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Original research
First-ever seizure and eligibility for commercial motor vehicle driving
  1. Nicholas Lawn1,
  2. Judy Lee1,
  3. John Dunne1,2
  1. 1 Neurology, WA Adult Epilepsy Service, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
  2. 2 Discipline of Internal Medicine, Medical School, The University of Western Australia, Perth, Western Australia, Australia
  1. Correspondence to Dr Nicholas Lawn, Neurology, WA Adult Epilepsy Service, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia; Nicholas.Lawn{at}health.wa.gov.au

Abstract

Background After a first-ever seizure, 6 months of seizure freedom is usually required before returning to driving a private motor vehicle, after which the annual risk of seizure recurrence has fallen to ≤20%. Stricter criteria apply for commercial driver’s licence (CDL) holders, and a longer period of seizure freedom sufficient for the annual risk of recurrence to be <2% is recommended. However, CDL guidelines are based on little data with few studies having long-term follow-up.

Methods 1714 patients with first-ever seizures were prospectively studied. Seizure recurrence was evaluated using survival analysis. The annual conditional risk of seizure recurrence was calculated for patients with first-ever unprovoked and acute symptomatic seizures, and according to the presence or absence of clinical, electroencephalogram (EEG) and neuroimaging risk factors for recurrence.

Results The annual risk of recurrence for unprovoked first seizures did not fall below 2% until after 9 years of seizure freedom. The annual risk after 5 years of seizure freedom was still 3.9% (95% CI 1.8% to 6.1%) including for those without epileptiform abnormalities on EEG and with normal imaging. For acute symptomatic first seizures, the annual recurrence risk was 4.5% (95% CI 2.3% to 6.7%) after 1 year and fell below 2% only after 4 years of seizure freedom.

Conclusions For unprovoked and acute symptomatic first-ever seizure and CDL, a higher-than-expected annual seizure risk persists beyond the currently recommended seizure-free periods, even in those without risk factors for recurrence. Our data can inform decisions regarding a return to driving for CDL holders after first-ever seizure.

  • EPILEPSY
  • EEG
  • HEALTH POLICY & PRACTICE

Data availability statement

Data are available on reasonable request. All data relevant to the study are included in the article or uploaded as online supplemental information. Not applicable.

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Data availability statement

Data are available on reasonable request. All data relevant to the study are included in the article or uploaded as online supplemental information. Not applicable.

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Footnotes

  • Contributors NL: study concept and design, acquisition of data, analysis and interpretation, drafted and revised manuscript, study supervision and is the guarantor of the study being responsible for the conduct of the study, overall content and decision to publish. JL: acquisition of data, analysis and interpretation. JD: study concept and design, acquisition of data, analysis and interpretation, critical revision of the manuscript for important intellectual content, statistical analyses.

  • Funding Funding for the establishment and maintenance of the first-seizure database in the form of a grant to cover the costs of a research assistant was received from the Medical Research Foundation of Royal Perth Hospital and UCB-Pharma.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.