Epilepsy and drowning

There should be as little restriction to the daily living of the epileptic as possible.

The patient should not:

• swim alone
  • people with epilepsy have a higher risk of death by drowning than the general population
    • risk of drowning in people with epilepsy is raised 15- to 19-fold compared with people in the general population (1)
• bathe a baby alone

Driving and epilepsy:

Epileptic attacks are the most frequent medical cause of collapse at the wheel (if within a 24 hour period more than one epileptic attack occurs, these are treated as a single event for the purpose of applying the epilepsy regulations. Epilepsy includes all events: major, minor and auras) (1).

The following features, in both Group 1 car and motorcycle and Group 2 bus and lorry drivers, are considered to indicate a good prognosis for a person under care for a first unprovoked or isolated epileptic seizure:

• no relevant structural abnormalities on brain imaging
• no definite epileptiform activity on EEG
• support of a neurologist
• annual risk of seizure considered to be 2% or lower for bus and lorry drivers
  
  
• group 1 entitlement
  • Epilepsy or multiple unprovoked seizures
    • must not drive and must notify the DVLA
    • provided the licence holder or applicant satisfies the regulations, a review licence will usually be issued. If there have been no seizures for 5 years (with medication if necessary), and no other disqualifying condition, a 'til 70 licence is usually restored
      
      
  • First unprovoked epileptic seizure/isolated seizure
    • must not drive and must notify the DVLA
    • driving will be prohibited for 6 months from the date of the seizure
    • clinical factors that indicate that there may be an increased risk of seizures require the DVLA not to consider licensing until after 12 months from the date of the first seizure
      
      
  • Seizures secondary to underlying cause
    • must not drive and must notify the DVLA
    • in all cases of an epilepsy diagnosis, the epilepsy regulations apply to Group 1 car and motorcycle drivers. This includes all cases of single seizure in which a primary cerebral cause is present and the likelihood of recurrence cannot be excluded
    • when seizures have occurred at the time of an acute head injury or intracranial surgery these may be excepted from the epilepsy regulations
    • when seizures have occurred at the time of an intracranial venous thrombosis there must be 12 months without seizure before driving may resume

Special considerations under the epilepsy regulations Group 1 car and motorcycle

The following special considerations apply under the epilepsy regulations for drivers of cars and motorcycles:

• 1. The person with epilepsy may qualify for a driving licence if they have been free from any seizure for 1 year. This needs to include being free of minor seizures and epilepsy signs such as limb jerking, auras and absences. Episodes not involving a loss of consciousness are included
  
  
• 2. The person who has had a seizure while asleep must stop driving for 1 year from the date of the seizure unless point 3 or 5 apply
  
  
• 3. Relicensing may be granted if the person, over the course of at least 1 year from the date of the first sleep seizure, establishes a history or pattern of seizures occurring only ever while asleep
  
  
• 4. Relicensing may be granted if the person, over the course of at least 1 year from the date of the first seizure, establishes a history or pattern of seizures which affect neither consciousness nor cause any functional impairment. The person must never have experienced any other type of unprovoked seizure
  
  
• 5. Regardless of preceding seizure history, if a person establishes a pattern of asleep seizures only (all seizures had onset during sleep), starting at least three years prior to licence application and there have been no other unprovoked seizures during those three years, a licence may be issued
  
  
• overriding all of the above considerations is that the licence holder or applicant with epilepsy must not be regarded as a likely source of danger to the public while driving and that they are compliant with their treatment and follow up
  
  
• if the licensed driver has any epileptic seizure, they must stop driving immediately unless considerations 3, 4 or 5 can be met, and they must notify the DVLA. If a licence is issued under considerations 3, 4 or 5 and the driver has a different type of seizure, they lose the concession, must stop driving, and must notify the DVLA.

Withdrawal of antiepileptic medication

• individuals should not drive whilst anti-epilepsy medication is being withdrawn and for 6 months after the last dose
• if a seizure occurs as a result of a physician-directed reduction or change in epilepsy medication, the epilepsy regulations state that a licence must be revoked for 12 months. However, earlier relicensing may be considered if previously effective medication has been reinstated for at least 6 months and the driver has remained seizure free for at least 6 months

Up-to-date guidance may be obtained from the publication "At a Glance Guide to the Current Medical Standards of Fitness to Drive" and the website www.dvla.gov.uk.
Reference:

• (1) DVLA (August 2018). At a glance guide to the current medical standards of fitness to drive