Counseling for driving restrictions in epilepsy and other causes of temporary impairment of consciousness: How are we doing?

In Arizona, other states, and other countries, people who experience a seizure or other transient alteration of consciousness may be legally restricted from driving. Arizona law requires that people with these conditions submit themselves for a medical review, whereas health care providers are not required to report to the authorities. Therefore, counseling people with these medical conditions about driving generally falls to health care providers, who are often not neurologists. Three hundred thirty-five consecutive charts of patients discharged from our Emergency Department were retrospectively reviewed by diagnosis codes associated with altered consciousness. A total of 267 patients met our inclusion criteria, of whom 27 (10.1%) were counseled regarding driving-by the Emergency Department physician and/or consulting neurologist. Although the counseling rate for driving was 10/29 (34.5%) when a neurologist was involved, it was found to be only 17/238 (7.1%) when neurological services were not sought. Patients presenting with seizure were more likely to be counseled than those presenting with other episodes of loss of consciousness. Accurate knowledge of driving laws by health care workers and patients has the potential to minimize liability and improve public safety and quality of care.