Driving and epilepsy …

David Gloss MD

Epilepsy & Seizures

Updated 04.22.2024
Released 01.11.2018
Expires For CME 04.22.2027

Driving and epilepsy

Author: David Gloss MD

See Contributor Disclosures

Editor: John M Stern MD

Driving and epilepsy

In This Article

Quick Link

Introduction

Overview

People with epilepsy are at increased risk of impaired driving. In this article, the authors provide an overview of issues related to driving for people with epilepsy. Epilepsy affects driving capability due to the paroxysmal nature of the disorder and associated impaired cognition, which may result in loss of vehicle control. It is estimated that people with epilepsy are 1.13 to approximately 2.16 times more likely to be involved in a motor vehicle accident compared to people without epilepsy (12). One study observed that approximately 0.2% of all motor vehicle accidents are related to seizures, more than all other medical conditions, including cardiovascular diseases and diabetes (31). Adding the factors of young driving age (25 years and younger) and alcohol consumption increased the risk of fatal motor vehicle accident by eight times. Among people with medication-resistant epilepsy, restriction from driving is universally accepted as a means to protect the public and the people with epilepsy themselves from driving-related accidents despite the capability to drive being important for both personal and professional life (17). State and federal regulators weigh individual needs versus the potential safety issues and make judgments depending on local factors. The period of restriction varies widely, as there are no clear scientific data to indicate a standard duration. Physicians play an important role in the medical opinion, counseling, and decision-making regarding driving privileges for people with epilepsy.

Key points

	• About 1 in 500 driving-related fatalities is related to seizures.
	• Driving restriction periods in people with epilepsy are not uniform and vary widely across jurisdictions.
	• Physicians should know their local driving laws.
	• Physicians, patients, and regulating bodies together are responsible for the safety of people with epilepsy with regard to driving.

Historical note and terminology

The modern car was invented in the 1880s, but it wasn’t until the first report of a motor vehicle accident in 1906 that safety issues related to driving became a focus of public attention and concern (33). Subsequently, when licensing for driving became mandatory, people with epilepsy along with those suffering from other conditions affecting driving capability, were not permitted to drive. In the 1940s, the understanding of epilepsy progressed with the emergence of electroencephalography, and effective antiepileptic medications led to improved clinical outcomes in patients with epilepsy. Sir Charles Symonds of England in 1948 advocated for people with epilepsy and suggested driving permits be granted after a certain seizure-free interval. In 1949, Wisconsin became the first state in the United States to allow patients with epilepsy to drive; by the 1970s, all other the states legalized driving for people with epilepsy (21). The duration of driving restriction for people with epilepsy varies between the states and has changed over time; driving restriction duration currently ranges between 3 to 12 months, but some states do not impose a prespecified duration of driving restriction. For the current status of driving restrictions in each state, see the Epilepsy Foundation website. The laws in other countries outside of the United States are quite different (05).

Data about driving with epilepsy are not entirely clear, but the evidence suggests that having some limits makes sense. A 10-year registry indicates that the rate of emergency room care related to a motor vehicle accident is seven times higher in people with epilepsy (95% CI 2.18 to 26.13) (26). In California, accidents involving people with epilepsy were nearly twice as prevalent as expected (observed 16.0 per 100,000 miles vs. expected 8.2 per 100,000 miles, p< 0.001) (34). A population-based cohort study suggested the possibility of a higher risk for motor vehicle accident among people with epilepsy with a relative risk of 1.38 (95% CI 0.97 to 1.96) (24). Another study analyzed all residents of seven zip codes in and around Marshfield, Wisconsin; they found a standard mishap ratio of 1.31 for people with epilepsy (95% CI 1.00 to 1.73), possibly suggesting there may not be a higher risk (18). These studies taken together seem to suggest a higher chance for emergency room care due to a motor vehicle accident for people with epilepsy and that there seems to be higher risk of motor vehicle accident in general, although the imprecision of the underlying data somewhat limits this latter conclusion.

States use the criteria of seizure freedom length to determine whether a people with epilepsy should be able to drive. The underlying evidence for seizure freedom versus risk of driving for people with epilepsy also seems somewhat limited. The 2-year period after a first-ever seizure is associated with the highest risk of seizure recurrence (40% to 50%); however, this risk is reduced variably with treatment (06). One study noted a reduction in the odds of motor vehicle accident for seizure-free periods of 6 to 12 months as compared to 3 months (20). However, Drazkowski and colleagues observed no significant changes in seizure-related motor vehicle accidents after the state adopted a 3-month instead of a 12-month driving restriction period (09).

