должный уровень безопасности дорожного движения. Даже при таком достаточно мягком подходе у 20% участвующих в дорожном движении лиц с ЭП отсутствует полный контроль припадков. В странах с абсолютным запретом вождения автомобиля при эпилепсии, таких как Российская Федерация и Китай, отсутствует доступная официальная статистика, отражающая состояние проблемы. На основании своего практического опыта авторы сделали вывод о высокой – не менее 35% – распространенности водителей среди пациентов, имеющих ЭП, что не может не повышать риск дорожно-транспортных происшествий, в том числе с летальным исходом. На примере описания клинического наблюдения проиллюстрирована неэффективность действующих в Российской Федерации механизмов профилактики дорожных аварий, связанных с ЭП. По мнению авторов, обсуждаемая проблема не имеет исключительно медицинского решения. Учитывая накопившийся мировой опыт, для обеспечения безопасности на дорогах необходимо государственное законодательное регулирование, предполагающее, с одной стороны, дифференцированный подход в решении вопроса допуска лиц с ЭП к вождению, а с другой – серьезную правовую оценку действий игнорирующих адекватное лечение эпилепсии пациентов, ставших причиной аварий с нанесением вреда здоровью людей.

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