How Soon Can Teenagers Be Allowed to Drive After Stopping Anticonvulsants?

Gregory L. Krauss, MD

Disclosures

March 24, 2005

Question

I wanted to know how others deal with tapering a teenager off anticonvulsants. Do you allow them to drive during this time period? Is there a special window when it is safe for them to go back to driving if they have been seizure-free?

Response from Gregory L. Krauss, MD

The risk that a patient who has recently discontinued treatment with an antiepilepsy drug (AED) will be involved in a motor vehicle crash during a seizure is determined by the patient's epilepsy prognosis and by crash-risk factors. Approximately 60% of patients with epilepsy enter long-term remissions after discontinuing AEDs, with relapse rates of approximately 25% after 1 year and 30% after 2 years off AEDs.[1] Teenagers stopping AEDs are at increased risk for seizure recurrence if they have had recent or difficult-to-control seizures, a history of focal cerebral injuries, epileptogenic activity on a recent EEG, and if they do not have benign epilepsy syndromes, such as childhood absence epilepsy or benign epilepsy with centrotemporal spikes.

The risks for motor vehicle crashes for patients stopping AEDs have not been established. Young drivers who do not have epilepsy, however, are at a markedly increased risk for motor vehicle crashes compared with older drivers: Over 10,000 young drivers (< 25 years) die in crashes each year in the United States (nearly one fourth of all fatal crashes). In contrast, less than 100 drivers with epilepsy are reported to die in crashes each year.[2] The relative risk for fatal crashes for young drivers (28 per 100,000) is approximately 3 times that for patients with epilepsy (8.6 per 100,000).

In a case-control study, we showed that a seizure-free period of 6-12 months markedly reduced the odds for seizure-related motor vehicle crashes.[3] Until recently, Maryland restricted driving for 3 months following seizures. During this period, I counseled patients stopping AEDs who had favorable epilepsy prognostic factors not to drive for a minimum of 3 months and to limit their driving for another 6 months. Although risk data may help patients and physicians assess the risks for driving, patients should be counseled to adhere to their state driving restrictions.[4,5]

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