It is possible that the difference in the outcomes could be from variations in study design. The relative paucity of data may in part be related to how often it occurs. Also, the data of a seizure-related motor vehicle accident are reported only if there is personal or property damage (21; 20). This disparity may also be the result of not looking at the correct risk factor: one study showed that only 11% of motor vehicle accidents in people with epilepsy were actually related to seizures (34); another study showed only 0.2% of fatal motor vehicle accidents involved seizures (31).

Scientific basis

Driving is a complex task that requires intact motor function, visual ability, memory, and alertness (32). Several medical conditions like hypoglycemia, cardiac arrhythmia, severe heart disease, alcoholism, and stroke can affect higher level functions and impair driving capabilities. Understanding the type of seizure and the extent of impairment regarding consciousness, alertness, and motor capability can assist the physician to manage the risks associated with driving. The availability of appropriate physician feedback also helps regulators to make the right decisions regarding driving restrictions. Typically, generalized tonic-clonic seizures are associated with severe alteration of awareness and are usually associated with a postictal phase, which clearly is incompatible with driving safely. The impairment of driving with other types of seizures is variable, and the physician response may depend on local regulations (16).

The likelihood of recurrence after a first-ever seizure ranges from 1.7% to 3.1% per month. If a community accepts an accident risk ratio (ARR) of 3.6, this results in 5 months of driving restriction for a provoked seizure and 8 months for an unprovoked seizure (07).

After a single unprovoked seizure, the predictors with the best evidence include nocturnal seizure, EEG with epileptiform abnormalities, and prior brain insult (22). In a study, seizure frequency was not, in general, associated with motor vehicle accidents; however, patients involved in motor vehicle accidents were noted to have frequent seizures (20). Patients were studied while using a driving simulator in an EMU. Secondarily generalized seizures and focal seizures with impaired consciousness led to impairment. Focal seizures without impaired consciousness did not lead to impairment, and only 1 of 19 with generalized nonmotor (generalized spike-wave) led to impairment (23).

A consensus statement by the American Academy of Neurology jointly with the American Epilepsy Society and the Epilepsy Foundation reported favorable and unfavorable modifiers for the duration of driving restriction (02). According to the consensus statement, there are some favorable factors: seizures from medication changes, sleep deprivation, acute toxic or metabolic states, reversible acute illness, simple partial seizures alone or prolonged with other seizure types, and pure nocturnal seizures. Note that there are some data suggesting simple partial seizures are not safer than other kinds of seizures (29). Unfavorable factors include medication noncompliance, alcohol or drug use in last 3 months, poor driving record, structural brain lesion, worsening seizures, or prior motor vehicle accident due to seizures in last 5 years (02). These factors can be helpful when deciding a proper duration of driving restriction in states where there is no specific duration established by law. Some states like Arizona are explicit about their exceptions to driving restrictions (see ARIZ. ADMIN. CODE R17-4-506(D)). Other states, such as Louisiana, leave it up to the physicians (see LA REV. STAT. ANN. § 32:403.2).

Discussion

In the United States, physicians are typically not required to report people with epilepsy to the regulatory bodies; however, six states do mandate physician reporting (California, Delaware, Nevada, New Jersey, Oregon, and Pennsylvania (at least to the best of the author’s knowledge). Most consensus statements have opposed mandatory reporting by treating physicians of patients with epilepsy who are actively driving (04). Mandatory reporting creates the risk of undermining the physician-patient relationship, as a patient may lie to preserve the driver license (08). In China, in a survey of 291 people with epilepsy, half disagreed with physician reporting to traffic authorities (36). Moreover, in a retrospective survey comparing two Canadian provinces, one with mandatory reporting and another without, there were no significant differences between either lifetime accidents or accidents in the previous year (27).

After a patient is reported, the state’s regulatory body must decide if the right to drive should be limited or curtailed. Most states explicitly assert that physicians are not legally liable if they faithfully follow all applicable laws, but every state differs. In some states, a physician who reports a person with epilepsy for having poor driving capabilities may be at risk of a lawsuit for breaching the physician-patient relationship (01). All physicians should clearly detail in the patient's medical chart discussions regarding driving restrictions as documented proof for a potential medicolegal discussion in future (21). Some studies suggest this is not routinely done (30). A systematic review suggested up to 39% of patients with epilepsy choose to drive in violation of restrictions (35).

There is a risk of liability for the physician who inadequately complies with local regulations. Several instances have been reported in which either people with epilepsy were prosecuted for seizure-related motor vehicle accident or physicians treating them were liable to injured third parties during the seizure-related motor vehicle accident (10; 19; 15). There is also a case where courts did not feel that physicians have a duty to injured third parties (Praesel v. Johnson 1998).

