AAN Issues Update on Driving, Seizures, and Medical Reporting: Here’s What to Know

The American Academy of Neurology (AAN), American Epilepsy Society (AES), and Epilepsy Foundation of America (EFA) have released an updated consensus position statement on seizures, driver licensure, and medical reporting. The document, published in the journal Neurology, is an update from the first 1994 joint position statement from the 3 organizations and a 2007 AAN consensus document.

The original 1994 consensus statement included appropriate criteria for driver licensing of patients with epilepsy.

Key positions from the 1994 statement emphasized that medical advisory boards should:

• Establish clear medical criteria for driver licensure
• Ensure that licensing criteria are set through regulations rather than statutes
• Design a licensing process that allows for individual assessment and is fair and nondiscriminatory
• Recommend a minimum seizure-free period of 3 months before considering licensure
• Permit health care practitioners to report unsafe drivers and provide them with legal immunity when doing so

In 2023, the AAN, AES, and EFA reconvened to review these position statements in light of new evidence, leading to the development of this updated position statement.

Licensing Authority

Decisions regarding driver licenses for individuals with epilepsy should be made by appropriate governmental regulatory bodies in the United States. For each relevant medical condition, medical advisory boards should convene to recommend regulations about that condition to the Department of Motor Vehicles (DMV). The position statement authors noted that policies and regulations have been enacted or amended in reaction to a single tragic accident or event, but they cautioned that regulations should not be based on single-incident events but relevant research and individualized assessments.

Practitioner Involvement in Licensing Process

Treating practitioners are provided with forms from the DMV and may provide detailed medical reports on whether the patient should be authorized to have license. However, the practitioner is not obligated to do so. After submitting recommendations, the ultimate decision on whether to license an individual remains with the medical advisory board, not the treating practitioner.

Reporting Seizures to the DMV

Reporting seizures to the DMV should be the responsibility of the patient at license application, renewal, and in between. Following a seizure, the patient should be advised to stop driving, they should consult with their doctor about the safety of resuming driving, and notify the DMV. These procedures should be stated clearly on licensure application and renewal forms.

If the practitioner believes a patient has not self-reported their seizure and is a risk to public safety, they should be legally authorized but not mandated to report the patient to the appropriate authority. Prior to reporting, the practitioner should inform their patient of their intention to report and document the interaction with the patient.

Recommended Seizure-Free Interval for Driving

The preferred minimum seizure-free interval for resumption of driving is 3 months. Current evidence suggests that longer seizure-free intervals do not reduce major vehicle accidents or fatalities. The current seizure-free intervals range between 3 and 18 months across the states. The position statement authors recommend for practitioners to abide by their state’s law, even if that law conflicts with evidence-based recommendations.

Factors that may support a shorter seizure-free interval include:

• Seizures triggered by practitioner-directed changes in medication
• Focal seizures without impaired awareness
• Seizures occurring exclusively during sleep
• Provoked seizures with a low likelihood of recurrence

Factors that may warrant a longer seizure-free interval include:

• Nonadherence to prescribed anti-seizure medication
• Seizures associated with substance use disorder
• History of a motor vehicle accident caused by a seizure
• Increasing seizure frequency, refractory seizures, or unawareness of seizure recurrence
• Presence of structural brain lesions

State-Level Medical Advisory Boards

Each state should establish a medical advisory board that includes at least 1 health care practitioner who specializes in epilepsy care. The AAN recommends that the medical advisory board assist in individualized assessments for an appropriate seizure-free interval. Additionally, the medical advisory board should set medical standards for driver licensure, educate practitioners and the public about medical considerations for licensure, review complex cases, and update processes on the basis of new guidelines.

Driving Risks and Functional Seizure

The authors of the position statement noted there is currently limited data available on the driving risks associated with functional seizures. However, they recommend that patients with functional seizures involving alterations to responsiveness and/or involuntary movements should be subject to similar restrictions as patients with epilepsy.

Patients’ Rights and License Suspension

When a driver’s license is suspended due to medical reasons, patients should receive timely notice and have the opportunity to appeal decisions about their license with a reasonably short administrative process. All patients who are subject to medical restrictions on driving should be provided with accommodations, including remote work options, access to public transportation, and subsidized transportation.

“This position statement is offered in hope of improving the public process of management of a complex societal, governmental, medical, and personal issue,” the position statement authors wrote.