PHILADELPHIA—Approximately 65% of US epileptologists advise their patients not to drive when the latter have been seizure-free for more than two years and are tapering off of antiseizure medications or have stopped medications altogether, according to data presented at the 69th Annual Meeting of the American Epilepsy Society. The data result from survey responses from more than 400 American neurologists.
Patients with epilepsy who have been seizure-free and are tapering down their medications have an approximately 0.3% annual risk for a seizure while driving if they drive for 30 minutes per day, said Joon-Yi Kang, MD, Assistant Professor of Neurology at Johns Hopkins University in Baltimore. About 53% of respondents advised abstinence from all driving during the three to six months after tapering is complete and patients are completely off antiseizure therapy.
Neurologists who advise their epilepsy patients who are tapering down or who have recently stopped antiseizure medications “need to think more carefully” about the actual risk that patients face when driving, suggested Dr. Kang. Typically, neurologists advise patients to taper down medications after they have been seizure-free for at least two years. No US guidelines cover driving once seizure-free epilepsy patients start to withdraw from treatment, and no states have laws that cover this situation, noted Dr. Kang.
Once tapering down of treatment begins, the immediate risk of a seizure is between 12% and 30%, based on published reports, and the risk drops below 20% once a patient has been seizure-free for at least three months on gradually reduced treatment or has completely stopped treatment. Based on these data, Dr. Kang estimated that during the first year of taper down and full withdrawal, the average US patient with epilepsy has an overall seizure risk of 15%. If this patient drove 30 minutes per day, his or her average seizure rate while driving would be about 0.3% for the entire year, she said.
“This sort of calculation is usually not done,” but estimating and discussing the risk faced by each patient is important, she said. “Some patients stay on their medications just so that they can continue to drive. We need to carefully think about what is an acceptable level of risk.” The restrictions many neurologists recommend to patients “unnecessarily limit patient function,” Dr. Kang said.
She and her coauthor sent their survey to 2,028 neurologist members of the American Epilepsy Society and received replies from 411 (20%) in 42 states. About 80% of respondents said that more than half of their practice involved patients with epilepsy, and about 70% said that they had at least five years of clinical experience.
In addition, 89% of respondents said that their recommendations to restrict or minimize driving often prompt patients to remain on treatment. “I think these findings reflect usual practice” among US neurologists, Dr. Kang said.
—Mitchel L. Zoler