Commercial driving. For people with epilepsy, the driving restrictions are significantly more stringent for commercial driving licenses. Federal guidelines stipulate a minimum of 10 years off antiseizure medication and seizure-free (see Advisory criteria to 49 CFR 391.43[f] and Appendix A section H for 49 CFR 391.41[b][8]). Of note, exemptions have rarely been granted. Twenty-two drivers successfully petitioned for exemption in 2013 (03). There were an additional eight who petitioned for exemption from the Federal Motor Carrier Safety Administration (FMCSA) rules in 2022 (Federal Motor Carrier Safety Administration 2022a). Later in 2022, citing the criteria found in Appendix A, section H of CFR 391.41 (b)(8), an additional 16 were granted exemption (Federal Motor Carrier Safety Administration 2022b). Most states follow federal guidelines; exceptions are mentioned in Table 1. Drivers should follow guidelines for each state in which they drive. This is particularly important for commercial drivers in states that do not follow the federal guidelines because they may find that they can drive in their state but may not drive in other states.

Table 1. Driving and Epilepsy Regulations According to State (Including Commercial Driving Rules)

State	Seizure-free period (passenger vehicles)	Commercial driving	Mandatory physician reporting	Periodic medical updates required	Exceptions
Alabama	6 months	Federal DOT standards*; no waivers granted. Individuals with epilepsy not to be licensed to drive taxi or school bus.	No	At DMV discretion	N/A
Alaska	6 months	Federal DOT standards.	No	At DMV discretion	N/A
Arizona	3 months	Federal DOT standards.	No	At DMV discretion	Individual may be license if physician reports: (1) seizure due to change in prescribed anticonvulsants medication and that seizures are under control after change; (2) was single event and will not reoccur; (3) seizure likely to occur but has established pattern, ie, only at night; (4) established pattern of aura of sufficient duration to allow person to cease operation of vehicle.
Arkansas	1 year	Federal DOT standards. Individuals with epilepsy not qualified for school bus licensing.	No	At DMV discretion	Office of driver services requires state license physician to evaluate person with epilepsy and then office to assess medical report to determine if person should be allowed to operate vehicle.
California	3 or 6 months	Federal DOT standards. Medical certificate required approved by DOT, FAA issued within 2 years of date of operation of that vehicle.	Yes	At DMV discretion	If individual has lapses of consciousness but symptoms are under control and individual is able to drive safely and maintain control, department may not take any action or place individual under probationary period (3 months, 3 to 5 months, 6 months).
Colorado	No set seizure-free period	Must receive medical waiver from Colorado state. Individual with epilepsy may be considered for taxi, bus, or school bus if physician certification is provided.	No	At DMV discretion	N/A
Connecticut	No set seizure-free period	Federal DOT standards. Individual with epilepsy not qualified for public service motor vehicle or service bus licensing.	No	At DMV discretion	If a person experiences an episode in last 6 months, commissioner must request the opinion of medical advisory board. Case-dependent restriction from 3 to 6 months.
Delaware	No set seizure-free period	Federal DOT standards. Individual with epilepsy not qualified for taxis, busses, or school bus licensing.	Yes	Annually	Epileptic patient requires medical certificate from physician stating that condition is under sufficient control. Certificate must then be presented annually.
District of Columbia	1 year	Federal DOT standards. Persons with epilepsy are not licensed for driving commercial vehicles; no waivers granted. No license consideration for taxi or other public vehicle for hire if at the time person has epilepsy.	No	Annually until seizure free for 5 years	Patient with epilepsy must submit to DOT a physician’s certificate indicating knowledge of disease and seizure-free status of at least 12 months.
Florida	6 months	Federal DOT standards. No waiver provision for epilepsy patients. Not eligible to be school bus driver or drive busses designed to seat 15 persons.	No	Discretion of MRB	Person with epilepsy may be licensed to drive after physician recommendation and seizure-free period of 2 years. If under regular medical supervision, then at end of 1-year seizure-free period.
Georgia	6 months	Federal DOT standards. No waivers granted.	No	Discretion of MRB	Nocturnal seizure patients may be eligible for limited license conditioned on periodic medical reports.
Hawaii	6 months	Federal DOT standards. Waivers not available. Epilepsy patients may be licensed to drive taxi.	No	At DMV discretion	Restricted licenses available. ‡
Idaho	No set seizure-free period	Federal DOT standards. Epileptic patients may not drive busses or school buses but may drive taxi.	No	At DMV discretion	Due to lack of medical board in Idaho, physician recommendations are taken into consideration for seizure-free period.
