Abstracts

Rationale: Patients with seizures while driving commercial vehicles pose a considerable risk to public safety. Current Federal Motor Carriers Safety Administration (FMCSA) guidelines require a lifelong restriction on interstate commercial driving for drivers who have had seizures, unless they are seizure-free >10 years off AED therapy or > 5 years following single, unprovoked seizures. The FMCSA asked a medical expert panel to conduct an evidence-based review of seizure recurrence risks, existing regulations, and, if judged necessary, to propose new guidelines for approving commercial drivers’ licenses for commercial drivers with either: 1) single precipitated seizures; 2) single unprecipitated seizures; 3) epilepsy. Methods: We conducted a systematic review of studies defining risks for seizure recurrence for adult patients with single seizures and epilepsy treated with medical or surgical therapy. We evaluated the quality and class of published studies and used a random, fixed effect model to estimate the annual risk for seizure recurrence for each group. In light of those findings, we reconsidered existing guidelines. Results: Current studies permit only general estimates of risks for seizure recurrence for adults with single provoked or unprovoked seizures or epilepsy. The expert panel, however, suggested several modifications in commercial driving guidelines. Limited studies support an estimate that 8 years of seizure-freedom with or without AED therapy reduces annual seizure-recurrence to <2%. This level of risk could qualify some patients with a history of epilepsy or seizures for driving; 4 years of seizure freedom may be sufficient to qualify drivers with single unprovoked seizures. These proposed new guidelines were presented at a public hearing in 2008. The FMSCA medical review board suggested that patients should be near population background risks for seizures (approximately 0.05% annually) before receiving commercial driving licenses and recommended that current guidelines be retained, except to permit some patients with single seizures precipitated by drug intoxication to be certified. The two sets of recommendations by the expert panel and the medical review board are under review by the FMCSA. Conclusions: Medical opinions vary on reasonable levels of risks for permitting patients with previous seizures to obtain commercial drivers’ licenses; the current US regulations pose a lifetime ban for patients receiving AED treatment for epilepsy and are more restrictive than those of several other countries. Note: The opinions expressed are those of the authors and do not necessarily reflect those of the U.S. Federal Government.