Mike Glynn IBE President 12 th Epilepsy and Society European Conference Porto August 2010 ID: 929787
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Driving and Epilepsy – The IBE Perspective
Mike Glynn, IBE President 12th Epilepsy and Society European Conference Porto August 2010
Slide2Epilepsy and Driving
DEADLINE FOR EUROPEAN UNION MEMBER STATES TO IMPLEMENT COMMISSION DIRECTIVE 2009/112/EC29TH August 2010 `
Slide3Epilepsy and Driving in Europe E C Directive Group 1 1st SeizureEpilepsy
Provoked seizure
Sleep seizures
Other seizures wihout influence on driving ability
Other loss of consciousness
Seizure because of change of medication
6 months
12 months
Varies
12 months + no other seizures
12 months + no other seizures
Varies
3 mo
Slide4Epilepsy and Driving in Europe E C Directive Group 2 First unprovoked seizure The applicant who has had a first unprovoked epileptic seizure can be declared able to drive once 5 years freedom of further seizures has been achieved without the aid of anti-epileptic drugs, if there has been an appropriate neurological assessment National authorities may allow drivers with recognised good prognostic indicators to drive sooner. Epilepsy 10 years freedom of further seizures has been achieved without the aid of anti-epileptic drugs. National authorities may allow drivers with recognised good prognostic indicators to drive sooner.
Slide5Driving is a privilege
Slide6Epilepsy and Driving
This (Driving) is undoubtedly one of the most emotionally charged issues for individuals with epilepsy. Until relatively recently most countries had extremely onerous restrictions on individuals with seizures. Some even took away driving privileges for life. Berg, A 2004 IBE Commission on Epilepsy, Risks and Insurability
Slide7Epilepsy and DrivingDriving Directive will needs pressure from IBE member in each countryUse MEPs –great issue for them, European concern but with local perspective
Put pressure on National Governments, politicians – use neighbouring countries situation (if better!)
Slide8Epilepsy and DrivingUse Media – they love Driving issue:
good human interest storyThey can identify with losing license
Slide9Epilepsy and DrivingDiabetes and Eyesight charities have the same issue – examine the possibilities of working with them
Slide10Epilepsy and DrivingDriving is a great issue for IBE members:
This is your issue –not a medical or legislative issueRecognition by Government of PWEs driving privileges means they have other rights tooCan lead to Employment, Education, Social Entitlements and other human rights too
Slide11Epilepsy and DrivingReasons why PWE are excluded from or
unfairly limited in driving privilegesFear / Stigma / Cultural / ReligiousAdherence / Compliance problemsEconomic ReasonsDoctor reporting issues with AuthoritiesLack of representation for PWE
Slide12Group 1 vehicles (private cars etc.)Epilepsy - USA
Huge variation from State to StateRanges from 3 months to 18 months seizure-free periodsMany States have ‘no set seizure-free period’5 States impose reporting requirement on PhysiciansWith minor exceptions, none of the 52 States are exactly the same
Slide13Group 1 vehicles (private cars etc.)Epilepsy – Asia Oceanic region/s
Japan – 2 years (with certification)Australia – 6 months to 2 yearsNew Zealand – 1 yearThailand – unclearMalaysia – In practice may be determined by PhysicianIndia, Singapore, Taiwan – complete banOther countries – no information
Slide14Epilepsy and Driving
Major changes in European Union regulations which must be introduced before September 2010 can be traced directly to:The IBE Driving Workshops held in 1995 & 1996 in Brussels
Slide15IBE Task Force on Driving & Epilepsy
Members:Mike Glynn Ireland ChairDr. Marshal Hsai Song TaiwanDr. Eric Schmedding BelgiumOrla Gilroy HongkongDr. Silvia Kochen ArgentinaDr.Andrew Pan Singapore
Slide16Epilepsy and Driving
European Countries by GDP ranking Countries with Driving Regs for Epilepsy Countries with no Driving Regs for Epilepsy1 Luxembourg 69,800 31 Slovenia 21,808 4 Ireland 40,610 33 Cyprus 21,177 6 Denmark 34,740 41 Hungary 16,823 9 Austria 33,432 43 Estonia 16,414 12 Belgium 31,244 45 Slovakia 16,041 13 Finland 31,208 49 Lithuania 14,158
15 Netherlands 30,862 51 Poland 12,994
17 Germany 30,579
53 Latvia 12,666
8 United Kingdom 30,436
66 Bulgaria 9,223 19 Sweden 29,926 67 Romania 8,785 20 France 29,187 21 Italy 28,534 25 Spain 26,320
30 Greece 22,392
In negotiation
37 Portugal 19,335
36 Malta 19,739
38 Czech Republic 18,341 75 Turkey 7,950
States with special EU relationship
2 Norway 42,364
5 Iceland 35,115
10 Switzerland 32,571
Slide17Epilepsy and DrivingCountries with Driving Regulations for Epilepsy
All have national member of IBE run by lay professionals 1 Luxembourg 69,800 4 Ireland 40,610 6 Denmark 34,740 9 Austria 33,432 12 Belgium 31,24413 Finland 31,208 15 Netherlands 30,862 17 Germany 30,579
18 United Kingdom 30,436
19 Sweden 29,926
20 France 29,187
21 Italy 28,534
25 Spain 26,320
30 Greece 22,392 37 Portugal 19,335 36 Malta 19,739 38 Czech Republic 18,341
2 Norway 42,364
5 Iceland 35,115
10 Switzerland 32,571
Slide18Epilepsy and driving in Europe
Second Working Group on Epilepsy and Driving of the European Union April 2005
Slide19Epilepsy & DrivingMembers of the Working Group
Mr Joël Valmain Dr Jaume Burcet DardeDr Bernhard GappmaierProf Guenter KraemerDr John KirkerDr Mikael OjalaDr Nicole MarkschiesDr Eric SchmeddingDr Anders SundqvistDr Elena ValdèsProf Hervé Vespigniani,Dr Graham WetherallDr Jörgen Worm-Petersen
