title: Counseling at a Seizure Clinic Does Not Ensure Disclosure to the Transportation Registry.
abstract: BACKGROUND
  The effectiveness of current self-reporting driving laws for medically-unfit potential seizure patients is unknown in Canada. We designed a prospective cohort study of patients' self-reporting practices to the local Transportation Registry (TR) and their driving behaviors following detailed counselling at a seizure clinic in a discretionary physician-reporting jurisdiction.
  
  
  METHODS
  Medically unfit drivers, referred to our seizure clinic, who had a valid driver's permit at the time of their episode of impaired consciousness were included. Patients' self-reporting and driving behaviours were assessed using a standardized interview prior to a neurologist's counseling and later at a follow-up visit.
  
  
  RESULTS
  Sixty three patients were included; 77% were diagnosed as having had a seizure at the time of their referral. Prior to their seizure clinic visit, 3/63 (5%) had been counseled to self-report to the TR by a non-neurologist physician, and none had done so. Following a neurologist's documented counseling 34/63 (54%) had self-reported themselves at the follow-up seizure clinic visit, and 53/63 (84%) were not driving.
  
  
  CONCLUSIONS
  This prospective study design is the first in North America to examine self-reporting rates for unfit drivers with a seizure disorder. Our findings suggest that self-reporting laws do not ensure high rates of self-reporting behaviors even when patients seen at a seizure clinic are appropriately counseled of their legal obligations. The rate of driving cessation appears greater than the rate of self-reporting to the TR among counseled patients.
authors.affiliation: Department of Medicine,Division of Neurology,University of Alberta,Canada.
authors.forename: Maria
authors.initials: M
authors.lastname: Siddiqi
authors.affiliation: Department of Medicine,Division of Neurology,University of Alberta,Canada.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Jirsch
mesh_terms: D000328:Adult; D000416:Alberta / Q000453:epidemiology; D001291:Attitude of Health Personnel; D001334:Automobile Driving / Q000331:legislation & jurisprudence; D002170:Canada / Q000453:epidemiology; D015331:Cohort Studies; D003244:Consciousness Disorders / Q000150:complications; D003376:Counseling; D030881:Disclosure; D005260:Female; D006801:Humans; D008297:Male; D019221:Mandatory Reporting; D008875:Middle Aged; D010820:Physicians; D011446:Prospective Studies; D012042:Registries; D012640:Seizures / Q000453:epidemiology*
keywords: altered consciousness; discretionary physician reporting jurisdiction; driving; epilepsy; notification; seizure; self-disclosure; self-reporting; transportation registry