Abstracts

Rationale: The ability to drive a motor vehicle is important for employment, independence and quality of life in people with epilepsy. After entering remission, many will consider anti-epileptic drug (AED) taper. However, AED taper increases the probability of seizure recurrence and raises concern for seizure associated motor vehicle accident (MVA). There is no formal guideline regarding driving restrictions when tapering AEDs. We conducted a survey to assess current practice regarding driving restrictions suggested by neurologists during and after AED taper.Methods: Surveys were emailed to a random geographic sampling of US based 2083 neurologists from the American Epilepsy Society (AES) membership directory. This consisted of a 12-item on-line survey of demographics and driving recommendations during and following AED taper in patients who were seizure free for at least two years. Surveys were managed and databased using Research Electronic Data Capture (REDCap).Results: 403 physicians (80% epilepsy specialists, 20% general neurologists) completed the survey, a 19% response rate. During AED taper, 64.5% stated they advised patients to stop driving, 24.5% recommended modifying driving habits (e.g., lower speeds, less driving), and 11% recommended no change in driving habits. After AED taper, 52.3% stated they advised patients to stop driving, 26.3% recommended modifying driving habits, and 21.4% recommended no change in driving habits. Mean duration of post-taper restrictions was 3 months (range 1-24 months). More physicians advised cessation of driving during AED taper than after taper (64.5% vs 52.3%, McNemar Chi Square = 4.82, p < .05). 20% reported treating a patient who had a seizure associated with AED taper. 89% of respondents believed that imposing driving restrictions influenced patient willingness to taper AED.Conclusions: Most neurologists advise driving restrictions when tapering AEDs. Whether such restrictions are justified is not known and evidence based guidelines are needed. The literature estimates of probability of recurrence after AED taper suggest that the chance of seizure relapse while driving is quite small. Guidelines and physician practice should consider this probability and decide what level of risk is acceptable.