Illinois	No set seizure-free period.	Federal DOT standards. Epilepsy patients are ineligible for waiver and cannot be licensed to drive vehicle or buses carrying 16 or more people, including school buses.	No	At MAB discretion	If physician statement says epileptic patient can operate vehicle, license is granted.
Indiana	No set seizure-free period	Federal DOT standards. Must pass physical examination by medical examiner. Epilepsy patients may be licensed to drive taxi, buses, or school buses if they meet same criteria as for personal vehicle.	No	At MAB discretion	If individual with epilepsy presents letter form physician stating patient is on epilepsy medication and is seizure free then he or she may not be denied a license. Restricted licensing available.
Iowa	6 months	Federal DOT standards. Epilepsy patients not eligible to drive school bus.	No	After first 6 months, then at renewal	Physicians report and recommendation required.
Kansas	6 months	Same rules as those driving personal vehicle. Must also meet federal regulations or obtain waiver.	No	Annually, until 3 years seizure free	Exceptions to 6-month rule: (1) nocturnal seizures only; (2) seizure resulted from medication change; (3) very minor seizure or odd seizures that do not alter mentation; (4) seizure result of acute illness or injury.
Kentucky	3 months or greater	Federal DOT standards. Epileptic person may apply for waiver if seizure free for 1 year, taking anticonvulsants with blood content proof, and clean driving record for 2 years. These individuals are also eligible to drive taxi and buses. School bus drivers must undergo annual medical examination.	No	On renewal	Epileptic patients applying for license or renewal of license must present physician letter stating condition is controlled by medication and description of the medication with dosages.
Louisiana	No set seizure-free period	Must submit medical report stating no mental or physical disability. No waiver for epilepsy, but epileptic patient may obtain chauffer license to transport fewer than 16 people.	No	At DMV discretion	May be provisioned to drive with medical report from physician stating disease is under control.
Maine	3 months to 2 years	Federal DOT standards. School bus endorsement necessary for school bus carrying 10 or more passengers.	No	At DMV discretion	Person with long-standing seizure (longer than 5 years) is eligible for driver license after being seizure free for 3 months and on medication. Must be evaluated every 4 years.
Maryland	3 months	Federal DOT standards with amendments and exceptions. Epileptic patients may not drive commercial motor vehicle interstate. Epileptic patients also disqualified from driving school buses.	No	At DMV discretion	Restricted licensing available.
Massachusetts	6 months	Federal DOT standards. No medical waiver for epileptic patients. Current epileptics† are ineligible to operate school bus.	No	At DMV discretion	Physicians report must state seizure-free period and recommendation for driving. May be extended if required by registrar.
Michigan	6 months	Michigan state will license epileptic patients with CDL, for trucks, taxi, and buses if they have been seizure free for 1 year. Denied school bus driving if epileptic.	No	At DMV discretion	Epileptic patients must present certification of controlled symptoms and be seizure free for 6 months. Time restrictions may be reduced or eliminated on physicians’ report. Restricted licensing available.
Minnesota	3 months	Same as personal vehicle for commercial drivers. Stringent for taxi drivers. School bus drivers must be epilepsy free for 5 years and off medication for 2 years.	No	Once every 6 months	Exceptions can be made if: (1) seizures due to temporary illness; (2) seizure occurred under physician order to change medication; (3) was first seizure experienced by driver in 4 years. (Patient must submit physician report every 6 months for 4 years then once every 4 years.)
Mississippi	6 months	Individuals who are seizure free for 6 months may be issued a commercial driver’s license for driving within Mississippi. Those who meet seizure-free criteria may also drive passenger transport vehicles.	No	At MAB discretion	N/A
Missouri	6 months	Federal DOT standard	No	At DMV discretion	Conditional license can be issued for a year at the end of which the bureau verifies that individual has been seizure free for the year.
Montana	No set seizure-free period	For commercial trucks, patient must be seizure free for 5 years and provide physician certificate. Must also follow federal DOT laws.	No	At DMV discretion	If physician verifies that patient condition will not affect his or her driving, he or she can be granted a license.
Nebraska	No set seizure-free period	Federal DOT standards. Same DOT rules for school bus driver. May be granted waiver for commercial licenses.	No	No	None
