Driving eligibility: Implications of studies on seizure recurrence risk.

Abstract

Driving is one of the most important issues for patients with seizures. The 2009 European directive provides a framework for evaluating standard situations in assessing the ability to drive. Such a framework may not be sufficient for individual scenarios. To analyse current data on seizure recurrence risks (RcRs) focusing on their potential implications for car driving issues (group 1). We evaluated current studies and meta-analyses on RcR. A meta-analysis of seizure-free patients who withdrew their medication (Lamberink et al Lancet Neurology 2017;16:523) created a nomogram and a web-based tool that allow estimating RcR in individual patients and thus to identify those in whom medication withdrawal is possible without the common driving ban during withdrawal. The 2-year prediction model of that meta-analysis has been recently externally tested and confirmed. A meta-analysis of patients with a first unprovoked seizure (Bonnett et al PloS ONE 2014;9:e99063) determined to which extent RcRs depend on established risk factors. The seizure-free period required to restart driving could be tailored according to the individual RcR. These current studies allow estimating individual RcR more precisely and thus modifying periods of driving bans beyond the existing guidelines.