title: Do drivers with epilepsy have higher rates of motor vehicle accidents than those without epilepsy?
abstract: OBJECTIVE
  We sought to understand the magnitude of the risk that drivers with epilepsy (DWE) contribute to motor vehicle accidents (MVAs) compared to other drivers.
  
  
  METHODS
  We performed an evidence-based, systematic review using the American Academy of Neurology (AAN) guideline methodology.
  
  
  RESULTS
  Contributory evidence consisted of six Class II studies and one Class III study. Two articles reported a trend toward a decreased rate of overall MVA rates for DWE when compared with the general population with a relative risk (RR) of 0.86 (95% CI: 0.65-1.14) (Class III) and a RR of 1.00 (95% CI: 0.95-1.06) (Class II); both studies used patient report to ascertain MVA rates. Three Class II studies reported either a trend toward or an increased risk of MVA rates for DWE when compared with the general population with a RR of 1.62 (95% confidence interval (CI): 0.95-2.76), as ascertained by insurance, emergency department, and physician reporting databases, a RR of 1.73 (95% CI 1.58-1.90), as ascertained by police reports, and a RR of 7.01 (95% CI 2.18-26.13), as ascertained by casualty department visits. One Class II study showed that, compared to fatal crashes with DWE, fatal crashes were 26 times more likely to occur because of other medical conditions and 156 times more likely to occur because of alcohol abuse. Motor vehicle accident crashes due to seizures in DWE occurred in one out of every 2800 MVAs, as reported in another Class II study.
  
  
  CONCLUSIONS
  The evidence for the difference in MVA rates in DWE compared to the general population is inconsistent, and no conclusion can be made. Important methodological differences across the studies contribute to the imprecision. Future research should be performed using objective measures rather than self-reporting of MVAs by DWE and "miles driven" as the denominator to calculate MVA rates.
authors.affiliation: Department of Neurology, Hofstra NSLIJ School of Medicine, 300 Community Drive, Manhasset, NY 11030, USA. Electronic address: PNaik@nshs.edu.
authors.forename: Puja Appasaheb
authors.initials: PA
authors.lastname: Naik
authors.affiliation: Department of Neurology, Hofstra NSLIJ School of Medicine, 300 Community Drive, Manhasset, NY 11030, USA. Electronic address: mfleming1@NSHS.edu.
authors.forename: Meghan Elizabeth
authors.initials: ME
authors.lastname: Fleming
authors.affiliation: Zucker Hillside Hospital, 75-59 263rd Street, Glen Oaks, NY 11004, USA. Electronic address: PBhatia@nshs.edu.
authors.forename: Padam
authors.initials: P
authors.lastname: Bhatia
authors.affiliation: Department of Neurology, Hofstra NSLIJ School of Medicine, 300 Community Drive, Manhasset, NY 11030, USA. Electronic address: charden@nshs.edu.
authors.forename: Cynthia L
authors.initials: CL
authors.lastname: Harden
mesh_terms: D000063:Accidents, Traffic / Q000706:statistics & numerical data*; D001334:Automobile Driving; D004636:Emergency Service, Hospital; D004827:Epilepsy / Q000150:complications*; D005260:Female; D006801:Humans; D007341:Insurance; D008875:Middle Aged; D018986:Motor Vehicles; D012306:Risk; D012640:Seizures / Q000150:complications*
keywords: Crashes; Driving risk; Loss of consciousness; Seizure; Seizure disorder