Epilepsy and Driving Regulations in Wisconsin

Summary: Driving regulations in the state of wisconsin have evolved In 1987, changes in these regulations focuseed the problem on loss of consciouness and bodily control of drivers rather than on specific diagnostic entities such as epilepsy or diabetes mellitus. Current wisconsin law encompasses loss of consciousness or events affecting bodily control, nop matter what the cause. Current regulations balance individual needs with the of safety for society Neurologists are encouraged come involved to keep the process of regulation with the dynamic changes in medical care and in portaion techonology (e.g. air bags, roll bars, etc).     

Epilepsy and Driving: An International Perspective

Summary: Individuals with a history of seizures may be granted driving privileges if the risks of future seizure while driving are relatively low. Different nations have defined these risks in a wide variety of ways. Some countries, e.g., Japan, Greece, Brazil, India, and Russia, preclude driving after a single seizure. Other countries, suchas Canada and the United States, allow driving 3 months after certain types of seizures. A Joint Commission of the International Bureau for Epilepsy/International League Against Epilepsy has summarized regulations in several countries. From a consideration of med-ical literature and existing practices, a series of proposedguidelines for driving and epilepsy is recommended. Ingeneral, these guidelines suggest use of a seizure-free interval, generally 1–2 years but less in particular instances, to determine fitness to drive. Required physician reporting is discouraged, but physicians should report patientswhom they believe pose a danger to themselves and topublic safety. Individualized consideration should begiven to special circumstances that may modify a generaldriving prohibition. Education and information programsare necessary for medical and regulatory authorities to develop a rational approach to driving and epilepsyworldwide.     

Epilepsy, Driving Laws, and Patient Disclosure to Physicians

To avoid loss of driving privileges, patients with epilepsy may elect not to report seizures to their physician or to the Department of Motor Vehicles (DMV). Reporting to the physician may differ depending upon the type of law in effect, i.e., mandatory physician reporting versus patient reporting to the DMV. Nondisclosure to the physician may have important consequences with regard to seizure management. We surveyed patients at two adult seizure clinics to determine the effect of driving laws on patients' reporting to their physician. One hundred fifty-eight patients completed an anonymous questionnaire asking whether they would report a breakthrough seizure under a physician versus a patient DMV reporting system. Under patient reporting, 96% would inform their physician and 56% would report to the DMV. Under physician reporting, 84% would inform their physician. This falls to 72% when considering currently driving patients only. An additional 9-17% of patients would continue to drive with a suspended license. In all, 53% would remain driving under patient reporting and 33% under physician reporting; however, with physician reporting, half of the illegally driving patients would have compromised their medical care, potentially increasing driving risk.     

Driving and Epilepsy: Changing the Law in Maryland

Summary: The Epilepsy Association of Maryland, an affiliate of the Epilepsy Foundation of America (EFA), recognized that the Maryland state regulations and laws ondriving licensing restricted the rights of individuals withepilepsy. After identifying the problem, the Associationdetermined the needed changes and planned a legislativestrategy to accomplish the change. Once the change wasachieved, the Association planned and executed stepsnecessary for successful implementation of the change.     

Total Patient Care in Epilepsy

Summary: The aim of total care in epilepsy is to ensure the best possible management for each individual patient. Although pharmacotherapy for reduction or suppression of seizures is the basis of treatment in epilepsy, social and environmental problems are as likely to distress patients as continuing seizures. One often neglected aspect of management is the provision of adequate information for patients and relatives with regard to the various aspects of the seizure disorder. Better education of society regarding epilepsy is necessary to remove the many preconceptions and prejudices that still prevail. It is important to encourage self-confidence in the patient and to avoid overprotection. Restrictions on lifestyle, including driving and employment, should be decided on a case-by-case basis, and only imposed if really necessary. Patients with epilepsy refractory to treatment should have access to specialized referral centers and institutions. One of the major goals of total patient care should be to help the patient with a seizure disorder lead a normal life, insofar as this is not prevented by additional mental retardation or cognitive dysfunctions.     

