In 1991, representatives from the American Academy of Neurology (AAN), the American Epilepsy Society (AES), and the Epilepsy Foundation of America (EFA) collaborated to establish driving safety standards for individuals with epilepsy. Through their joint efforts, these organizations crafted consensus recommendations in 1994 that were intended to provide safe and fair rules for licensing drivers who have epilepsy.
The medical advisory boards were designated to establish driver licensing standards according to individual needs. The boards should require three consecutive months without seizures for persons to operate vehicles. The recommendations received validation again in 2007 and included guidance for offering transportation alternatives to people who cannot drive because of their health conditions.
The AAN joined AES and EFA to reevaluate these guidelines in 2023 using the latest research, healthcare professionals, and epilepsy patient feedback. According to the 2023 guide issued by the AAN, AES, and EFA, government regulatory bodies need to take the final authority on whether people with seizures can drive but should not replace individual practitioners. Driving standards at the national level should be developed to eliminate confusion and establish standard policies. Individual states should establish assessment systems using medical advisory boards to evaluate patients for their fitness to drive when national standards prove unworkable.
The updated guidelines emphasize that driving decisions should be grounded in research and made on a case-by-case basis rather than being reactions to isolated incidents. The medical facts about patients should be reported to the Department of Motor Vehicles (DMV) by practitioners, yet they should avoid advising patients about driving decisions. Hospital staff do not need to conduct road tests unless they have specific reasons to believe patients have cognitive limitations. A driving resumption after a seizure requires at least 3 months of being seizure-free, yet individual conditions can influence the necessary period prior to operation.
The guidelines examine several variables that affect people’s choice to return to driving. Medical sleep seizures and medication-induced seizures constitute positive factors, whereas negative factors involve medication non-adherence, existing accidents, and the recurrence of seizures. Health professionals should evaluate multiple factors when they determine patient driving appropriateness.
People whose thinking or coordination is affected by medications taken to prevent seizures should not drive. This applies to medical cannabis (where it is legally allowed). These medications are not excluded from legal control merely because they are being used to treat epilepsy. Patients must notify the Department of Motor Vehicles (DMV) about their health condition, and doctors should educate patients regarding driving risks when seizures occur. Doctors are not legally bound to report unsafe drivers, yet they maintain the authority to submit reports according to serious safety considerations.
Medical professionals have questioned mandatory reporting because research demonstrates mixed results regarding reducing accidental risks and its negative impact on doctor-patient trust. The new guidelines emphasize the value of individual risk analysis whereby doctors need to report cases only when public safety demands it. Medical practitioners must educate their patients about driving safety regulations and make clear records of patient-physician driving safety discussions. Medical advisory boards play a vital role according to the updated guidelines while epilepsy experts must form the core membership of these boards. The proposed medical advisory boards have three responsibilities: establishing licensing standards, examining difficult cases, and performing educational tasks for both practitioners and public members. Patients must have access to an approval process for suspensions while retaining the ability to voluntarily abandon their licenses when they are no longer fit to drive.
Stricter regulations are recommended for professional drivers, such as those operating trucks or buses, due to the increased risks associated with driving larger vehicles or transporting passengers. According to the guidelines, functional seizure patients must follow comparable limitations as those with epileptic seizures, provided their seizures do not affect their driving capabilities.
Alternative methods of transportation receive emphasis as part of the updated guidelines, which address individuals who have limited driving rights. The provision of public transport and accommodations assists people with epilepsy or other health conditions to maintain their community involvement.
These modified guidelines establish a balance between protecting those with epilepsy along with protection of public safety. The guidelines support a careful assessment process for driver licenses that uses evidence-based decisions while providing alternative transportation options for restricted drivers.
References: Tolchin B, Krauss GL, Spanaki MV, et al. Seizures, driver licensure, and medical reporting update: An AAN position statement. Neurology. 2025;104(7). doi:10.1212/WNL.0000000000213459