Nevada	3 months	Federal DOT standards for truck drivers. CDL may be given if physician certifies seizure free for 1 year preceding application. May be licensed for passenger vehicle, taxi, buses, or school bus if they obtain federally approved waiver or have been seizure free for 3 years.	Yes	Annually for 3 years	Epileptic patient may be granted license if not seizure free for 3 years if physician certifies symptoms are under control or incident was isolated. Restricted license available (requires annual medical report).
New Hampshire	1 year	Federal DOT standard for all commercial driving licenses.	No	No	May be licensed earlier if physician certifies that patient condition is stable enough to not cause harm to others. Restricted licenses are available.
New Jersey	6 months	Federal DOT standard for all commercial licensing.	Yes	Every 6 months for 2 years then annually	None
New Mexico	6 months	Federal DOT standard for interstate drivers. No waivers for patients with epilepsy. Patients with single unprovoked seizure may be licensed if seizure free and off medication for 5 years.	No	At MAB discretion	Restricted license available.
New York	1 year	Federal DOT standard for commercial drivers. Those who obtained CDL before September 1999 are able to retain license without medical examiner certificate. Patients with epilepsy are disqualified from driving buses.	No	At DMV discretion	May be licensed if: (1) loss of consciousness was due to medication change, (2) physician certificate states patient is safe to drive despite symptoms that are under control, and (3) department’s medical consultant has no objection to such issuance. No restricted license.
North Carolina	6 months	Federal DOT standard for commercial interstate vehicles. Waivers are granted. Person with epilepsy may be licensed to drive passenger carrying vehicle such as taxi but restricted from driving buses or school buses.	No	Annually (less at DMV discretion)	May be less on physician recommendation. Restricted licensing is available.
North Dakota	6 months	Federal DOT standard for commercial interstate truck driver. If licensed before march 1991, may continue despite having epilepsy. Bus and school bus also follow federal DOT standard.	No	Annually for 3 years	Patients who have had single episode may be licensed without restriction. Restricted license available after 3 months.
Ohio	No set seizure-free period	State has NOT adopted federal DOT standard. To drive transit bus or taxi, person with epilepsy must meet same requirement as personal vehicle license. Cannot be licensed to operate school bus.	No	At DMV discretion	If patient has epilepsy, physician must certify that he or she is under treatment, and symptoms are under control; restricted 6-month license can be granted. At 6 months if patient remains symptom free, he or she may be granted extension of restricted license or unrestricted license.
Oklahoma	6 months	Must be seizure free for 5 years and have normal examination and normal EEG. However, patient may be licensed earlier for interstate commerce if patient shows proof of no symptoms for 2 years and is off all medication for 2 years.	No	At DPS discretion	May be exempt if (1) due to medication change, (2) isolated occurrence, (3) nocturnal seizure. In these cases, patient must be seizure free for 3 months and submit proof of episode control.
Oregon	3 months	Federal DOT standards. Waiver can be obtained if seizure free for 2 years while on medication with medical evaluation including history, current prescription, recent EEG, anticonvulsant blood level. These requirements apply to driver of busses and taxis. School bus driver have additional requirement set by education department.	Yes	At DMV discretion	Restricted licenses are available.
Pennsylvania	6 months	Federal DOT standard for commercial vehicles interstate.	Yes	At MAB discretion	May be exempt if: (1) nocturnal seizure, seizures occurring on wakening, with or without medication, established for at least 2 years; (2) aura with or without meds, established over period of 2 years; (3) was seizure free for 6 months but subsequent seizure occurred due to prescription change; (4) was seizure free for 6 months subsequent and seizure occurred due to some illness, toxic ingestion, metabolic imbalance, or trauma.
Rhode Island	18 months	To qualify for commercial license, applicant must have no medical history or clinical diagnosis of epilepsy or any other condition likely to cause loss of consciousness.	No	At DMV discretion	May be less if physician certifies patient is stable enough to drive safely.
South Carolina	6 months	Federal DOT standard. Epileptic patients not approved for passenger vehicles carrying more than 16 people. Passenger vehicle rules apply for taxi and bus driver licensing.	No	At 6 months then annually or 3 years	Restricted licenses available.
South Dakota	6 to 12 months	Federal DOT standard for commercial vehicle. Federal DOT for school bus as well.	No	Every 6 months until 1 year seizure free	May be less with doctor recommendation. Restricted licenses available.
