Obtaining a driver's license and seizure relapse in patients with childhood-onset epilepsy.

OBJECTIVE

To examine factors influencing obtaining a driver's license and subsequent prognosis among people with epilepsy vs control subjects.

METHODS

Eighty-one patients from a population-based cohort with childhood-onset epilepsy, followed prospectively for 45 years, and 96 general population control subjects were compared with regard to driving licensing, seizure relapses, and accidents.

RESULTS

By the end of the follow-up period, all 81 subjects had achieved at least one 2-year seizure-free interval in adulthood and were eligible for a driver's license. Of these, 64 vs 90% of control subjects had obtained a license (p < 0.0001). On multivariable analysis, factors associated with not obtaining a driver's license among subjects were female gender (relative risk [RR] 2.4, 95% CI 1.0 to 5.5, p = 0.02), nonidiopathic etiology (RR 2.0, 95% CI 1.1 to 3.8, p = 0.02), and presence of learning disabilities (RR 2.0, 95% CI 1.2 to 3.2, p = 0.02). Having a driver's license was associated with a higher rate of employment (RR 1.9, 95% CI 1.2 to 3.0, p = 0.0002). Relapses of seizures had occurred in 37% of the 81 patients theoretically eligible for a license but only in 25% of the 52 subjects who actually obtained one (p = 0.003). Shortening the eligibility period from 2 to 1 year would not significantly alter the relapse rate in this population. The accident rate was not increased among patients vs control subjects.

CONCLUSIONS

During a long-term follow-up, differences in driving licensing between patients with uncomplicated epilepsy and healthy control subjects persist despite legal eligibility. The lower actual relapse rates among those with epilepsy who obtain a license than in those who are eligible suggest that those at higher risk of relapse are less likely to obtain a license.