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How Can Neurologic Disorders Impact Driving
In the United States, automobile driving has become the norm and a necessity of daily life. And, is directly linked to economic livelihood, freedom and independence. Even though driving a vehicle is essential in so many ways, millions of Americans are involved in injury crashes and fatalities each year. Based on recent statistics, many of today’s automobile accidents result in annual deaths of 40,000 and 250 billion dollars each year.
Medical content reviewed by Dr Eric Jackson-Scott MD, Chief Medical Officer 
Also, as doctors and other medical professionals continue to evaluate the reasons why, there is at least one common obvious concern that’s involved. This is a problem that relates to impairment in an individual’s ability to drive, such as psychiatric, neurological or medical disorders. In specifics, some of the most commonly named are as follows:
- Parkinson Disease
- Alzheimer
- Illicit drugs
- Sleep disorders
- Multiple sclerosis (MS)
- Cerebrovascular disease
All of which can severely impair an individual’s ability to drive safely while on the road. With that being said, here are 2 common neurological questions that need to be addressed to solve these concerns. And, they are provided for you below.
At what point, should driving on the road be curtailed?
When should an individual with an impairment be reported to the public authorities over the safe and unsafe driving privileges.
While these are important questions to find answers to, it is also important to consider all of the variables in making the proper decision.
The Neurology of Driving
First of all, everyone should know that driving is a complex task that easily be deceptive to anyone behind the wheel. This is because the act of driving safely involves a variety of different essential neurological systems, including the following:
- Ability to maintain attention
- Intact coordination
- Vision
- Motor Control
- Cognitive functioning
So, it is important to note that any lack in one or more of these neurological systems, creates an impairment that may eventually lead to unsafe driving practices. Therefore, based on the individual’s neurological condition or impairment, the neurologists should address and recommend the appropriate course for that individual. In fact, during these types of consultations, the physician can determine and document the fitness for driving for an individual. Here are some of the more commonly known cognitive functions that must be fully evaluated.
Attention and Perception are requirements for quickly determining how to handle situations while on the road.
Previous Memory and Experiences required to formulate decisions quickly in certain situations.
Cognitive Functioning that’s needed to consistently evaluate when to steer, when to accelerate and when to apply brakes.
To reduce the number and frequency of accidents on the road annually, physicians must be able to evaluate and accurately predict a patient’s neurological conditions for driving. With the data that the physician finds, they can protect an individual’s ability to drive safely while on the road. And, will also help to accurately assess a patient’s neurological impairments such as Clinical Dementia Rating score of 0.5. When this is the case, the driver's license for this individual may need to be revoked.
Some signs and symptoms of neurological problems tend to overlap considerably. Therefore, clinicians should lean a lot more to practical frameworks to properly provide a final diagnosis to their patients. Also, because some of these neurological conditions are often broadly classified into fixed deficits (i.e. strokes, neurodegenerative) or into paroxysmal disorders like sleep disorders and epilepsy, clinicians can use this applicable information to assist in counseling their patients. .
Fixed Deficit Disorders: AD
Some fixed deficit disorders like dementia increase with age. Also , because dementia is a form of AD (attention deficit) the decision to continue driving becomes a huge issue. This is because AD leads to a number of serious cognitive impairments, including affecting memory and executive functions. For instance, according to studies on car crashes and dementia, driving abilities sharply decline, particularly after 3 years from onset of this neurological deficit.
As a result of these and other similar studies, the American Academy of Neurology (AAN) recommends assessing a patient's fitness and ability to drive at least every 6 months. These recommendations, however, apply to patients that have shown mild signs of AD.
Additionally, based on a patient’s poor driving history and their associated score (on a scale of 1 to 4, poor score = 4), a patient's driving privileges should be suspended. One major concern, however, with this approach is it leads to a one-size-fit all diagnosis that is normally discouraged.. So, this research and guidelines for restricting driving for common conditions like PD, stroke, MS and others is still ongoing.
Paroxysmal conditions: Epilepsy
Today, driving laws can vary from state to state, particularly when it comes to conditions like epilepsy. The right to drive with neurological conditions like epilepsy is not under federal jurisdiction but under the state. With this being the case, each state determines when a person who has been diagnosed with this condition can legally operate a motor vehicle.
Based on the laws of each state, an individual may legally operate a vehicle if they have been seizure free for a period of time. Since the capability to drive has a huge impact on that individual's quality of life, these and other factors are taken into consideration. For instance, in some states, if an individual has been SFI ((Seizure Free Interval) within 3 months, they may be free to drive. On the other hand, in some states, if a person has been SFI for up to a year, they may be free to drive again, according to the laws of that state.
It is also important to note that the intent of these laws is to keep the public and the individual safe. This is one of the primary reasons why the SFI scores are being used to minimize and eliminate the possibilities of motor vehicle accidents that’s related to epilepsy seizures. For more information on these types of accidents, you should visit the American Medical Association’s website.