Tennessee	6 to 12 months	Federal DOT standard for CDL. Epilepsy patients are eligible for CDL if he or she is seizure free for 1 year with physician recommendation or 6 months with physician recommendation and MRB approval. Waiver granted if off medication and seizure free for 10 years.	No	At MAB discretion	If symptoms controlled for 6 months with doctor recommendation, may be approved for license.
Texas	3 months	Must be seizure free and off medication for 5 years. Federal DOT standards do apply. No waiver granted.	No	At MAB discretion	Restricted licensing on following conditions: (1) epilepsy under physician observation; (2) no evidence of clinical seizure in 3-month driving restriction period; (3) physician vouches for patient taking medication, avoiding sleep deprivation and fatigue, and avoiding alcohol abuse; (4) if seizure was due to drug change.
Utah	3 months	Federal DOT standards for commercial driving. But may be issued to epileptic patients depending on disease severity. No specific mention of taxi or buses.	No	At MAB discretion	Restricted licenses are available. Circumstances in which license may be issued: (1) single seizure or cluster of seizures; (2) seizure only in sleep over period of 3 or more years; (3) low intensity seizure not affecting control, if stable for 1 year; (4) seizure occurred due to medication change; (5) seizure caused by identifiable cause.
Vermont	No set seizure-free period	Federal DOT standards for interstate truck rivers. No waivers are available. Epileptic patients may be licensed to drive taxi or other vehicle that carries less than seven passengers if he or she meets requirements for personal license.	No	At MAB discretion	Restricted licenses available. May be licensed if medical report by physician is submitted and the commissioner grants permission on physician recommendation.
Virginia	6 months	Federal DOT standards for commercial driving. No waivers.	No	At MAB discretion	Restricted licenses available. Department may (1) suspend driving privileges, (2) require driver to submit periodic medical and vision reports every 3, 6, 12, or 24 months.
Washington	6 months	Federal DOT standards for interstate commercial drivers. Patients with epilepsy may petition waivers that are granted based on seizure-free period of 6 months and under adequate medication and supervision. Annual medical reports required.	No	At MAB discretion	6 months may be waived on physician recommendation and medical report.
West Virginia	6 months	Federal DOT standards for truck or passenger-carrying vehicles. Waivers granted if seizure free for 3 years.	No	At MAB discretion	None
Wisconsin	3 months	Federal DOT standards for CDL. For CDL, person must show that he has only had a single nonrecurring episode of loss of consciousness or body control for at least 2 years preceding application and that the cause of the episode was identified and requires no treatment or that the seizure disorder was diagnosed and the person has been episode free for the past 5 years preceding application for licensing. Same requirements apply for school buses and other passenger-carrying vehicles.	No	At MAB discretion	Restricted licenses available.
Wyoming	3 months	Federal DOT standards for CDL with exceptions. Medical proof from physician stating control of symptoms may allow grant of license to truck drivers WITHIN the state. Same requirement for passenger vehicles. Waivers are available for medically qualified drivers to drive commercial vehicles interstate only if DOT-certified physician determines it is safe.	No	At MAB discretion	License cancellation may be reconsidered if DMV is notified by physician that there has been either no loss of consciousness or motor function for at least 1 year or the disorder no longer exist or symptoms have been medically controlled for a period of 3 months.
From (11). Note: this table is NOT a substitute for legal advice, and although we make no explicit or implicit guarantee for accuracy, it is true to the best of our knowledge at the time it was created. Abbreviations: MRB, medical review board; DOT, department of transportation; FAA, federal aviation administration; CDL, commercial driving license; DPS, department of public safety; MAB, medical advisory board * United States Department of Transportation allows people with a history of epilepsy who have been seizure-free off and medication for 10 years to obtain a commercial driver’s license. People with epilepsy cannot obtain a commercial driver’s license if they have ongoing seizures or are seizure-free but taking seizure medication. There may be other restrictions, depending on a person’s risk; laws may vary state to state. Check your state department of motor vehicles for up-to-date laws and how to apply for a commercial driver’s license. † Patients with past history of epilepsy may be licensed to drive school bus. ‡ Restricted licenses are those that may have limitations on speed, highway restriction and time of day restrictions.