Impact of New Regulations On Assessing Driving Status (INROADS): A South Australian seizure clinic cohort

The ability to drive is important to patients and driving restriction often leads to restriction of employment and social opportunities. In March 2012, Austroads released revised Assessing Fitness to Drive Guidelines (AFTDG) with significant changes for drivers with seizures and epilepsy. Our study aimed to assess the impact of the 2012 AFTDG on a Seizure Clinic cohort compared to the previous 2003 AFTDG and an individual’s current driving status. We also aimed to quantify the difference in AFTDG interpretation between expert and non-expert doctors. We performed a retrospective observational audit of case notes for all patients managed in a public hospital outpatient Seizure Clinic between 1 March 2010 and 1 March 2012. A total of 142 patients were included in the analysis. Comparison between the 2003 and 2012 AFTDG resulted in reduced eligibility to drive a private vehicle by 2.1% (52.5% versus 50.4%) and commercial vehicle by 2.2% (4.5% versus 2.3%). The proportion of those currently driving against guideline recommendations increased (private 8.8% versus 19%; commercial 50% versus 100%) and the non-expert assessor was more likely to agree with the experts with the 2012 AFTDG. In summary, the 2012 AFTDG has had a measurable impact on driving eligibility in individuals with seizure although it is easier to interpret for non-expert doctors. Greater awareness of the 2012 AFTDG is required to reduce the proportion of patients driving against current recommendations.     

Overview and Perspectives of Employment in People with Epilepsy

Summary:  Even though it is now the viewpoint of the majority of professionals working in epilepsy care that most people with epilepsy should and can perform on the labor market as does anybody else, research tells a different story. Most figures concerning employment rates of people with epilepsy indicate that they do not perform as well on the labor market as others do. Although both research figures and research groups vary, generally unemployment rates are higher for people with epilepsy than for the general population. Early studies showed that the situation for people with epilepsy was rather grim. Later studies showed similar outcomes. Unemployment rates vary between groups and countries. Research shows that being employed is an important ingredient of the quality of life of people with epilepsy. The World Health Organization also recognizes the importance of employment as a part of social health, and therefore, improving the quality of life. It is important to know the perspectives on the labor market for people with epilepsy and what the possible problems are. I describe a Dutch research project and give an overview of the findings concerning the employment and consequent employability of people with epilepsy and questions pertaining to employment and epilepsy. Possible interventions [i.e., public education and employment programs for people with epilepsy with the aim to improve the (re)integration of people with epilepsy into the labor market, thus improving the quality of life of (potential) employees with epilepsy], are described extensively.     

Driving prevalence and factors associated with driving among patients with epilepsy

PURPOSE: The goal of the work described here was to determine the prevalence of driving and associated variables among patients followed at a level 4 epilepsy center. METHOD: A survey was mailed out to patients seen at the University of Florida/Jacksonville Comprehensive Epilepsy Program. RESULTS: The study population comprised 308 respondents. Nearly 20% of patients with poorly controlled seizures continued to drive. Although several demographic and clinical variables were associated with driving, on univariate analysis, using multiple logistic regression, being employed, not receiving disability benefits, having less frequent seizures, and taking fewer antiepileptic drugs were the variables independently associated with driving. A subset analysis of patients with poorly controlled seizures indicated that being employed was still an independent factor associated with driving, along with higher annual household income and absence of convulsions and waking seizures. CONCLUSION: A significant number of patients with poorly controlled seizures drive. Being employed is a major reason these patients continue to drive.     

Epilepsy and law

Epilepsy can define who one is rather than the diagnosis one has. It may be considered under the rubric of disability with legislative protection against discrimination. Those seeking remedy should investigate alternative dispute resolution in preference to litigation. Many areas of the life of a person with epilepsy deserve examination when considering epilepsy and law. Just some of these include: duty of care; informed consent; driving; research; social interactions; insurance; recreational pursuits; employment; and privacy. This article examines the legal implications and ramifications of these selected topics, acknowledging that the limited scope of the article has only exposed the tip of the iceberg to encourage further exploration.     

Driving and Epilepsy: A Historical Perspective and Review of Current Regulations

Summary: Historically, persons with seizures or epilepsyhave been prohibited from driving automobiles or motorvehicles because of concern for public safety. Seizureshave a tendency to recur and pose risks of traffic accidents, property damage, and personal injury. In our modern world, however, driving an automobile is such aneconomic and social necessity that a conflict results between our need to protect public safety and our responsibility to provide reasonable opportunities to drive forpersons handicapped by seizures and epilepsy. Currently, there is a trend toward liberalization of driving standardsfor persons with epilepsy, but there is still considerablecontroversy regarding the specific driving restrictionsnecessary for persons with seizures, the way in whichsuch policies should be administered, and the role physicians should have in the process.     

