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.