Today’s practitioners can also visit this site to find the most updated laws on motor vehicle driving, as it relates to epilepsy. There is a host of valuable information on AMA’s website that has been compiled, including a help guide that addresses local laws and restrictions on driving. For instance, this website provides the following information:
- Guidelines on when and how a practitioner must notify the appropriate driving authorities whenever their patient or patients have been diagnosed with paroxysmal conditions like epilepsy.
- There is also supporting information to this content available in table format
While this information can help to assist practitioners with making the appropriate medical/driving decisions, there is still at least one huge problem that can adversely affect a patient’s optimal care. And, this involves patients with epilepsy withholding vital information from their practitioners, particularly as it relates to the frequency of their seizures. Simply put, some patients may not fully disclose an accurate account of their seizures in order to keep their driving privileges.
Even though epilepsy is a very high risk medical condition for causing serious motor vehicle accidents, it is not the only paroxysmal disorder that is subject to the same or similar risk factors. On the other hand, when it comes to defining the laws for these other medical conditions, the driving restrictions are not the same. For instance, patients that have been diagnosed with disorders like excessive daytime sleepiness, syncope or narcolepsy do not have the same legal consequences (i.e. civil or criminal prosecution, based on the situation or circumstances) that an epilepsy patient would have.
As mentioned before, the state laws for these driving restrictions are not the same. In some states, advocacy groups for patients with epilepsy are seeking to incorporate specific exemption into these driving laws.
- Certain patterns of nocturnal seizures must be established
- Allow the patient with epilepsy to meet specific requirements like sufficient length and consistency of certain seizures. Primary objective is to identify patients/drivers that have the capability to stop the car safely.
- Extraneous factors outside of the norm like an illness or a prescription med that caused the incident.
Typically, most patients with epilepsy are covered by non-commercial legislation. On the flipside, if a patient drives commercial vehicles for a living (chauffer or commercial truck driver etc.), commercial driving laws will automatically apply. For instance, if a patient with epilepsy drives a vehicle from state to state, federal laws apply to that particular circumstance. And, these laws are a lot more restrictive for these positions, including governing other neurological conditions that impact the person’s ability to drive safely without problems with epilepsy seizures.
Counseling a Neurology Patient Regarding Driving
Even though practitioners are responsible for counseling their patients on these and other similar legal driving issues, they are not trained in the field of medico-legal. With that being said, due to the severity of these legal implications, practitioners must still be open, honest, and frank with all of their WBE patients. Particularly, as it relates to their primary role in ensuring, the patient and public is safe and not compromised at any time. For instance, in some situations, the practitioner might be conflicted with the information that they are privy to. However, they are also legally accountable for providing the right legal advice and action. Simply stated, if the practitioner finds out that a patient with epilepsy is driving illegally, it is important that they report this information to the correct driving authorities right away. This is because practitioners are still not immune from civil or criminal prosecution if that patient continues to drive illegally.
That said, it is important that practitioners all over the U.S. are familiar with these and other discussion points. Specifically, because driving privileges for a patient with epilepsy may need to be restricted at one point in time. Unfortunately, when this is the case, some patients may not agree with these basic freedoms being taken away and they want to continue to drive.
To keep these physician and patient relationships from becoming adversarial, this conversation must be framed in such a way that the patient can understand all of the surrounding implications. For instance, each patient needs to know their personal responsibility in keeping the road safe for everyone. Furthermore, patients will need to understand the following and their role in these situations.
- State and federal laws in place that covers patients with epilepsy (WEB)
- Practitioner responsible for consulting with WEB based on each individual’s medical diagnosis, including their present frequency of seizures and time frames.
- Possibilities of Civil and Criminal Prosecution when driving illegally
- Joint decision between practitioner and patient to arrive at the appropriate individual medical care and driving decisions. (i.e. prudent course of action that needs to be taken)
- Consequences on the book for causing a injury or fatality accident
- Possibilities of auto insurance companies rejecting applications for covering individuals with epilepsy.
Discussion
When a practitioner is consulting with a PWE, a patient with epilepsy, it is important that everyone involved fully understands the individual facts of that particular case. Since there are no simple solutions to determine when driving privileges for PWE should be terminated, the above discussion points must be addressed.
Also, because of the potential civil and criminal liabilities for both the patient and the neurologist involved, the applicable laws must be thoroughly understood, communicated and factored in. For instance, neurologists must advise all of their patients with epilepsy according to their individual personal medical conditions (i.e. frequency of epilepsy seizures) and other related medical factors. These situations must also be well documented at all points of medical provider and patient interactions, including all telephone call conversations, in-person consultations and advice given that’s related to these patient’s driving.
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References:
1.Epilepsy Foundation
https://www.epilepsy.com/driving-laws
2. Tennessee Traffic Safety
https://tntrafficsafety.org/sites/default/files/seizures.pdf
3. Mayoclinic
https://www.mayoclinicproceedings.org/article/S0025-6196(11)62679-7/pdf
4. UpTo Date- Medline Abstracts
https://www.uptodate.com/contents/driving-restrictions-for-patients-with-seizures-and-epilepsy/abstract/41-43
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