Table 2. List of States That Have Changed Their Seizure-Free Period (Months) Since 2001

State	2001	2017
Connecticut	3	No set period
Florida	24	6
Georgia	12	6
Hawaii	None	6
Louisiana	6	No set period
Minnesota	6	3
Mississippi	12	6
Nebraska	3	No set period
New Jersey	12	6
Oklahoma	12	6
Oregon	6	3
Rhode Island	None	18
Texas	6	3
West Virginia	12	6
(11)

References

01: American Medical Association. Physician’s guide to assessing and counseling older drivers. 2nd Edition. Accessed April 10, 2017. Available at: www.nhtsa.gov. February 2010. PMID 8026421
02: Anonymous. Consensus statements, sample statutory provisions, and model regulations regarding driver licensing and epilepsy. American Academy of Neurology, American Epilepsy Society, and Epilepsy Foundation of America. Epilepsia 1994;35(3):696-705. PMID 8026421
03: Anonymous. Petition for exemption. Federal Register 2013;78(10):3069-72.
04: Bacon D, Fisher RS, Morris JC, Rizzo M, Spanaki MV. American Academy of Neurology position statement on physician reporting of medical conditions that may affect driving competence. Neurology 2007;68(15):1174–7. PMID 17420399
05: Beran RG, Devereaux JA, Buchanan D. Some legal aspects of epilepsy. Epilepsy Behav 2020;111:107244. PMID 32575008
06: Berg AT. Risk of recurrence after a first unprovoked seizure. Epilepsia 2008;49 Suppl 1:13-8. PMID 18184149
07: Brown JW, Lawn ND, Lee J, Dunne JW. When is it safe to return to driving following first-ever seizure? J Neurol Neurosurg Psychiatry 2015;86(1):60-4. PMID 24769470
08: Dalrymple J, Appleby J. Cross sectional study of reporting of epileptic seizures to general practitioners. BMJ 2000;320(7227):94-7. PMID 10625265
09: Drazkowski JF, Fisher RS, Sirven JI, et al. Seizure-related motor vehicle crashes in Arizona before and after reducing the driving restriction from 12 to 3 months. Mayo Clin Proc 2003;78(7):819-25. PMID 12839076
10: Duvall v Goldin. 362 N.W.2d 275. Available at: https://www.courtlistener.com. Michigan Court of Appeals, 1984.
11: Epilepsy Foundation. State Driving Laws Database. Available at: http://www.epilepsy.com/driving-laws. Accessed: March 25, 2017.
12: Federal Motor Carrier Safety Administration. Evidence Report: Seizure Disorders and Commercial Motor Vehicle Safety (Comprehensive Review). Available at: https://www.fmcsa.dot.gov. Presented to FMCSA, 2007.
13: Federal Motor Carrier Safety Administration. Qualification of drivers; exemption applications; epilepsy and seizure disorders. A Notice on 04/01/2022. Available at: https://www.federalregister.gov/documents/2022/04/01/2022-06861/qualification-of-drivers-exemption-applications-epilepsy-and-seizure-disorders. Accessed 01/27/2022a.
14: Federal Motor Carrier Safety Administration. Qualification of drivers; exemption applications; epilepsy and seizure disorders. A Notice on 09/01/2022. Available at: https://www.federalregister.gov/documents/2022/09/01/2022-18934/qualification-of-drivers-exemption-applications-epilepsy-and-seizure-disorders. Accessed 01/27/2022b.
15: Finucane AK. Legal aspects of epilepsy. Neurol Clin 1999;17:235-43. PMID 10196405
16: Gastaut H, Zifkin BG. The risk of automobile accidents with seizures occurring while driving: relation to seizure type. Neurology 1987;37(10):1613-6. PMID 3658165
17: Gilliam F, Kuzniecky R, Faught E, Black L, Carpenter G, Schrodt R. Patient-validated content of epilepsy-specific quality-of-life measurement. Epilepsia 1997;38(2):233-6. PMID 9048677
18: Hansotia P, Broste SK. The effect of epilepsy or diabetes mellitus on the risk of automobile accidents. N Engl J Med 1991;324(1):22-6. PMID 1984160
19: Harden v Dalrymple. Harden v Allstate Ins Co. 883 F. Supp. 963. Available at: http:law.justia.com. US District Court for the District of Delaware 1995.
20: Krauss GK, Krumholz A, Carter RC, Kaplan P. Risk factors for seizure-related motor vehicle crashes in patients with epilepsy. Neurology 1999;52(7):1324-9. PMID 10227613
21: Krumholz A, Fisher RS, Lesser RP, Hauser WA. Driving and epilepsy: A review and reappraisal. JAMA 1991;265(5):622-6. PMID 1987412
22: Krumholz A, Wiebe S, Gronseth GS, et al. Evidence-based guideline: Management of an unprovoked first seizure in adults: Report of the Guideline Development Subcommittee of the American Academy of Neurology and the American Epilepsy Society. Neurology 2015;84(16):1705-13. PMID 25901057
23: Kumar A, Marton R, Chen W, et al. Simulated driving in the epilepsy monitoring unit: Effects of seizure type, consciousness, and motor impairment. Epilepsia 2022;63(1):e30-4. PMID 34816425
24: Kwon C, Liu M, Quan H, Thou H, Wiebe S, Jette N. Motor vehicle accidents, suicides, and assaults in epilepsy: a population-based study. Neurology 2011;76(9):801-6. PMID 21288978
25: Lin M, Chen J, Li S, et al. Individual prediction of motor vehicle accidents for patients with epilepsy. Epilepsy Behav 2021;121(Pt A):108406. PMID 34111767
26: Lings S. Increased driving accident frequency in Danish patients with epilepsy. Neurology 2001;57(3):435-9. PMID 11502909
27: McLachlan RS, Starreveld E, Lee MA. Impact of mandatory physician reporting on accident risk in epilepsy. Epilepsia 2007;48(8):1500-5. PMID 17442011
28: Nishida T, Kawai K, Tachimori H. Risks of seizure with fatal traffic crash at wheel in people with epilepsy. Seizure 2020;76:110-5. PMID 32062321
29: Punia V, Farooque P, Chen W, et al. Epileptic auras and their role in driving safety in people with epilepsy. Epilepsia 2015;56(11):e182-5. PMID 26391317
30: Shareef YS, McKinnon JH, Gauthier SM, Noe KH, Sirven JI, Drazkowski JF. Counseling for driving restrictions in epilepsy and other causes of temporary impairment of consciousness: how are we doing? Epilepsy Behav 2009;14(3):550-2. PMID 19162227
31: Sheth SG, Krauss G, Krumholz A, Li G. Mortality in epilepsy: driving fatalities vs other causes of death in patients with epilepsy. Neurology 2004;63(6):1002-7. PMID 15452290
32: Spiers HJ, Maguire EA. Neural substrates of driving behaviour. Neuroimage 2007;36(1):245–55. PMID 17412611
33: Thalwitzer F. Epileptiker als Autofahrer. Munch Med Wochenschr 1906;37:1818.
34: Waller JA. Chronic medical conditions and traffic safety: review of the California experience. N Engl J Med 1965;273(26):1413-20. PMID 5848415
35: Xu Y, Shanthosh J, Zhou Z, et al. Prevalence of driving and traffic accidents among people with seizures: a systematic review. Neuroepidemioogy 2019;53(1-2):1-12. PMID 31129671
36: Zhang, Z, Zhang J, Fu Y, Cao Y, Wang S, Fang J. Driving status and attitudes of patients with epilepsy holding a driving license in eastern China. Epilepsy Behav 2023;142:109178. PMID 36966590

