Epilepsy and driving: Potential impact of transient impaired consciousness

- Loss of consciousness during seizures is an important factor in driving risk.
- Testing of ictal behavior is needed to better understand effects of seizures.
- Driving simulators are a safe method of ictal testing and interictal testing.
- Different types of seizures may pose different levels of driving risk.
- Better evidence will encourage more flexible driving restrictions.

Driving is an important part of everyday life for most adults, and restrictions on driving can place a significant burden on individuals diagnosed with epilepsy. Although sensorimotor deficits during seizures may impair driving, decreased level of consciousness often has a more global effect on patients' ability to respond appropriately to the environment. Better understanding of the mechanisms underlying alteration of consciousness in epilepsy is important for decision-making by people with epilepsy, their physicians, and regulators in regard to the question of fitness to drive. Retrospective cohort and cross-sectional studies based on surveys or crash records can provide valuable information about driving in epilepsy. However, prospective objective testing of ictal driving ability during different types of seizures is needed to more fully understand the role of impaired consciousness and other deficits in disrupting driving. Driving simulators adapted for use in the epilepsy video-EEG monitoring unit may be well suited to provide both ictal and interictal data in patients with epilepsy. Objective information about impaired driving in specific types of epilepsy and seizures can provide better informed recommendations regarding fitness to drive, potentially improving the quality of life of people living with epilepsy.This article is part of a Special Issue entitled “Epilepsy and Consciousness”.