Elsevier

Epilepsy & Behavior

Volume 62, September 2016, Pages 304-305
Epilepsy & Behavior

Editorial
Fitness to drive — When all may not be as it seems

https://doi.org/10.1016/j.yebeh.2016.06.032Get rights and content

Introduction

Providing the driving licensing authority (DLA) advice as to which patients with epilepsy should, or should not, be allowed to drive is fraught with potential hazards. A recent Queensland case [1] involved the Medical Registration Board to attempt to have a doctor disqualified from practicing medicine consequent to inappropriately allowing a patient with epilepsy to drive.

Much debate surrounds mandatory reporting of patients with epilepsy to the DLA [2], [3], [4]. Those opposed to mandated notification cite interference with the doctor–patient relationship [5], [6] and depreciated capacity to advocate for the patient [7] as major obstacles undermining forced reporting. Having strongly opposed mandatory reporting of patients [8], [9], [10], I have concurrently argued in favor of indemnified notification if this is undertaken in good faith [8], although this was not specifically related to epilepsy, which is the focus of this paper. According to AUSTROADS Guidelines, patients with uncontrolled epilepsy are expected to self-report to the DLA [11]. An inherent problem, within this concept, is the need for that patient to both appreciate and acknowledge that (s)he has had a seizure, something which is not always the case, as will be demonstrated in the material to follow. This raises profound problems, which will also be identified and analyzed. Appreciation of these considerations has massive implications for how one deals with epilepsy and driving. The case study that follows demonstrates how correct procedure can protect both the doctor and patient and their relationship, as well as the society in which they live.

Section snippets

Example

JC, a 25-year-old Caucasian male, was referred by a neurologist for a second opinion because the patient, with a past history of epilepsy controlled with levetiracetam and clonazepam, had been witnessed to be driving erratically and had his license to drive revoked. At the time of referral, EEG and MRI were reported as normal. He lost his job, as a diesel mechanic, because of his inability to drive.

At age 8 years, 6 months after what was considered a minor head injury, he had his first

Discussion

This case highlights many factors including the need to advise the DLA of clinical decisions and the basis thereof. While the DLA was provided with the police report, this was not available to either neurologist who had assessed the patient.

The explanation provided by the mother and stepfather, and corroborated by the patient, was both plausible and convincing. The description of the sobriety tests, in the face of a negative alcohol screen, added weight to the argument that this was a young man

Conclusion

Recommendation to the DLA, concerning fitness to drive, is a very important function of those who treat people with epilepsy. What this case conveys is that those doctors who are responsible to give such advice must be in control of all the facts, something that is not always possible. This underscores the need to have a good relationship between doctors and the DLA, because it is ultimately the DLA which does have access to all reports and hence must take responsibility to make the final

Conflict of interest

The author declares no conflict of interest.

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