Abstracts

Patients with epilepsy generally are discouraged from driving due to the risk of experiencing a seizure, losing control, and causing harm to themselves and/or others. Driving regulations for epilepsy patients vary across the U.S.; some states requiring physicians to report patients to motor vehicle bureaus and/or requiring patients to be seizure-free for varying periods of time, while others have no regulations at all. Few studies examine why patients with epilepsy disregard medical advice and continue to drive. The purpose of this study is to examine demographic, disease, and health-related correlates of driving status among medically intractable epilepsy patients., Participants are two hundred and twenty-five adults (44% male, 88% Caucasian, 44% married, 42% employed full or part-time) aged 18-75 with medically intractable epilepsy referred for surgery evaluation at the Cleveland Clinic. They participated in a health psychology evaluation that included a chart review for demographic, disease, and health-related information., Nineteen percent of the patients continue to drive against medical advice. Current driving status is not associated with age, gender, marital or employment status, duration of epilepsy, seizure frequency, or the use of tobacco, alcohol, or illicit drugs. However, patients on disability are less likely to be currently driving.
Descriptive data on a subset of 49 patients indicate 11 of the 12 patients currently driving have never been in an epilepsy-related motor vehicle accident (MVA), while 13 of the 37 not currently driving have been in at least 1. Only 2 of the 12 (17%) currently driving report limited social support, and 11 of the 37 (30%) not driving report limited support., A fair number of patients with medically intractable epilepsy continue to drive against medical advice, but those in an epilepsy-related MVA are less likely to be currently driving. Do these patients drive out of necessity (i.e. limited social support or employment) or because they are generally nonadherent? Results suggest the answer is not that straightforward. While employment status is not associated, patients on disability are less likely to be driving, possibly due to the severity of seizures.
What would increase epilepsy patients[apos] adherence to the recommendation against driving? Anecdotally, our patients report community neurologists are less restrictive about driving than neurologists affiliated with epilepsy centers. This suggests more consistent guidelines and follow-up are needed. Ideally an epilepsy-related MVA should not be needed for adherence. Subsequent analyses will examine how personality factors (i.e. anti-social or risk taking characteristics) are related to driving status, and when data are available we will re-examine how driving status relates to epilepsy-related MVAs and social support.,