Employment after anterior temporal lobectomy

Purpose: To explore the effect of anterior temporal lobectomy on employment and define demographic and clinical predictors of postoperative employment in a large cohort with a prolonged observational period. Methods: Subjects had an anterior temporal lobectomy for refractory epilepsy. All had an assessment period of 4 years or more with documentation of demographic factors, employment status, and seizure frequency prospectively registered in a database at surgery and at each contact after surgery. McNemar chi‐square and a Wilcoxon matched pairs test were used to compare employment status before and after surgery. A multiple logistic regression assessed independent predictors of postoperative employment status based on preoperative employment status. Key Findings: Three hundred sixty‐nine patients were evaluated. Employment levels were higher and unemployment levels were lower after surgery (McNemar χ² = 3.96; p = 0.047). Working before surgery (Wald’s χ² = 22.69, p < 0.0001) and having a greater percent of seizure‐free years (Wald’s χ² = 34.43, p < 0.0001) were associated with being employed after surgery. Of 131 patients who were unemployed or homemakers before surgery, 67 (51.1%) became employed postoperatively, with a younger age at surgery, a younger age of epilepsy onset, and driving a motor vehicle associated with gaining employment. Of 172 patients who were working at baseline, 27 (15.7%) became unemployed or homemakers after surgery. Gender was the only variable associated with loss of employment, with women being more likely to become homemakers (χ² = 14.98, d.f. = 6, p = 0.02). Most students were working after surgery, with seizure control influencing outcome. Significance: Anterior temporal lobectomy is followed by reduced unemployment and underemployment, with elimination of seizures, relative youth, and operating a motor vehicle serving as the main driving forces for improvement. This is important information for patients and physicians who contemplate surgery as it helps define reasonable expectations, and provides further objective evidence for benefits beyond purely medical outcomes after epilepsy surgery.     

What We Confront with Employment of People with Epilepsy in Korea

Summary:  Purpose: To investigate the current status of employability in people with epilepsy (PWE) in Korea.
   Methods: Data were collected from 543 adult epilepsy patients. Housewives and students were excluded. Information was obtained from self-completed questionnaires.
   Results: The unemployment rate for Korean PWE was as high as 31%. This figure was five times higher than that of the general population. The unemployed PWE had significantly lower quality of life than the employed PWE. The employability of PWE was significantly affected by certain factors: the frequency and severity of seizures; age at onset; interseizure psychosocial disabilities including self-esteem, personality, and problem-solving style; and social discrimination. Actual discriminatory practices in the employment of the PWE were prevalent in Korea. Overall, 24.5% of respondents believed they had ever been treated unfairly at work or when trying to get a job. More than half of those who disclosed their disease to employers reported that they were refused a job because of epilepsy. About 75% of the patients surveyed said that they had never disclosed their disease in applying for a job.
   Conclusions: In Korea, PWE have faced many difficulties in employment. The discrimination against PWE and negative social attitudes toward epilepsy might play an important role in the employability of PWE. We need active participation in the "Out of the Shadows" world campaign.     

Attitudes of Major Employers Toward the Employment of People with Epilepsy: A 30-Year Study

Beginning in 1956, major San Francisco Bay area employers were sampled at 10-year intervals for a 30-year period to assess attitudes toward the employment of epileptic workers. In this time, we documented a trend of sustained positive change that appears to validate the efforts of organizations that have focused on raising public awareness of this disorder.     

Epilepsy and driving in Japan

PURPOSE: The driving regulations in Japan were amended in 2002, which lifted the absolute ban on driving by persons with epilepsy (PWE) and granted licenses to PWE after a 2-year seizure-free period. METHODS: To survey the effect of the new driving regulations, we sent questionnaires both to the driving authorities (DAs) and to doctors of the Japan Epilepsy Society (JES). RESULTS: Around 1,400 PWE legally obtained a driving license within 1 year after the amendment, licenses were rejected in 157, and 61 had the license withheld for <6 months. In most cases, the attending doctor assessed fitness for driving; 171 doctors responded to the questionnaire. One third of them commented on a positive change in attitude of PWE with respect to driving. Their main remarks included the need to shorten the seizure-free period to qualify for fitness to drive and the need for special guidelines for conditions such as rare seizure occurrence, recently diagnosed epilepsy, or reflex epilepsy. Problems of assessment identified included difficulty in deciding the time for reassessment, distress of PWE over cancellation of license, cost of the assessment, responsibility of the assessing doctors in case of seizure recurrence, and protection of privacy. They requested the DAs to promote publicity about the information and asked the JES to establish a guideline for assessing fitness to drive. CONCLUSIONS: The results highlighted the need for cooperation between the DAs and the JES for further amendment of the regulations as well as the importance of education for the public, patients, and professionals.     