Contributors

All contributors' financial relationships have been reviewed and mitigated to ensure that this and every other article is free from commercial bias.

Author

David Gloss MD

Dr. Gloss of The NeuroMedical Center in Baton Rouge has no relevant financial relationships to disclose.
See Profile

Editor

John M Stern MD

Dr. Stern, Director of the Epilepsy Clinical Program at the University of California in Los Angeles, received honorariums from Ceribell, Jazz, LivaNova, Neurelis, SK Life Sciences, Sunovian, and UCB Pharma as advisor and/or lecturer.
See Profile

Former Authors

Muhammad Taimoor Khan MD
Konark Malhotra MD
Appaji Rayi MBBS

Patient Profile

Age range of presentation: 0 month to 65+ years
Sex preponderance: Female = male
Heredity: Hereditary may be a factor
Population groups selectively affected: Some populations may be affected
Occupation groups selectively affected: None

This is an article preview.
Start a Free Account
to access the full version.

Nearly 3,000 illustrations, including video clips of neurologic disorders.
Every article is reviewed by our esteemed Editorial Board for accuracy and currency.
Full spectrum of neurology in 1,200 comprehensive articles.
Listen to MedLink on the go with Audio versions of each article.

Questions or Comment?

MedLink®, LLC

3525 Del Mar Heights Rd, Ste 304
San Diego, CA 92130-2122

Toll Free (U.S. + Canada): 800-452-2400

US Number: +1-619-640-4660

Support: service@medlink.com

Editor: editor@medlink.com

ISSN: 2831-9125

Driving and epilepsy

Also Relevant

Cognition and epilepsy
Epilepsy
First unprovoked seizure: workup and management
Generalized onset tonic-clonic seizures
Impact of sleep on epileptic manifestations
- Myoclonic absences
- Pharmacological treatment of epilepsy in adolescents and adults
- Sleep and epilepsy
- Typical absences

Clinical Categories

Epilepsy & Seizures

Driving and epilepsy …

Driving and epilepsy

Introduction

Overview

Key points

Historical note and terminology

Scientific basis

Discussion

Table 1. Driving and Epilepsy Regulations According to State (Including Commercial Driving Rules)

Table 2. List of States That Have Changed Their Seizure-Free Period (Months) Since 2001

Discussion

References

Contributors

Author

Editor

Former Authors

Patient Profile

This is an article preview.
Start a Free Account
to access the full version.

Questions or Comment?

Also in This Category

Anti-LGI1 encephalitis

Self-limited (familial) neonatal epilepsy

Alcohol withdrawal seizures

Epileptic lesions due to malformation of cortical development

Epileptic spasms

Sleep and epilepsy

Neocortical temporal lobe seizures

Jacksonian seizures

Driving and epilepsy

Introduction

Overview

Key points

Historical note and terminology

Scientific basis

Discussion

Table 1. Driving and Epilepsy Regulations According to State (Including Commercial Driving Rules)

Table 2. List of States That Have Changed Their Seizure-Free Period (Months) Since 2001

Discussion

References

Contributors

Author

Editor

Former Authors

Patient Profile

This is an article preview. Start a Free Account to access the full version.

Questions or Comment?

Also in This Category

Anti-LGI1 encephalitis

Self-limited (familial) neonatal epilepsy

Alcohol withdrawal seizures

Epileptic lesions due to malformation of cortical development

Epileptic spasms

Sleep and epilepsy

Neocortical temporal lobe seizures

Jacksonian seizures

This is an article preview.
Start a Free Account
to access the full version.