Abstracts

Rationale: We examined attitudes about driving and driving behaviors of people with epilepsy (PWE) in Australia. Driver licence restrictions on PWE are a sensitive issue and attempt to balance wellbeing of patients, safety of the community, and patients’ right to drive. Patients may conceal their diagnosis to obtain or retain their licence, while others drive without a licence. There is limited evidence on these issues in the Australian population. Methods: A 52-item survey was mailed to all patients who attended the Comprehensive Epilepsy Service or First Seizure Clinic at the Prince of Wales Hospital, Sydney between 8 August 2014 and 8 August 2016. Questions addressed licensing status, seizures while driving, attitudes towards, compliance with and knowledge of driving laws and the role of the doctor in determining licence eligibility. SPSS v23 was used to carry out X^2 tests, Fisher’s exact tests and multiple logistic regression. Results: 219/975 surveys (22.5%) were returned. 217 were eligible for analysis. More participants were women (58%) and aged 16-45 years (40% >45 years). Of 100 (46% of 217) patients who held a driver’s licence, 15/100 had not informed the Driver Licensing Authority (DLA) of their epilepsy (as required by law), and 10/100 admitted to withholding information about seizures from their treating doctor for fear of losing their licence. Of 117 patients who did not hold a valid driver’s licence, 54 (46%) said it was their doctor who decided they could not drive, 19 (16%) said it was the DLA who decided, 48 (41%) said their personal choice contributed to the decision, and 2 admitted to driving without a licence. Non-compliance by concealing information from the DLA or doctor and/or unlicensed driving  was admitted by 27/217 (12.4%) participants. On multivariate analyses, PWE diagnosed at an older age (21-30 v <21 years old) were more likely to be non-compliant with driving rules (p = 0.016, OR = 1.065, 95% CI 1.012-1.120) and more likely to have had a seizure while driving (p = 0.018, OR = 1.052, 95% CI 1.009-1.097). Of 39 seizures while driving, a crash ensued in 46% (18/39), of which 83% (15/18) required towing of a vehicle. The cohort’s knowledge of the driving rules was poor - only 30% (66/217) knew the required seizure-free period, yet 54% (117/217) said they knew the rules, with those currently holding a driver's licence more likely to believe they knew the rules (X^2 = 5.253, p=0.022). Conclusions: One in eight PWE admitted non-compliance with driving laws. Although anonymous, the survey was returned to the patients’ treating team and therefore, this figure is likely to be an underestimate. The strongest indicator of noncompliance was age at diagnosis, suggesting that those diagnosed at a younger age are less impacted by driving restrictions. Understanding of the driving rules and the reasoning behind them was limited. Many patients held their doctor responsible for their denial of a driving licence, rather than the DLA. These factors should be considered when counselling patients as to the risks of driving following a seizure. Funding: University of New South Wales