PHILADELPHIA – Many U.S. epilepsy specialists take a conservative stance and advise their patients not to drive when they have been seizure free for more than 2 years and taper off of anti-seizure medications or have just stopped medications altogether, based on survey replies from more than 400 U.S. neurologists.
Roughly two-thirds of these physicians said they advise their tapering-down epilepsy patients not to drive even though these patients face about a 0.3% annual risk for a seizure while driving if they drive for 30 minutes a day, Dr. Joon-Yi Kang said in a poster she presented at the annual meeting of the American Epilepsy Society. And more than half the surveyed neurologists advised abstaining from all driving during the 3-6 months after taper down completes and patients are completely off anti-seizure therapy.
Dr. Joon-Yi Kang
Neurologists who advise their epilepsy patients who are tapering down or recently stopped anti-seizure medications “need to think more carefully” about the actual risk patients face when driving, suggested Dr. Kang, a neurologist at Johns Hopkins Hospital in Baltimore. Typically neurologists advise patients to taper down medications after they have been seizure free for at least 2 years, she said in an interview. No U.S. guidelines cover driving once seizure-free epilepsy patients start to withdraw from treatment and no states have laws that cover this situation, she noted.
Once tapering-down of treatment begins, the immediate risk for a seizure runs from 12%-30%, based on published reports, with the risk dropping below 20% once a patient has been seizure free for at least 3 months on gradually reduced treatment or completely stopped treatment, she noted. Based on this Dr. Kang estimated that during the first year of taper down and then full withdrawal the average U.S. epilepsy patient has an overall seizure risk of 15%. If this patient drove 30 minutes each day their average seizure rate while driving would be about 0.3% for the entire year, she reported in her poster.
“This sort of calculation is usually not done” but estimating the risk faced by each patient and discussing that risk with each patient is important, she said. “Some patients stay on their medications just so that they can continue to drive. We need to carefully think about what is an acceptable level of risk.” The restrictions many neurologists recommend to patients “unnecessarily limit patient function,” Dr. Kang said.
She and her co-author sent their survey to 2,028 neurologist members of the American Epilepsy Society and received replies from 411 (20%) in 42 states. About 80% of respondents said that more than half of their practice involved patients with epilepsy, and about 70% said that they had at least 5 years of clinical experience.
During the taper-down period, 65% of respondents said they advise patients to not drive and an additional 24% said they advise patients to minimize their driving. Once patients totally withdrew from treatment, 53% advised continuing to restrict all driving, usually for an additional 3-6 months, and 26% said they advise patients to minimize driving. In addition, 89% of respondents said that their recommendations to restrict or minimize driving often prompted patients to remain on treatment. “I think these findings reflect usual practice” among U.S. neurologists, Dr. Kang said.
On Twitter @mitchelzoler