The relationship between epilepsy and transport accidents is well known in many countries, to the extent that epilepsy has a well known effect on the ability to drive or to access reliable transportation, which is closely related to employment and education, social activity and health care, independence and quality of life (Institute of Medicine of the National Academies, USA). In general the capacity to drive is related to the risk of seizure recurrence after a period of seizure freedom, and not on the actual risk, which nowadays is possible to be determined. Usually this is done with careful investigation and diagnosis of each individual patient, through clinical care, EEG and imaging studies, and later, patient adherence to treatment.

see epilepsy and transport accidents, editorial: Krumholz and Berger, Neurology 2018, 90: 583-584

The editorial puts emphasis  on the quality and main findings of the study, which is then described in detail. The importance of the findings is that they contradict common knowledge and even the laws in just about every country.

see epilepsy and transport accidents, rough data: Sundelin et al Neurology 2018, 90:e1111-1118

In their paper Sundelin and colleagues published one of the largest populations ever, 30000 people in Sweden, looking at the risks of motor, bycicle and pedestrian transport accidents, adjusting to medication and psychiatric co-morbidity. The authors found a modest increase in risk in epileptic patients – 4,6% – compared to matched controls – 3,4% – similar to the risk of diabetics, for example. The risk of epilepsy and transport accidents was not related to type of medication, or to the fact that patients were treated or untreated at the time of the accident. The risk elevation was the same for motor, bycicle and pedestrian accidents.

The results of this study may not be immediately appplicable to other countries. The Swedish health system is universal, very easily and widely available, cheap, and access to treatment of epilepsy is also similarly cheap and widely available. The well known problem of lack of adherence to therapy is likely to occur less in this environment.

Dr Paulo Bittencour


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