Traffic Bureau EU
Spain
Austria
Ireland
Germany
GermanyFinlandBelgiumSwedenSpainFranceUnited KingdomDenmark
Slide20Actual v Proposed S-Free period
GROUP 1 First seizure
Slide21Actual v Proposed S-Free period GROUP 1 Epilepsy
Slide22Actual v Proposed S-Free period
GROUP 2 First seizure
Slide23Actual v Proposed S-Free period GROUP 2 Epilepsy
Slide24Epilepsy and Driving in Europe Schmedding et al Recommendations Group 2
Final report; 3 April 2005 32 Table 9 Proposed guidelines for GROUP 2 Clinical situation Advise General conditions for all Group 2 drivers The applicant should be without anti-epileptic medication for the required period of seizure freedom; There has been a appropriate medical follow-up; On extensive neurological investigation no relevant cerebral pathology has been established and there is no epileptiform activity on the EEG. The subject can only be declared able to drive subject to neurological opinion. The risk of having a seizure should be 2% per annum or less. - Provoked seizure, because of a recognisable and avoidable provoking factor The applicant that has had a provoked epileptic seizure because of a recognisable provoking factor that is unlikely to recur at the wheel can be declared able to drive on an individual basis, subject to neurological opinion.
An EEG and an appropriate neurological assessment should be performed after the acute episode.
Someone with a structural intracerebral lesion who has increased risk of seizures should not be able to drive vehicles of group 2 until the epilepsy risk has fallen to at least 2% per annum.
NOTE: The assessment should be if appropriate in accordance with other relevant sections of Annex III. (e.g. in the case of alcohol)
First unprovoked seizure The applicant who has had a first unprovoked epileptic seizure can be declared able to drive once 5 years freedom of further seizures has been achieved without the aid of anti-epileptic drugs, if there has been an appropriate neurological assessment
National authorities may allow drivers with recognised good prognostic indicators to drive sooner.
Other loss of consciousness The loss of consciousness should be assessed according to the risk of recurrence while driving. The risk of recurrence should be 2% per annum or less. Epilepsy 10 years freedom of further seizures has been achieved without the aid of anti-epileptic drugs. National authorities may allow drivers with recognised good prognostic indicators to drive sooner.
Special situations
Driving ban
Prophylactic ban Certain disorders have an increased risk of seizures, even if seizures have not yet occurred. In such a situation an assessment should be done: the risk of having a seizure should be 2% per annum or less.
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Slide25Epilepsy and Driving: The chance of having an accident while driving
(with frequent seizures)367 pre-surgical patients: do you drive?30 % admit this, most of them drive at least weekly40 % (!) at some point had a seizure while driving 70 % of them (27% of the whole group) had, at one point in time, one or more accidents while driving. Of these 32% had physical damage himself; 20% caused physical damage in others Berg A et al: “Driving in adults with refractory localisation-related epilepsy” Neurology 2000; 54: 625-630
Slide26Epilepsy and Driving Causes of a “provoked seizure”May be avoidable (depending on the circumstances):Medication: Antipsychotics, antidepressives, anesthetics, antibiotics, theophylline, cardiovascular drugs
Metabolic
Hypo- Mg, Ca, Na, glucose; Hyper- Na, glucose
Traumatic; infection; stroke
Not (sufficiently) avoidable:
Alcohol and alcohol withdrawal
Drugs Fever Sleep deprivation, (sleep), arousalStressReflex epilepsies
Slide27Epilepsy & Driving Compulsory notification
Compulsory notification of the authorities by the treating physician leads to underreporting of seizures. (up to 90%) This interferes with the doctor-patient relationship and with treatment. Moreover, it is not effective: only 25% of people breaking the law are traced. (Canada)It is strongly advised against by:The First Working Group on Epilepsy and Driving 1996The Second Working Group on Epilepsy and Driving 2004 An advisory body to the Driving Licence Committee of the European Union A consensus of the Am. Acad. Neurology (AAN), the Am. Epilepsy Society (AES) and the Epilepsy Foundation (USA) 1994
Slide28Driving & EpilepsyConcealment of seizures
The number of patients who conceal their seizures from their treating physician increases if this physician has the power to take their licence awayIn an American study 4% of patients concealed their seizures for the treating physician. This increased to 28% where the doctors had to report to the authorities
Slide29Epilepsy and Driving-Insurance`
Slide30Epilepsy and Driving
Motor Insurance `-Provided PWE are driving under their country’s regulations they should have equal access to Insurance.
Slide31Epilepsy and Driving`
Motor Insurance `-There have been problems in some countries but these have been solved by the IBE member Assoc.e.g. a) Brainwave and ILAE medics established a relationship with the Irish Insurance Federation and can go directly to them b) Epilepsy Action in UK set up its own Insurance plan for PWE.IBE Driving Task Force can help any member assoc. With Insurance problems.
Slide32Safe Driving
Slide33Epilepsy and Driving
http://europa.eu.int/comm/
transport/home/driving
licence/index_en.htm
.
DRIVE ON !