Joseph Sirven, MD: Variables Impacting Vehicle Use for Patients with Epilepsy

December 9, 2018

The Director of the Epilepsy Division at Mayo Clinic in Phoenix discussed the issue of driving when withdrawing patients off seizure medication either because of treatment, remission or surgical intervention.

“The issue of driving is probably one of the most emotionally latent, polarizing topics that any neurologist has and there is nothing more, in terms of how emotional and upset everyone gets because driving is life.”

At the American Epilepsy Society’s annual meeting in New Orleans, Louisiana, Joseph Sirven, MD, Director of the Epilepsy Division at Mayo Clinic in Phoenix, Arizona, sat down with NeurologyLive to discuss variables impacting the issue of driving for patients withdrawing from seizure medication.

Sirven explains that while time seems to be an essential variable, there has been interesting ways of applying big data to individualize the decision for the patient. New analyses have been published utilizing nomograms to determine a patients’ risk of seizure recurrence, which then informs physicians if a patient should or should not drive.

Another approach is based on a recently published paper that identified and compared cases of seizure-related vehicle crashes involving patients with epilepsy with non-seizure-related crashes by cross referencing medical records and the Victorian Police Traffic Incident database and the Road Crash Information System Database.1 This type of data, which Sirven adds never existed before, can be used to feed algorithms that input the creation of autonomous cars, which could ultimately disrupt this entire debate.

The bottom line, Sirven concludes, is that clinicians need to document their counsel with patients according to state driving laws and that while nomograms and EEG have been used to better estimate the risk of seizure occurrence, good old-fashioned time is still the ultimate component of making the decision.

REFERENCE

1. Neal A, Carne R, Odell M, et al. Characteristics of motor vehicle crashes associated with seizure. Neurology. 2018;91(12). doi: 10.1212/WNL.0000000000006208.