Effect of fatigue on performance measured by a driving simulator in automobile drivers

OBJECTIVE: To identify risk factors of performance decrement in automobile drivers. METHODS: 114 drivers (age <30 years, n=57; age > or =30 years, n=57) who stopped at a rest stop area on a freeway were recruited for the study. They filled out a questionnaire on their journey, sleep/wake patterns and performed a 30-min test on a driving simulator. The test evaluates, by computerized analysis, the lateral deviation of a virtual car from an appropriate trajectory on a virtual road. A sex/age matched control group was recruited in the community. Control subjects were studied at the same time of day as the index case driver. Controls had normal sleep wake schedule, absence of long driving and performed the same driving test. RESULTS: Drivers performed significantly worse than controls on the driving test. Age and duration of driving were the main factors associated with decreased performance. CONCLUSION: Our driving simulator can identify fatigue generated by driving but results must be considered in relation with age of subjects.     

Epilepsy and Traffic Safety

We previously reported that drivers with epi lepsy have somewhat higher age-adjusted rates of traffic accidents and moving violations than do drivers without epilepsy. We attempted to identify medical and other fac tors contributing to this increase. Medical records of 241 drivers with a history of seizures, representing essentially all such persons from a contiguous seven ZIP postal code area served by the Marshfield Clinic were studied. This zip code refers to a defined geographic area around Marshfield where virtually the entire population receives its care at the Marshfield Clinic and for which we have accurate records. Information abstracted from medical charts was used to identify potential risk factors for traffic accidents and violations among these drivers. Careless driving violations, alcohol or drug violations, and accidents (especially injury accidents) occurred at higher rates and speeding violations occurred at lower rates for drivers with epilepsy. Young age, unmarried state, history of multiple seizures, and lack of antiepileptic drug (AED) treatment appear to be risk factors for accidents among drivers who had a history of seizures. Male sex, psychiatric disorders, alcohol abuse, and generalized seizures or complex partial seizures (CPS) were also suggestively associated with higher risk. For moving violations, young age, male sex, unmarried state, symptomatic etiology, and history of alcohol abuse contributed to in creased risk. We conclude that drivers with epilepsy appear to have identifiable risk factors for traffic mishaps, especially accidents.     

Severe Burns as a Consequence of Seizures in Patients with Epilepsy

We report 10 seizure-related thermal injuries severe enough to require hospitalization in patients with epilepsy. Eight of the ten incidents were with patients who had had seizures with impaired consciousness two or more times a month. This suggests that seizure frequency is a risk factor and implies the importance of striving for optimal seizure control. Two burns each occurred from an electric iron, a hand-held hair dryer, and stove-top cooking. Minimizing these activities, especially in patients with frequent consciousness-altering seizures, may be useful. Three burns occurred while showering; these resulted in the most severe injuries, with hospital stays of 29, 30, and 41 days. Simple plumbing devices may have prevented these injuries.     

Which features of Parkinson's disease predict earlier exit from the workforce?

IntroductionFew objective data exist regarding predictors of leaving the workforce (LWF) in Parkinson's disease (PD).MethodsEmployed PD patients were followed prospectively. Baseline demographics, disease duration, and measures of disease severity, cognition, disability, and mental health were compared between patients working at last follow-up versus those who left the workforce using student's t-tests and multivariate analyses controlling for age, gender, and PD duration.ResultsOf 419 employed patients, 224 had left the workforce by last follow-up. Patients who left the workforce were more likely to be older, female, have lower-income, and have longer PD duration. LWF patients had greater baseline depression, anxiety, and overall psychiatric distress. PD severity did not differ between groups.ConclusionDemographics, disease duration, and mental health contribute to LWF, but not motor severity. Age, gender and income contributions are difficult to modify but important to recognize. Worse baseline mental health is associated with LWF, suggesting a potential target for intervention.